Bethesda classification of thyroid nodule fine needle aspirations i. The bethesda system for reporting thyroid cytopathology tbsrtc established a standardized, categorybased reporting system for thyroid fineneedle aspiration fna specimens. It serves as a reference guide not just for pathologists, but also endocrinologists, surgeons, and radiologists. The bethesda system classifies thyroid fnac into six categories. Classifying your thyroid fna specimens using bethesda. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Bethesda system for reporting thyroid cytopathology. The ausflus to malignant ratio may be a useful laboratory quality measure that should not exceed 3. Predominant population of microfollicles in an aspirate that does not fulfill criteria for a follicular neoplasm or suspicious for follicular neoplasm. Aug 31, 2010 thyroid fna suffers from a reporting confusion due to multiplicity of category terminologies. Each category in tbsrtc is associated with an estimated risk of malignancy rom. Review the bethesda system for reporting thyroid cytopathology tbsrtc the pathologists perspective individual categories with case examples emphasis on the indeterminate category and potential options the dawn of noninvasive follicular thyroid neoplasm with papillarylike nuclei niftp the updated bethesda system 2017.
Papillary thy carcinoma bethesda category v suspicious. The sensitivity and specificity of thyroid fna in pediatric population is 100% and 94. The bethesda system for reporting thyroid cytopathology, 2017. Schlumberger mj pacini f thyroid tumor third edition 5. Application of the bethesda thyroid system in the pediatric. The 2017 revision described herein was inspired by new data and new developments in the field of thyroid pathology. The meeting took place on october 22 and 23, 2007 in bethesda, maryland and was comoderated by susan j. To address terminology and other issues related to thyroid. Bethesda classification of thyroid nodule fine needle aspirations. Pdf introduction to the second edition of the bethesda system for.
The cytopathology files were searched for all thyroid fnas performed. Tbsrtc is a sixcategory scheme of thyroid cytopathology reporting table 1. Jan 24, 2017 the bethesda system for reporting thyroid cytopathology moderator dr g k parvathidevi presenter dr dhanya a n 2. The bethesda system for reporting thyroid cyto pathology bsrtc is a standardized reporting system for classifying thyroid fineneedle aspiration results comprising of 6 diagnostic categories with unique risks o malignancy and recommendations for clinical management. The bethesda system for reporting of thyroid cytopathology. An external file that holds a picture, illustration, etc. An inspiration for the thyroid proposal was the bethesda system for reporting cervical cytology interpretations, first developed at an nci workshop in 1988 and. Bethesda category v is considered 60% 75% likely to be malignant. Nature of the nodule location, size, cystic component skills of operator and reader. To apply the bethesda thyroid fna classification system in the evaluation of thyroid fna. This document was prepared as a collaborative effort between the american association of clinical endocrinologists aace, american college of endocrinology ace and associazione medici endocrinologi ame.
Click on the thumbnails to see the intermediate images. Implied risk of malignancy and recommended clinical management open in new tab a repeated aspiration with ultrasound guidance is recommended for nduns and clinically or sonographically worrisome cfo cases and is diagnostic in 50% to 88% of cases, 2, 6, 9, 11, , 14 but some nodules. Purpose of the conference georgia society of otolaryngology. The authors are all consultant cellular pathologists, reporting thyroid histology andor cytology, some of. To address this, the bethesda system for reporting thyroid cytopathology tbsrtc was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. This report is intended to be comprehensive and to serve as an authoritative reference on risks to the th.
Chen, md, mph, facs emory department of otolaryngology professor nci thyroid fna state of the science conference bethesda md october 2223, 2007 154 registrants. Atypia of undetermined significance or follicular lesion of undetermined significance 3 6% of thyroid fnas broad category of not easily classified fnas, including. C professor, department of pathology mcgill university director, cytopathology laboratory. Faquin, md, phd director, head and neck pathology massachusetts eye and ear massachusetts general hospital professor of pathology harvard medical school. Narrative comments are strongly recommended to further describe the findings, especially if it would potentially influence management.
Pdf bethesda categorization of thyroid nodule cytology. Thyroid cytopathology recent advances october 21, 2017 dr. The american thyroid association guidelines task force on thyroid nodules and. Thoroughly revised and updated, the bethesda system for reporting thyroid cytopathology, second edition will provide the reader with a unified approach to diagnosing and reporting thyroid fna interpretations. To address this, the bethesda system for reporting thyroid cytopathology tbsrtc was. This atlas is the offspring of the the national cancer institute nci thyroid fine needle aspiration fna state of the science conference, hosted by. The bethesda system for reporting thyroid cytopathology tbsrtc established a standardized, categorybased reporting system for thyroid. Fineneedle aspiration fna remains the most effective and safe method of evaluating thyroid nodules for potential surgical management. Thyroid nodules are commonly encountered in clinical practice. These documents underwent extensive discussion and appropriate modifications after 2 runs of bulletin board discussions at the.
Review article appropriate and accurate diagnosis of thyroid. The bethesda system for reporting thyroid cytopathology is effective for clinical management of thyroid nodules jerome m. Incidentally detected lesions in the surgical specimens that were not the target of the thyroid fna were excluded from the analysis. Thyroid bethesda system for reporting thyroid cytology from an international panel william c. Proposed modifications and updates for the thyroid bethesda. The bethesda system for reporting thyroid cytopathology tbsrtc has attempted to standardize reporting and cytological criteria in aspiration smears. Classification of thyroid fineneedle aspiration cytology into. The bethesda system for reporting thyroid cytopathology is. Oct 15, 2015 the bethesda system for reporting thyroid cytopathology bsrtc dr. This can happen when a cyst is aspirated or when the specimen is almost entirely composed of blood. According to a 1993 article, such nodules need to be treated only if they become toxic. An update to the bethesda system for reporting thyroid nodule cytopathology is set to alter clinical practice, with the primary aim of reducing the number of unnecessary thyroid surgeries.
The bethesda system for reporting thyroid cytopathology will provide the reader with a unified approach to diagnosing and reporting thyroid fna interpretations. This atlas is the offspring of the the national cancer institute nci thyroid fine needle aspiration fna state of the science conference, hosted by the nci and organized by dr. Benign consistent with a benign follicular nodule includes adenomatoid nodule, colloid nodule, etc. Ata initiatives to reduce the extent of surgery for many low risk thyroid cancers 4 cm or smaller, without extra thyroidal extension and lacking regional nodal metastasis and decreased routine use of postoperative radioactive iodine treatment increasingly raise the possibility for lobectomy as initial surgical management. The 2017 bethesda system for reporting thyroid cytopathology. Guidelines american association of clinical endocrinologists. The bethesda system for reporting thyroid cytopathology the nci conference participants acknowledged the importance of developing a uniform terminology for reporting thyroid fna results. The bethesda system for reporting thyroid cytopathology edmund s. Contents introduction bethesda categories nondiagnostic or unsatisfactory benign atypia of undetermined significance or follicular lesion of undetermined significance follicular neoplasm or suspicious for a. Apr 25, 2018 the 2017 bethesda system for reporting thyroid cytopathology. Click on document the bethesda system for reporting thyroid cytopathology. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer the american thyroid association guideline taskforce thyroid. The first draft of the committees summary documents. Thyroid fna suffers from a reporting confusion due to multiplicity of category terminologies.
History introduced and formed in 2007, nci thyroid fna state of science conference bethesda, maryland, by various cytopathologists and summarised by baloch et al. An autonomous thyroid nodule or hot nodule is one that has thyroid function independent of the homeostatic control of the hpt axis hypothalamicpituitarythyroid axis. The official site for bethesda, publisher of fallout, doom, dishonored, skyrim, wolfenstein, the elder scrolls, more. Proposed modifications and updates for the thyroid. The bethesda system for reporting thyroid cytopathology categorizes thyroid cytology findings into six groups, with each group assigned a putative malignancy risk. Guidance on the reporting of thyroid cytology specimens. Noninvasive follicular thyroid neoplasm with papillary. Thyroid cytopathology reporting by the bethesda system. Fineneedle aspiration fna biopsies have been an important component in the preoperative evaluation of thyroid nodules.
The objective of this study was to analyze the thyroid cytology smears by tbsrtc, to determine the distribution of diagnostic categories and subcategories, to analyze cytological features, and to correlate the. The bethesda system for the reporting of thyroid cytopathology tbsrtc is used to categorize and diagnose thyroid nodules by fine needle aspiration biopsy fnab. The bethesda system for reporting thyroid cytopathology. Fish sa thyroid nodules meet the professor handouts the endocrine societys 89 annual meeting endo 07 6.
Bethesda classification of thyroid nodule fine needle. It has been speculated that the bethesda classification system for thyroid fineneedle aspirate fna may be used to predict aggressive features among histologically proven malignancies. Rapid on site evaluation helps assess adequacy after sampling. Pdf the bethesda system for reporting thyroid cytopathology tbsrtc is an. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules. It represents the results of the multidisciplinary national cancer institute thyroid fine needle aspiration state of the science conference, held in bethesda, md in october, 2007. The discussions and conclusions regarding terminology and morphologic criteria 1, 2 from the meeting were summarized in publications by baloch et al. Pdf the bethesda system for reporting thyroid cytopathology is a standardized reporting system for classifying thyroid fineneedle aspiration results. Application of the bethesda classification for thyroid fineneedle aspiration institutional experience and metaanalysis elliot a. Pdf analysis of the bethesda system for reporting thyroid. Subsequently a monograph the bethesda system for reporting thyroid cytopathology tbsrtc which includes definitions, diagnosticmorphologic criteria, explanatory notes, and a brief management plan for each diagnostic category was published.
These guidelines cover diagnostic and therapeutic aspects of thyroid nodular disease but not thyroid cancer management. The format of the original, and now the 2017, tbsrtc follows the familiar format first established by the bethesda system for reporting. For clarity of communication, the 2017 bsrtc continues to recommend that each report begin with a general diagnostic. Ptc is the most common malignancy in pediatric thyroid nodules. The bethesda system for reporting thyroid cytopathology bsrtc dr. How to interpret thyroid fineneedle aspiration biopsy.
Document name guidance on the reporting of thyroid cytology specimens version number 2 produced by dr p cross chair, dr a chandra, dr t giles, dr s johnson, dr g kocjan, dr d poller and professor t stephenson. The bethesda system for reporting thyroid cytopathology moderator dr g k parvathidevi presenter dr dhanya a n 2. Application of the bethesda classification for thyroid. Thyroid thyroid cytopathologycytopathology recent advances. Discussion bethesda system is very sensitive and specific in diagnosing pediatric thyroid nodules.
The bethesda system for reporting thyroid cytopathology, 2nd edition, 2018. To advise clinicians on the implications of the each diagnostic category of the bethesda classification system and the results of molecular testing. In these biopsies not enough thyroid cells were obtained to render a diagnosis. The thyroid web atlas contains 300 images of key thyroid lesions in an easytosearch format. Description of the book the bethesda system for reporting thyroid cytopathology. The uncertainty is when there are features that may be cancer, or may be benign, as found in the follicular variant of papillary carcinoma that can look benign, and viceversa, benign cells that look like fvptc. Thyroid nodule, thyroid cancer, fineneedle aspiration, bethesda criteria background thyroid nodules are clinically palpable in 47% of adults in the united states 17. Thyroid fineneedle aspiration and the bethesda classification. The bethesda system for reporting thyroid cytopathology is a standardized reporting system for classifying thyroid fineneedle aspiration results comprising of 6 diagnostic categories with unique risks of malignancy and recommendations for clinical management.
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