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Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Ann+Surg+Oncol 2014 ; 21 (11): 3522-7 Nephropedia Template TP
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The Bethesda System for Reporting Thyroid Cytopathology: A Single Center Experience over Five Years #MMPMID24796967
Kiernan C; Broome J; Solórzano C
Ann Surg Oncol 2014[Oct]; 21 (11): 3522-7 PMID24796967show ga
Background: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was developed to refine fine needle aspiration (FNA) cytology definitions and improve clinical management. This study evaluates the impact of the BSRTC five years after its adoption at a single institution. Methods: A total of 1625 patients undergoing thyroidectomy in the pre-(group-1: 7/07?1/09) and post-BSRTC (group-2: 2/09?9/13) periods were reviewed. Cytologic diagnoses in group-1 included nondiagnostic, benign, follicular neoplasm, suspicious for malignancy and malignant. Atypia/follicular lesion of undetermined significance (AUS/FLUS) was included in group-2. The proportions of each FNA category and malignancy rate per cytologic diagnosis were compared. Results: Fifty-four percent (187/347) of group-1 patients had a preoperative FNAs vs. 61% (777/1278) in group-2 (p=0.02). Group-1 FNA results included 3% nondiagnostic, 48% benign, 17% follicular, 13% suspicious for cancer and 19% cancer. Group-2 results included 3% nondiagnostic, 36% benign, 9% follicular, 8% suspicious for malignancy, 18% malignant and 26% AUS/FLUS. In group-2, the proportions of benign, follicular and suspicious for malignancy FNAs decreased significantly (p<0.05). In group-2, there were more indeterminate FNA diagnoses overall (30% vs. 43%, p<0.001). The rate of cancer in suspicious for cancer FNA lesions increased from 44% to 65% (p=0.07). The AUS/FLUS malignancy rate was 15%. Conclusions: Since the adoption of the BSRTC at our institution, the proportion of indeterminate FNAs has increased, however the diagnostic accuracy of the suspicious for cancer category improved. We recommend periodic review of the utilization and malignancy rates per cytologic category at each institution to help tailor clinical management.