title: The use of the Bethesda terminology in thyroid fine-needle aspiration results in a lower rate of surgery for nonmalignant nodules: a report from a reference center in Turkey.
abstract: The Bethesda system (BS) for reporting thyroid fine-needle aspiration (FNA), which classifies nodules as nondiagnostic (ND), benign (B), atypia/follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFN/FN), suspicious for malignancy (SFM), or malignant (M), uses clinically valuable management guidelines. The authors employed a similar in-house classification system (IS) for thyroid FNAs, using the categories of ND, B, suspicious follicular cells (SFC), follicular lesion/neoplasm (FL/FN), SFM, and M. The authors compared IS and BS, and assessed the utility of BS in clinical practice. A total of 581 nodules with cytological/histological follow-up were examined and indeterminate lesions by BS were reclassified. The sensitivity and specificity for malignancy using IS were similar to that of BS (77% vs 99%). However, when SFN/FN and SFM were both considered positive, the results for IS and BS were as follows: sensitivity, 85% versus 85%; specificity, 87% versus 94%; and diagnostic accuracy, 86% versus 90%, respectively. Discrepancies between cytological and histological data were evident in 35 cases among all categories of BS except AUS/FLUS. The rate of surgery for nonmalignant nodules was lesser (20% vs 9%) by BS. Among 34 AUS/FLUS cases with follow-up data, hypocellularity was the case in 11 (46%) nonneoplastic and 10 (100%) neoplastic nodules. The use of BS results in a lower rate of surgery for nonmalignant nodules even though patients with borderline cytopathologic features are still encountered. AUS/FLUS category can be separated into subgroups according to the factors causing difficulties in the interpretation. There is a need of accumulation of AUS/FLUS cases to do further evaluations and studies.
authors.affiliation: Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. yasozluk@gmail.com
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ozluk
authors.forename: Esmehan
authors.initials: E
authors.lastname: Pehlivan
authors.forename: Mine G
authors.initials: MG
authors.lastname: Gulluoglu
authors.forename: Arzu
authors.initials: A
authors.lastname: Poyanli
authors.forename: Artur
authors.initials: A
authors.lastname: Salmaslioglu
authors.forename: Nese
authors.initials: N
authors.lastname: Colak
authors.forename: Yersu
authors.initials: Y
authors.lastname: Kapran
authors.forename: Dilek
authors.initials: D
authors.lastname: Yilmazbayhan
mesh_terms: D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D013964:Thyroid Neoplasms / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D016606:Thyroid Nodule / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000706:statistics & numerical data*; D014421:Turkey