title: Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology.
abstract: OBJECTIVE
  We aimed to determine whether the presence of Hürthle cells altered the distribution of categories in the Bethesda system for reporting thyroid cytopathology, or the expected neoplastic and malignant outcome.
  
  
  METHODS
  Fine needle aspiration (FNA) cytology reports of Hürthle cells in a 2-year period were evaluated. The distribution of Bethesda system categories and the outcome at partial or complete thyroidectomy were compared for FNAs with and without Hürthle cells.
  
  
  RESULTS
  Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign, 86 (9.6%) as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 32 (3.6%) as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 12 (1.3%) as suspicious for malignancy (SFM) and one (0.1%) as malignant. Of 10 359 adequate FNAs without Hürthle cells, 9707 (93.7%) were classified as benign, 412 (4.0%) as AUS/FLUS, 77 (0.7%) as FN/SFN, 93 (0.9%) as SFM and 70 (0.7%) as malignant. The distribution of categories in FNAs with and without Hürthle cells was significantly different (P < 0.001) as a result of a decrease in benign and an increase in AUS/FLUS and FN/SFN categories. Among 128 patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates were higher in the former than in the latter group (27.3% versus 14.9%, P < 0.001; 21.1% versus 11.7%, P = 0.003; respectively). Although neoplastic and malignant rates were higher in the group with than without Hürthle cells in all categories, the differences were only significant for a neoplastic outcome of benign cytology (15.1% versus 6.0%, P = 0.0013) and a malignant outcome of FN/SFN cytology (63.6% versus 21.9%, P = 0.0108).
  
  
  CONCLUSIONS
  We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.
authors.affiliation: Department of Pathology, Yildirim Beyazit University Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Yazgan
authors.forename: S
authors.initials: S
authors.lastname: Balci
authors.forename: N
authors.initials: N
authors.lastname: Dincer
authors.forename: G
authors.initials: G
authors.lastname: Kiyak
authors.forename: D
authors.initials: D
authors.lastname: Tuzun
authors.forename: R
authors.initials: R
authors.lastname: Ersoy
authors.forename: B
authors.initials: B
authors.lastname: Cakir
authors.forename: G
authors.initials: G
authors.lastname: Guler
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D024862:Oxyphil Cells / Q000473:pathology; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016606:Thyroid Nodule / Q000473:pathology
keywords: Bethesda system; Hürthle cell; fine needle aspiration cytology; thyroid cytopathology; thyroid neoplasia