title: 'Suspicious for papillary thyroid carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology.
abstract: BACKGROUND
  The high-risk 'suspicious for papillary thyroid carcinoma' (SPTC) is a clinically relevant diagnosis in the cytological interpretation of thyroid aspirates. While The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has provided invaluable terminology standardization, a performance comparison for this diagnostic category has not been performed. Therefore, this study evaluates the SPTC diagnosis before and after the introduction of TBSRTC in a large meta-analysis and at a single institution.
  
  
  METHODS
  The meta-analysis analyzed publications of SPTC or similar diagnoses before and after the introduction of TBSRTC. Similarly our own institutional experience was analyzed for the 8 years surrounding the introduction of TBSRTC. A correlation of the cytopathology and surgical pathology diagnoses was performed.
  
  
  RESULTS
  The introduction of TBSRTC coincided with a significant decrease in the fraction of cases called SPTC in the meta-analysis (4.5-3.1%, p < 0.00001) and in the institutional review (1.7-0.9%, p = 0.005). Meanwhile, the malignancy risk for those cases increased significantly in the meta-analysis from 62.5 to 80.5% (p < 0.00001) and trended upwards in the institutional review from 69 to 79% (p = 0.4). The follow-up rate was similar in both time periods in the meta-analysis and the institutional review.
  
  
  CONCLUSIONS
  The introduction of TBSRTC coincided with a decrease in the fraction of cases called SPTC and an increase in the malignancy risk associated with that diagnosis.
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Olson
authors.forename: Thiraphon
authors.initials: T
authors.lastname: Boonyaarunnate
authors.forename: Aysegul Aksoy
authors.initials: AA
authors.lastname: Altinboga
authors.forename: Aysegul Aksoy
authors.initials: AA
authors.lastname: Atlinboga
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
mesh_terms: D002277:Carcinoma / Q000145:classification* / Q000175:diagnosis*; D002291:Carcinoma, Papillary; D006801:Humans; D010340:Pathology, Surgical / Q000592:standards*; D009626:Terminology as Topic; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000145:classification* / Q000175:diagnosis*