The 2017 bethesda system for reporting thyroid cytopathology. The bethesda system for reporting thyroid cytopathology, 2017. Updates to the bethesda system for reporting thyroid. Bethesda and bethesda classification systems in the differentiation of benign and malignant thyroid nodules. Thyroid nodules tns assigned to the bethesda system categories iii and iv include numerous clinical characteristics, which increase or decrease the risk of. See thyroid biopsy and diagnostic approach to and treatment of thyroid nodules and evaluation and management of thyroid nodules with indeterminate cytology. Classifying your thyroid fna specimens using bethesda terminology. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant.
The bethesda system for reporting thyroid cytopathology, 2nd edition, 2018. Rapid on site evaluation helps assess adequacy after sampling. Discuss the key modifications of the bethesda system for reporting thyroid cytopathology 2018 tbsrtc iifor reporting thyroid cytopathology 2018 tbsrtc ii. Head and neck cytopathology is dealt with in the head and neck cytopathology article. For clarity of communication, tbsrtc recommends that each report begin with 1 of 6 general diagnostic categories. It is interesting that uniform spacing in the context of thyroid. The bethesda system for reporting cervical cytology. Fine needle aspiration has been widely accepted as diagnostic procedure of choice in assessment of nontoxic thyroid nodule. Thyroid nodules are nodules raised areas of tissue or fluid which commonly arise within an otherwise normal thyroid gland. The bethesda system for reporting thyroid cytopathology tbsrtc established a standardized, categorybased reporting system for thyroid. The role of thyroid fine needle aspiration cytology and the bethesda system for reporting thyroid cytopathology. Nature of the nodule location, size, cystic component skills of operator and reader.
Using tbsrtc, cytopathologists can communicate their interpretations to the referring physician in terms that are succinct, unambiguous, and clinically. Classifying your thyroid fna specimens using bethesda. Cytological analysis of fnab specimens is used to estimate malignancy risk. Ata initiatives to reduce the extent of surgery for many low risk thyroid cancers 4 cm or smaller, without extra thyroidal extension and lacking. The bethesda system for reporting thyroid cytopathology bsrtc dr. The name comes from the location bethesda, maryland of the conference that established the system. Thyroid fna bethesda classification scheme the bethesda system for reporting thyroid cytopathology. The bethesda system for reporting thyroid cytology tbsrtc. The first edition of the bethesda system for reporting thyroid cytopathology was published in 2010 and has greatly influenced the practice of thyroid cytopathology.
The authors are all consultant cellular pathologists, reporting thyroid histology andor cytology, some of. The bethesda system for reporting thyroid cytopathology tbsrtc was formalized in october 2007 by experts in thyroidology at the national institute of health in bethesda, maryland. Thyroid biopsy techniques including core needle biopsies and an overview of the diagnosis and treatment of thyroid nodules are discussed separately. Such notes can be useful in helping guide surgical management. The bethesda system for reporting of thyroid cytopathology. The bethesda system for reporting thyroid cytopathology tbsrtc1 is now in its second edition. C professor, department of pathology mcgill university director, cytopathology laboratory. The bethesda classification was introduced in 2008 to provide standardisation in the evaluation of thyroid fine needle aspiration cytology fnac.
The bethesda system and guidelines for the management of. Incidentally detected lesions in the surgical specimens that were not the target of the thyroid fna were excluded from the analysis. The australian modified bethesda structured reporting for thyroid. History introduced and formed in 2007, nci thyroid fna state of science conference bethesda, maryland, by various cytopathologists and summarised by baloch et al. The international academy of cytology is a organization of cytopathologists, cytotechnologists and other professionals concerned with research in and practice of clinical cytology. Fineneedle aspiration fna remains the most effective and safe method of evaluating thyroid nodules for potential surgical management. The bethesda system for reporting thyroid cytopathology uniform terminology for reporting thyroid cytopathology involved physicians caring for and managing pts with thyroid nodules associated risk of malignancy rom with diagnostic categories atlas published in 2010. However, the risk of malignancy associated with the various categories is likely to shift. She was depressed about the looks of visible nodule. The bethesda system and guidelines for the management of cervical intraepithelial neoplasia attila l major, md, phd. This article deals only with thyroid cytopathology.
Pdf application of bethesda system for reporting thyroid. The bethesda system for reporting thyroid cytopathology tbsrtc has attempted to standardize reporting and cytological criteria in aspiration smears. For clarity of communication, the bethesda system for reporting thyroid cytopathology recommends that each report begin with one of the six general diagnostic categories. Definitions, criteria, and explanatory notes ebook description the first edition of the bethesda system for reporting thyroid cytopathology was published in 2010 and has greatly influenced the practice of thyroid cytopathology. While revisions to the bethesda system for reporting thyroid cytopathology are underway, they are unlikely to incorporate major categorical changes in response to niftp, based on the limited literature to date. Patients with iii and iv category of the bethesda system. An inspiration for the thyroid proposal was the bethesda system for reporting cervical cytology interpretations, first developed at an nci workshop in 1988 and. Strain elastography as a valuable diagnosis tool in. The most appropriate cytological classification of malignancy risk is the bethesda system for thyroid cytopathology. The pap test and bethesda 2014 american cancer society. The bethesda system for reporting thyroid cytopathology is effective for clinical management of thyroid nodules jerome m. Small, asymptomatic nodules are common, and often go unnoticed.
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. Guidance on the reporting of thyroid cytology specimens. Use of adjunct molecular reflex testing constantine theoharis, md assistant professor david chhieng, md, mba, mshi professor director of cytology department of pathology yale university new haven ct. The bethesda system for reporting thyroid cytopathology tbsrtc established a standardized, categorybased reporting system for thyroid fineneedle aspiration fna specimens. The bethesda system tbs is a system for reporting cervical or vaginal cytologic diagnoses, used for reporting pap smear results. 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. Bethesda system for reporting thyroid cytopathology. An introduction to cytopathology is in the cytopathology article. Pdf the bethesda system for reporting thyroid cytopathology.
Pdf the bethesda system for reporting thyroid cytology tbsrtc was proposed in 2007 at the national cancer institute thyroid fine. Author no of patients repeat cytology sensitivity 95% ci hpv testing sensitivity 95% ci. Wilbur, md2 thereportsofmydemisehavebeengreatlyexaggerated. Pollerthe bethesda thyroid terminology and progress. This can happen when a cyst is aspirated or when the specimen is almost entirely composed of blood. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillarylike nuclear features niftp has. Thyroid cytopathology thyroid center of santa monica. Pdf bethesda categorization of thyroid nodule cytology. By the publication and acceptance of what has become known as the bethesda system for reporting thyroid cytopathology bsrtc, it was hoped that there would be more effective communi. Thyroid fna key cytology and histology for clinicians.
Additionally, the bethesda system is used for cytopathology of thyroid nodules. Cold nodule nonfunctioning hot nodules are almost always benign toxic adenomas. The bethesda system for reporting thyroid cytopathology is. The bethesda system for reporting thyroid cytopathology. With its inception, the bethesda system for reporting thyroid cytopathology tbsrtc established a standardized reporting system with a limited number of diagnostic categories for thyroid fineneedle aspiration fna specimens. Fna is not advised for hyperfunctioning or hot nodules because these are rarely malignant, but frequently show cytological features which may mimic thyroid. Implied risk of malignancy and recommended clinical management diagnostic category risk of malignancy % usual management nondiagnostic or unsatisfactory repeat fna with ultrasound guidance benign 03% clinical followup. The first edition of the tbsrtc book was published in 2010 and the second edition in 2018. For nodules with fnsfn cytology, after consideration of clinical and.
Thyroid cytopathology reporting by the bethesda system. The bethesda system for reporting thyroid cytopathology has been widely. 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. To address terminology and other issues related to thyroid fineneedle aspiration fna, the national. The pap test and bethesda 2014 ritu nayar, md1 and david c. The bethesda system for reporting thyroid cytopathology, 2017 laila khazai 11417. 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 use of a standardized reporting system for thyroid cytology, such as tbsrtc, improves reproducibility, clinical significance, and the predictive value of thyroid fna. Nodules that grow larger or produce symptoms may eventually need medical care.
Thyroid cytopathology is a large part of cytopathology. Application of bethesda system for reporting thyroid aspiration cytology article pdf available in the korean journal of pathology 44445. Bethesda classification of thyroid nodule fine needle. In these biopsies not enough thyroid cells were obtained to render a diagnosis. W ith its inception, the bethesda system for reporting thyroid cytopathology tbsrtc established a standardized reporting system with a limited number of diagnostic categories for thyroid fineneedle aspiration fna specimens. Thyroid cytologybethesda classification part 1 youtube. Thyroid cytopathology recent advances october 21, 2017 dr. It was introduced in 1988 and revised in 1991, 2001, and 2014. What is the bethesda system for thyroid cytopathology used. Each of the categories has an implied cancer risk that links it to an appropriate clinical management guideline.
The american thyroid association guidelines task force on thyroid nodules and. The objective of this study was to analyze the thyroid cytology smears by tbsrtc. Cytology the bethesda system for reporting of thyroid cytopathology shamlal mangray, mb, bs attending pathologist rhode island hospital, providence. The terminology proposed and illustrated in this text has been widely adopted not only in the u. Thyroid thyroid cytopathologycytopathology recent advances and update of the bethesda system manonauger m. The terminology described in this book is an important advance in the field of cytopathology. The role of thyroid fine needle aspiration cytology and. Application of the bethesda classification for thyroid.
Bethesda classification of thyroid nodule fine needle aspirations i. 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. Comparison of thyroid fine needle aspiration biopsy. The bethesda system for reporting thyroid cytopathology the nci conference participants acknowledged the importance of developing a uniform terminology for reporting thyroid fna results. Solitary nodule or dominant nodule radionuclide studies not specific for malignancy. The conclusions regarding terminology and morphologic criteria from the nci meeting led to the bethesda thyroid atlas project and form the framework for the bethesda system for reporting thyroid cytopathology tbsrtc.
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