scholarly journals Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology

2015 ◽  
Vol 124 (3) ◽  
pp. 181-187 ◽  
Author(s):  
William C. Faquin ◽  
Lawrence Q. Wong ◽  
Amir H. Afrogheh ◽  
Syed Z. Ali ◽  
Justin A. Bishop ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Cytological Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma before and after the Bethesda System for Reporting Thyroid Cytopathology

2016 ◽  
Vol 60 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Roghayeh Fazeli ◽  
Christopher J. VandenBussche ◽  
Justin A. Bishop ◽  
Syed Z. Ali
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Surgical Resection ◽  
Follicular Neoplasm ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System ◽  
The Impact

Background: The follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary carcinoma after the classical variant. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been introduced to standardize the practice of thyroid fine needle aspiration (FNA) reporting. We evaluated the impact of TBSRTC on the FNA interpretation of histologically proven FVPTCs. Method: Cytology reports of 455 histologically proven FVPTCs were reviewed. The rate of each TBSRTC category was compared between pre- and post-TBSRTC eras. Results: The distribution of FNA diagnoses for pre-TBSRTC cases included suspicious for follicular neoplasm (SFN; n = 51, 28.7%), papillary thyroid carcinoma (PTC; n = 47, 26.4%), suspicious for malignancy (SFM; n = 32, 18%), atypia of undetermined significance (AUS; n = 23, 13%), benign (n = 18, 10.1%), and nondiagnostic (ND; n = 7, 4%). Post-TBSRTC diagnoses were: AUS (n = 68, 24.6%), PTC (n = 64, 23.1%), SFM (n = 50, 18%), SFN and benign (n = 42, 15.2%) and ND (n = 11, 4%). SFN rate decreased significantly from 28.7 to 15.2% (p = 0.001) and AUS increased from 12.9 to 24.5% (p = 0.003). Conclusion: Following implementation of TBSRTC, the frequency of AUS diagnoses on FNA prior to surgical resection increased. Given that the rate of FVPTC diagnoses on thyroidectomy increased over the same period, this suggests that the use of AUS has resulted in greater surgical resection of FVPTC.

New Concept of the Encapsulated Follicular Variant of Papillary Thyroid Carcinoma and Its Impact on the Bethesda System for Reporting Thyroid Cytopathology: A Single-Institute Experience

2016 ◽  
Vol 60 (3) ◽  
pp. 198-204 ◽  
Author(s):  
Sule Canberk ◽  
Pembegul Gunes ◽  
Mine Onenerk ◽  
Murat Erkan ◽  
Emine Kilinc ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Follicular Neoplasm ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Bethesda System ◽  
The Subject ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Background: The encapsulated follicular variant (EFV) of papillary thyroid carcinoma (PTC) is the most discussed entity in thyroid pathology. Recently, the question of whether or not EFV-PTC is a malignant entity has been the subject of renewed discussion in the light of recent molecular and clinical studies. The aim of this study was to analyze the malignancy ratios of each category of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) if EFV-PTC is no longer considered as a malignant entity. Materials and Methods: Data on thyroid fine-needle aspirations (n = 1,886) with surgical follow-up between 1999 and 2014 were studied. EFV-PTC cases constituted 27% (94/343) of the malignant cases. Results: Malignancy ratios were determined as nondiagnostic, benign, atypia/follicular lesion of undetermined significance, suspicious for follicular neoplasm/follicular neoplasm, suspicious for malignancy, and malignant categories of the TBSRTC in 13, 7, 45, 30, 72 and 98%, respectively. If EFV-PTC was not regarded as malignant, malignancy ratios would decrease to 6.5, 6, 30, 10, 48, and 87% for each category in the same order. Conclusions: The current study showed that the most significant decrease in relative malignancy ratios was seen in the suspicious for follicular neoplasm/follicular neoplasm category (66% relative decrease), but all categories represented a considerable decrease.

Impact of the Reclassification of the Non-Invasive Follicular Variant of Papillary Carcinoma as Benign on the Malignancy Risk of the Bethesda System for Reporting Thyroid Cytopathology: A Meta-Analysis Study

2017 ◽  
Vol 61 (3) ◽  
pp. 187-193 ◽  
Author(s):  
Lester J. Layfield ◽  
Zubair W. Baloch ◽  
Magda Esebua ◽  
Rohini Kannuswamy ◽  
Robert L. Schmidt
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Meta Analysis ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Malignancy Risk ◽  
Diagnostic Categories ◽  
Non Invasive ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Objectives: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established diagnostic categories for cytologic specimens of the thyroid. Each category was associated with an estimated risk of malignancy. Recently, the non-invasive follicular variant of papillary thyroid carcinoma has been reclassified as benign. This reclassification may alter the malignancy risk of TBSRTC diagnostic categories. Study Design: A literature search was made for all studies investigating the effect of reclassification of some non-invasive follicular variant papillary thyroid carcinomas as benign on the malignancy risk associated with TBSRTC categories. The authors calculated the malignancy risk for TBSRTC categories in a series of 315 thyroid aspirates when the non-invasive follicular variant of papillary thyroid carcinoma was considered benign. A meta-analysis of malignancy risk data for the 3 published studies and the current study was performed. Results: The meta-analysis showed that the malignancy risk was reduced for all TBSRTC categories except the “non-diagnostic” category. The reduction in malignancy risk was greatest in the categories “suspicious for malignancy” and “atypia/follicular lesion of undetermined significance.” Conclusion: A meta-analysis of all pertinent studies demonstrated that re-categorization of the non-invasive follicular variant of papillary thyroid carcinoma as benign reduces the malignancy risk in the majority of TBSRTC categories.

Prognostic role of the Bethesda System for conventional papillary thyroid carcinoma

Head & Neck ◽  
2016 ◽  
Vol 38 (10) ◽  
pp. 1509-1514 ◽  
Author(s):  
Hye Mi Gweon ◽  
Hye Ryoung Koo ◽  
Eun Ju Son ◽  
Jeong-Ah Kim ◽  
Ji Hyun Youk ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid ◽  
Prognostic Role ◽  
Bethesda System ◽  
The Bethesda System

scholarly journals MON-484 Thyroid Nodules: Not so Simple to Manage

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Alegyari Figueroa Cruz ◽  
Yineli Ortiz Torres ◽  
Victor J Carlo Chévere ◽  
Jose M Garcia-Mateo
Keyword(s):  
Decision Making ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Papillary Thyroid ◽  
Risk Of Malignancy ◽  
History Of ◽  
Bethesda System ◽  
Undetermined Significance

Abstract Thyroid Nodules: Not So Simple to Manage Thyroid nodules diagnosis and malignancy risk stratification remains a challenge for decision making between conservative vs invasive management. The development of the clinical guidelines provides alternatives for evaluation and management for thyroid nodules, but can be used for all patients? A 43 y/o female without known past medical history is referred to the endocrine service by her primary care physician for evaluation of a thyroid nodule. She was presenting with 1 month history of mild discomfort on the neck and was evaluated with thyroid US that was relevant for multiple bilateral solid nodules measuring <1.0cm and a one spongiform measuring 1.7 x 1.2 x 1.3cm in the right lobe extending minimally to the capsule laterally and to the carotid artery wall. Patient denies cough, hoarseness, odynophagia, shortness of breath, family history of thyroid cancer or radiation exposure. On examination there were no goiter nor palpable thyroid nodules, as well as no clinical signs and symptoms of thyroid disease. Patient is clinically and biochemically euthyroid with a very low suspicion thyroid nodule (3% estimated malignancy risk). Despite nodule is below the 2.0cm cutoff point for fine needle aspiration biopsy (FNAB) according to American Association of Clinical Endocrinologist (AACE) and American Thyroid Association (ATA) guidelines, it was done based on additional suspicious sonographic features detect by the endocrinologist on evaluation of ultrasound images. FNAB was performed and reveals Atypia of undetermined significance/Follicular Lesion of undetermined significance (AUS/FLUS) Bethesda system category III with a risk of malignancy of 5–15%. Patient was reluctant to surgery given the very low risk nodule and biopsy results of AUS/FLUS. In order to further manage this patient with undetermined significance thyroid nodule, Gene Expression Classifier (GEC) Molecular Analysis (AFIRMA) was performed. AFIRMA test was done with a second FNAB that also reveals AUS/FLUS but was found positive for BRAFv600, Bethesda system category IV: Suspicious of Papillary Thyroid Carcinoma. BRAFv600 is the only mutation that have high specificity (99%) for papillary thyroid carcinoma and is associated with increased disease-specific mortality, aggressive histologic phenotypes, lymph node metastases, extrathyroidal extension and risk of recurrence. Based on this data patient now have 95% risk of malignancy and requires surgical therapy. Patient preferred total thyroidectomy over lobectomy; pathology results shows 2.0cm Papillary Thyroid Carcinoma Stage I (T1N0M0). Despite very low risk nodule finding, malignancy was diagnosed. As depicted in this case, thyroid nodules aren’t so simple to manage, and their management should involve imaging and pathology findings along with clinical judgement and patient individualization in decision making process.

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