Comparison of Fine Needle Aspiration Cytology in Thyroid Lesions using The Bethesda System for Reporting Thyroid Cytopathology with Ultrasonography using Thyroid Imaging Reporting and Data System
Abstract
Introduction: Thyroid nodule is a common presentation. The estimated prevalence of thyroid nodules is 4-7% by clinical examination and 50-60% on ultrasonographic (USG) evaluation. Most are benign without any symptoms or cosmetic concerns. Only around 5% are found to be malignant. Methods: This prospective study evaluated a total of 54 patients with thyroid lesions presenting to Otorhinolaryngology, Surgery and Internal Medicine out-patient departments of a tertiary hospital for a period of nine months. The thyroid lesions were categorized into different categories using Thyroid Imaging Reporting and Data System (TIRADS) by USG and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) by fine needle aspiration (FNA). The agreement between TIRADS and TBSRTC was evaluated using Cohen's kappa statistics. Results: By FNA, 68.5% were benign lesions whereas 7.4% were malignant. Follicular Neoplasm (FN) or Suspicious for FN and Suspicious for Malignancy category comprised 5.6% each. 1.9% of the lesions showed Atypia of Unknown Significance (AUS). 11.1% of the lesions were non-diagnostic or unsatisfactory for evaluation. Overall agreement between the cases by USG and FNA using the TIRADS and TBSRTC respectively was 77.77%. There was a substantial agreement between the diagnosis made by these systems, kappa (κ)= .633 (95% CI, 0.41 to 0.85, p<0.05). Conclusion: This study observed a substantial agreement between the diagnosis made by TIRADS on USG and TBSRTC on FNA. Our study advocates the stratification of thyroid lesions according to TIRADS so that only suspicious lesions undergo FNA.
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References
Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules–2016 update. Endocrine practice. 2016 May;22(s1):1-60. PMID: 27167915 DOI: 10.4158/EP161208.GL [Publisher Full Text]
Gharib H, Papini E, Paschke R, Duick D, Valcavi R, Hegedüs L, Vitti P. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine Practice. 2010 May 1;16(Supplement 1):1-43. PMID: 20543550 DOI: 10.4158/10024.GL [Publisher Full Text]
Wu HH, Swadley MJ. The Bethesda system for reporting thyroid cytopathology: into the clinic. Pathology and Laboratory Medicine International. 2015 Sep 1;2015(1):47-54. DOI: 10.2147/PLMI.S59827 [Publisher Full Text]
Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS committee. Journal of the American college of radiology. 2017 May 1;14(5):587-95. PMID: 28372962 DOI: 10.1016/j.jacr.2017.01.046 [Publisher Full Text]
Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017 Nov;27(11):1341–6. PMID: 29091573 DOI: 10.1089/thy.2017.0500
Al Dawish MA, Robert AA, Muna A, Eyad A, Al Ghamdi A, Al Hajeri K, Thabet MA, Braham R. Bethesda system for reporting thyroid cytopathology: A three-year study at a tertiary care referral center in Saudi Arabia. World journal of clinical oncology. 2017 Apr 10;8(2):151-7. PMID: 28439496 DOI: 10.5306/wjco.v8.i2.151 [Publisher Full Text]
Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. The Journal of Clinical Endocrinology & Metabolism. 2009 May 1;94(5):1748-51. PMID: 19276237 DOI: 10.1210/jc.2008-1724 [Publisher Full Text]
Vargas-Uricoechea H, Meza-Cabrera I, Herrera-Chaparro J. Concordance between the TIRADS ultrasound criteria and the BETHESDA cytology criteria on the nontoxic thyroid nodule. Thyroid research. 2017 Dec;10(1):1. PMID: 28184253 DOI: 10.1186/s13044-017-0037-2 [Publisher Full Text]
Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Cytology-ultrasonography risk-stratification scoring system based on fine-needle aspiration cytology and the Korean-thyroid imaging reporting and data system. Thyroid. 2017 Jul 1;27(7):953-9. PMID: 28463597 DOI: 10.1089/thy.2016.0603
Rossi M, Lupo S, Rossi R, Franceschetti P, Trasforini G, Bruni S, Tagliati F, Buratto M, Lanza G, Damiani L, Degli Uberti E. Proposal for a novel management of indeterminate thyroid nodules on the basis of cytopathological subclasses. Endocrine. 2017 Jul 1;57(1):98-107. PMID: 27623969 DOI: 10.1007/s12020-016-1105-4
Moon HJ, Kim EK, Yoon JH, Kwak JY. Malignancy risk stratification in thyroid nodules with nondiagnostic results at cytologic examination: combination of thyroid imaging reporting and data system and the Bethesda System. Radiology. 2015 Jan;274(1):287-95. PMID: 25133852 DOI: 10.1148/radiol.14140359 [Publisher Full Text]
Periakaruppan G, Seshadri KG, Krishna GV, Mandava R, Sai VP, Rajendiran S. Correlation between ultrasound-based TIRADS and Bethesda system for reporting thyroid-cytopathology: 2-year experience at a tertiary care center in India. Indian journal of endocrinology and metabolism. 2018 Sep-Oct;22(5):651. PMID: 30294576 DOI: 10.4103%2Fijem.IJEM_27_18 [Publisher Full Text]
Popoveniuc G, Jonklaas J. Thyroid nodules. Medical Clinics. 2012 Mar 1;96(2):329-49. PMID: 22443979 DOI: 10.1016/j.mcna.2012.02.002 [Publisher Full Text]
Agarwal S, Jain D. Thyroid cytology in India: contemporary review and meta-analysis. Journal of pathology and translational medicine. 2017 Nov;51(6):533-47. PMID: 28994274 DOI: 10.4132%2Fjptm.2017.08.04 [Publisher Full Text]
Ha SM, Ahn HS, Baek JH, Ahn HY, Chung YJ, Cho BY, Park SB. Validation of Three Scoring Risk-Stratification Models for Thyroid Nodules. Thyroid. 2017 Dec 1;27(12):1550-7. DOI: 10.1089/thy.2017.0363
Valderrabano P, McIver B. Evaluation and management of indeterminate thyroid nodules: the revolution of risk stratification beyond cytological diagnosis. Cancer Control. 2017 Dec 25;24(5):1073274817729231. PMID: 28975825 DOI: 10.1177%2F1073274817729231 [Publisher Full Text]
Sánchez JF. TI-RADS classification of thyroid nodules based on a score modified according to ultrasound criteria for malignancy. Revista Argentina de RadiologÃa. 2014;78(3):138-48. [Publisher Full Text]
Copyright (c) 2018 Sudeep Regmi, Archana Tiwari, Rupesh Sharma
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