ANALYSIS OF FINE NEEDLE ASPIRATIONS OF THE THYROID: CYTOLOGICAL-HISTOPATHOLOGICAL CORRELATION AND OUTCOMES OF THE BETHESDA SYSTEM

Year 2022, , 213 - 222, 30.06.2022

Ayca Tan

https://doi.org/10.17343/sdutfd.1100450

Abstract

Objective
The Bethesda system is widely used to evaluate
aspiration of thyroid nodules. The aim of the study is to
evaluate the usability of the system by the correlation
between cytology and final histopathology results and
to review the literature.
Materials and Methods
Fine needle aspiration of thyroid nodules reported using
Bethesda system were analyzed. Malignancy rates
were calculated by the results of thyroidectomies. To
analyze the power of the Bethesda system six distinct
subgroups were designed. The sensitivity, specificity,
positive predictive value, negative predictive value
and diagnostic accuracy were calculated separately
in these subgroups. The data were analyzed using
SPSS 20 for Windows.
Results
The distribution of thyroid nodules according to
the Bethesda was 2212 (33.5%), 3163 (47.9%),
720 (10.9%), 67 (1%), 361 (5.5%) and 75 (1.1%),
respectively. Of 873 nodules that underwent
thyroidectomy, 254 (29.9%) were diagnosed as
malignant. The diagnostic categories according to
thyroidectomies were 233 (26.7 %), 277 (31.7%),
137 (15.7%), 23 (2.6%), 163 (18.7%) and 40 (4.6%),
respectively. The malignancy rates of each Bethesda
category were 14.5%, 6.8%, 32.8%, 52.1%, 66.8%
and 97.5%. The sensitivity, spesifity, positive
predictive value (PPV), negative predictive value
(NPV) and accuracy of fine needle aspiration was
calculated and ranged from 61.8% to 89.3%, 79.6% to
99.6%, 70.4% to 97.5%, 84.5% to 93.1% and 79.5%
to 93.6%, respectively.
Conclusion
The limitation of this study is that the B1 category is very
high. However, since the data are evaluated by only
one pathologist and it is one of the first three studies
with the highest number of cases, it makes a significant
contribution to the literature in terms of all categories
except B1. The Bethesda system is a classification
that provides the clinician with appropriate clinical
follow-up and the accurate treatment approach, and a
high interobserver agreement for pathologists.

Keywords

thyroid, fine-needle, thyroidectomy, Bethesda

TİROİD İNCE İĞNE ASPİRASYONLARININ ANALİZİ: SİTOLOJİK-HİSTOPATOLOJİK KORELASYON VE BETHESDA SİSTEMİNİN SONUÇLARI

Abstract

Amaç
Bethesda sistemi, tiroid nodüllerinin aspirasyonunu
değerlendirmek için yaygın olarak kullanılmaktadır.
Çalışmanın amacı sitoloji ve histopatoloji sonuçları
arasındaki korelasyonun ışığında sistemin kullanılabilirliğini
değerlendirmek ve literatür eşliğinde gözden
geçirmektir.
Gereç ve Yöntem
Bethesda sistemi kullanılarak raporlanan tiroid nodüllerinin
ince iğne aspirasyon sonuçları analiz edildi.
Tiroidektomi sonuçlarına göre malignite oranları hesaplandı.
Bethesda sisteminin gücünü analiz etmek
için altı farklı alt grup tasarlandı. Duyarlılık, özgüllük,
pozitif prediktif değer, negatif prediktif değer ve tanısal
doğruluk bu alt gruplarda ayrı ayrı hesaplandı. Veriler,
Windows için SPSS 20 kullanılarak analiz edildi.
Bulgular
Tiroid nodüllerin Bethesda'ya göre dağılımı sırasıyla
2212 (%33,5), 3163 (%47,9), 720 (%10,9), 67 (%1),
361 (%5,5) ve 75 (%1,1) idi. Tiroidektomi yapılan 873
nodülün 254'ü (%29.9) malignite tanısı aldı. Tiroidektomilere
göre tanı kategorileri sırasıyla 233 (%26,7),
277 (%31,7) 137 (%15,7), 23 (%2,6), 163 (%18,7) ve
40 (%4,6) idi. Her Bethesda kategorisinin malignite
oranları %14,5, %6,8, %32,8, %52,1, %66,8 ve %97,5
idi. İnce iğne aspirasyonunun sensitivitesi, spesifisitesi,
pozitif prediktif değeri (PPV), negatif prediktif değeri
(NPV), doğruluğu hesaplandı ve sırasıyla %61,8 ile
%89,3, %79,6 ile %99,6, %70,4 ile %97,5, %84,5 ile
%93,1 ve %79,5 ila %93,6 arasında değişmekteydi.
Sonuç
Bu çalışmanın sınırlılığı B1 kategorisinin çok yüksek
olmasıdır. Ancak verilerin sadece bir patolog tarafından
değerlendirilmesi ve en fazla vaka sayısına sahip
ilk üç çalışmadan biri olması nedeniyle B1 dışındaki
diğer kategoriler açısından literatüre önemli bir katkı
sağlamaktadır. Bethesda sistemi, klinisyene uygun
klinik takip ve doğru tedavi yaklaşımı sağlayan ve patologlar
için gözlemciler arası uyumun yüksek olduğu
bir sınıflandırmadır.

Keywords

tiroid, ince iğne, tiroidektomi, Bethesda

References

• 1. Güneş P, Demirtürk P, Aker F, Tanrıöver Ö, Gönültaş A, Akkaynak Ş. Evaluation of Fine-Needle Aspiration of Thyroid Nodules in a Series of 1,100 Patients: Correlation Between Cytology and Histopathology Original Article. The Indian journal of surgery. 2015;77(Suppl 3):990-5.
• 2. İnan G, Sert S, Bircan S, Karahan N, Çiriş M, Başpınar Ş, et al. Tiroid lezyonlarında tiroid ince iğne aspirasyon biyopsisi ve histopatoloji sonuçlarının karşılaştırılması. SDÜ Tıp Fak Derg. 2006;13(4):27-31.
• 3. Abi-Raad R, Prasad M, Baldassari R, Schofield K, Callender GG, Chhieng D, et al. The Value of Negative Diagnosis in Thyroid Fine-Needle Aspiration: a Retrospective Study with Histologic Follow-Up. Endocrine pathology. 2018;29(3):269-75.
• 4. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid : official journal of the American Thyroid Association. 2009;19(11):1159-65.
• 5. Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid : official journal of the American Thyroid Association. 2017;27(11):1341-6.
• 6. Abdullah N, Hajeer M, Abudalu L, Sughayer M. Correlation study of thyroid nodule cytopathology and histopathology at two institutions in Jordan. CytoJournal. 2018;15:24.
• 7. Arul P, Akshatha C, Masilamani S. A study of malignancy rates in different diagnostic categories of the Bethesda system for reporting thyroid cytopathology: An institutional experience. Biomedical journal. 2015;38(6):517-22.
• 8. Avior G, Dagan O, Shochat I, Frenkel Y, Tessler I, Meir A, et al. Outcomes of the Bethesda system for reporting thyroid cytopathology: Real-life experience. Clinical endocrinology. 2021;94(3):521-7.
• 9. Bohacek L, Milas M, Mitchell J, Siperstein A, Berber E. Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules. Annals of surgical oncology. 2012;19(1):45-51.
• 10. Bongiovanni M, Crippa S, Baloch Z, Piana S, Spitale A, Pagni F, et al. Comparison of 5-tiered and 6-tiered diagnostic systems for the reporting of thyroid cytopathology: a multi-institutional study. Cancer cytopathology. 2012;120(2):117-25.
• 11. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. American journal of clinical pathology. 2010;134(3):450-6.
• 12. Ke J, Jianyong L, Ying L, Genpeng L, Linlin S, Zhihui L, et al. The use of The Bethesda System for Reporting Thyroid Cytopathology in a Chinese population: An analysis of 13 351 specimens. Diagnostic cytopathology. 2019;47(9):876-80.
• 13. Kim SK, Hwang TS, Yoo YB, Han HS, Kim DL, Song KH, et al. Surgical results of thyroid nodules according to a management guideline based on the BRAF(V600E) mutation status. The Journal of clinical endocrinology and metabolism. 2011;96(3):658-64.
• 14. Lee YB, Cho YY, Jang JY, Kim TH, Jang HW, Chung JH, et al. Current status and diagnostic values of the Bethesda system for reporting thyroid cytopathology in a papillary thyroid carcinoma-prevalent area. Head & neck. 2017;39(2):269-74.
• 15. Madgar O, Avior G, Shochat I, Joshua BZ, Baraf L, Avidor Y, et al. Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2021;47(6):1370-5.
• 16. Mandal S, Barman D, Mukherjee A, Mukherjee D, Saha J, Sinhas R. Fine needle aspiration cytology of thyroid nodules--evaluation of its role in diagnosis and management. Journal of the Indian Medical Association. 2011;109(4):258-61.
• 17. Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. Journal of cytology. 2013;30(2):94-9.
• 18. Mufti ST, Molah R. The bethesda system for reporting thyroid cytopathology: a five-year retrospective review of one center experience. International journal of health sciences. 2012;6(2):159-73.
• 19. Nandedkar SS, Dixit M, Malukani K, Varma AV, Gambhir S. Evaluation of Thyroid Lesions by Fine-needle Aspiration Cytology According to Bethesda System and its Histopathological Correlation. International journal of applied & basic medical research. 2018;8(2):76-82.
• 20. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009;117(3):195-202.
• 21. Naz S, Hashmi AA, Khurshid A, Faridi N, Edhi MM, Kamal A, et al. Diagnostic accuracy of Bethesda system for reporting thyroid cytopathology: an institutional perspective. International archives of medicine. 2014;7:46.
• 22. Paajanen I, Metso S, Jaatinen P, Kholová I. Thyroid FNA diagnostics in a real-life setting: Experiences of the implementation of the Bethesda system in Finland. Cytopathology : official journal of the British Society for Clinical Cytology. 2018;29(2):189-95.
• 23. Park JH, Yoon SO, Son EJ, Kim HM, Nahm JH, Hong S. Incidence and malignancy rates of diagnoses in the bethesda system for reporting thyroid aspiration cytology: an institutional experience. Korean journal of pathology. 2014;48(2):133-9.
• 24. Renshaw AA. Should "atypical follicular cells" in thyroid fine-needle aspirates be subclassified? Cancer cytopathology. 2010;118(4):186-9.
• 25. Reuters KB, Mamone M, Ikejiri ES, Camacho CP, Nakabashi CCD, Janovsky C, et al. Bethesda Classification and Cytohistological Correlation of Thyroid Nodules in a Brazilian Thyroid Disease Center. European thyroid journal. 2018;7(3):133-8.
• 26. Ronen O, Cohen H, Abu M. Review of a single institution's fine needle aspiration results for thyroid nodules: Initial observations and lessons for the future. Cytopathology : official journal of the British Society for Clinical Cytology. 2019;30(5):468-74.
• 27. Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. Thyroid : official journal of the American Thyroid Association. 2009;19(11):1215-23.
• 28. Williams BA, Bullock MJ, Trites JR, Taylor SM, Hart RD. Rates of thyroid malignancy by FNA diagnostic category. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2013;42(1):61.
• 29. Wu HH, Rose C, Elsheikh TM. The Bethesda system for reporting thyroid cytopathology: An experience of 1,382 cases in a community practice setting with the implication for risk of neoplasm and risk of malignancy. Diagnostic cytopathology. 2012;40(5):399-403.
• 30. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306-15.
• 31. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-16.
• 32. Yildirim E, Akbas P, Erdogan KO, Bektas S, Gumuskaya PO, Er AM, et al. The comparison of the histopathological results of the thyroid fine-needle aspiration biopsies in the 795 patients with thyroidectomy. Diagnostic cytopathology. 2021;49(6):671-6.
• 33. Yilmaz N, Cansu GB, Toru S, Sari R, Ocak GG, Arici C, et al. Cytopathology-histopathology correlation and the effect of nodule diameter on diagnostic performance in patients undergoing thyroid fine-needle aspiration biopsy. Journal of cancer research and therapeutics. 2020;16(Supplement):S53-s8.