Assessment of the Bethesda System for Reporting Thyroid Cytopathology

Jennifer L. Sauter, Heidi Lehrke, Xiaotun Zhang, Osamah T. Al Badri, Rene Rodriguez-Gutierrez, Danae A. Delivanis, Naykky Singh Ospina, Diane Donegan, Oksana Hamidi, Nicole Iñiguez-Ariza, Anu Sharma, Nana Esi N. Kittah, Shrikant U. Tamhane, Maria D. Hurtado Andrade, Anupam Kotwal, Sarah M. Jenkins, Grant Spears, Michael Rivera, Diana S. Dean, Michael R. Henry

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objectives: Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA). Methods: Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated. Results: Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM). Conclusions: Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.

Original languageEnglish (US)
Pages (from-to)502-511
Number of pages10
JournalAmerican journal of clinical pathology
Issue number4
StatePublished - Sep 9 2019


  • Atypia of undetermined significance/follicular lesion of undetermined significance
  • Bethesda
  • Cytopathology
  • FNA
  • Fine-needle aspiration
  • Follicular neoplasm/suspicious for follicular neoplasm
  • Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)
  • Papillary thyroid carcinoma
  • Risk of malignancy
  • Thyroid

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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