The Bethesda System for Reporting Thyroid Cytopathology: A Single-Center Experience of 2 257 Thyroid Nodules_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SUNYing-he ¹ , LIUNian ² ,  JIANGYong ² , SUXue-ying ² , GONGRi-xiang ¹ , LIZhi-hui ¹ , WEITao ¹ , ZOUXiu-he ¹ , LIUFeng ¹ ,  ZHUJing-qiang ¹

1. Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding?author：

JIANGYong, Email: brave.heart@163.com; ZHUJing-qiang, Email: zjq-wkys@163.com

Keywords：

The Bethesda system for reporting thyroid cytopathology; Cytologic diagnosis; Fine-needle aspiration; Thyroid nodule

DOI：

10.7507/1007-9424.20140260

Video：

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Objective To report our experience in using The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC), and to investigate the diagnostic value of the system based on the cytologic-histologic result. Methods Pathological data of 2 257 thyroid nodules classified by TBSRTC which were obtained from the Department of Pathology of West China Hospital between Jan.2010 to Dec.2012 were collected and analyzed, to investigate the diagnostic evaluation indicators, such as the sensitivity, specificity, and diagnostic accuracy of the system based on the cytologic-histologic result. Results Of the 2 257 thyroid nodules, 442 (19.6%) were diagnosed as categoryⅠ, 1 184(52.4%) were diagnosed as categoryⅡ, 216(9.6%) were diagnosed as categoryⅢ, 38(1.7%) were diagnosed as categoryⅣ, 172(7.6%) were diagnosed as categoryⅤ, 205(9.1%) were diagnosed as categoryⅥ. Using TBSRTC categoryⅡas the boundary point of diagnosing benign and malignant diseases, the sensitivity, specificity, and diagnostic accuracy were 93.7%(236/252), 86.6%(323/373), and 89.4%(559/625)respectively, while categoryⅢwas excluded from analysis. When including categoryⅢinto analysis, the sensitivity, specificity, and diagnostic accuracy were 94.3%(267/283), 74.9%(323/431), and 82.6%(590/714)respectively. Conclusion The validity of TBSRTC was high at our institution. TBSRTC has proven to be an accurate and reliable approach for the diagnosis of thyroid nodules.

Citation： SUNYing-he, LIUNian, JIANGYong, SUXue-ying, GONGRi-xiang, LIZhi-hui, WEITao, ZOUXiu-he, LIUFeng, ZHUJing-qiang. The Bethesda System for Reporting Thyroid Cytopathology: A Single-Center Experience of 2 257 Thyroid Nodules. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1076-1080. doi: 10.7507/1007-9424.20140260 Copy

1.	閻玉芹.全球甲狀腺結節及甲狀腺癌的流行趨勢及其原因分析[J]. 中華地方病學雜志, 2013, 32(3):239-240.
2.	車煥永, 尤巧英, 婁偉英, 等.體檢人群中成年人常見甲狀腺疾病發病情況調查[J]. 中華健康管理學雜志, 2013, 7(6):415-416.
3.	Gharib H, Papini E.Thyroid nodules:clinical importance, assessment, and treatment[J]. Endocrinol Metab Clin North Am, 2007, 36(3):707-735.
4.	Mazzaferri EL.Management of a solitary thyroid nodule[J]. N Engl J Med, 1993, 328(8):553-559.
5.	Ezzat S, Sarti DA, Cain DR, et al.Thyroid incidentalomas. Prevalence by palpation and ultrasonography[J]. Arch Intern Med, 1994, 154(16):1838-1840.
6.	Tan GH, Gharib H.Thyroid incidentalomas:management approaches to nonpalpable nodules discovered incidentally on thyroid imaging[J]. Ann Intern Med, 1997, 126(3):226-231.
7.	Hegedüs L.Clinical practice.The thyroid nodule[J]. N Engl J Med, 2004, 351(17):1764-1771.
8.	Mandel SJ.A 64-year-old woman with a thyroid nodule[J]. JAMA, 2004, 292(21):2632-2642.
9.	Popoveniuc G, Jonklaas J.Thyroid nodules[J]. Med Clin North Am, 2012, 96(2):329-349.
10.	李曉明.重視甲狀腺癌手術治療的規范化[J]. 中華耳鼻咽喉頭頸外科雜志, 2009, 44(4):265-267.
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13.	Ali SZ, Cibas ES.The Bethesda system for reporting thyroid cytopathology:definitions, criteria and explanatory notes[M]. New York:Springer New York Dordrecht Heidelberg London, 2010:2-3.
14.	Jo VY, Stelow EB, Dustin SM, et al.Malignancy risk for fineneedle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology[J]. Am J Clin Pathol, 2010, 134(3):450-456.
15.	Theoharis CG, Schofield KM, Hammers L, et al.The Bethesda thyroid fine-needle aspiration classification system:year 1 at an academic institution[J]. Thyroid, 2009, 19(11):1215-1223.
16.	Bohacek L, Milas M, Mitchell J, et al.Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules[J]. Ann Surg Oncol, 2012, 19(1):45-51.
17.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al.Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2009, 19(11):1167-1214.
18.	Eedes CR, Wang HH.Cost-effectiveness of immediate specimen adequacy assessment of thyroid fine-needle aspirations[J]. Am J Clin Pathol, 2004, 121(1):64-69.
19.	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[J]. Cancer, 2009, 117(3):195-202.
20.	鄒秀和, 孫映荷, 朱信心, 等.2000~2012年期間華西醫院甲狀腺疾病構成的變化分析[J]. 中國普外基礎與臨床雜志, 2013, 20(9):987-991.
21.	Park JY, Lee HJ, Jang HW, et al.A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J]. Thyroid, 2009, 19(11):1257-1264.
22.	馬步云, Sundar PS, 彭玉蘭, 等.甲狀腺影像報告和數據系統在超聲檢查甲狀腺結節中的應用[J]. 中國普外基礎與臨床雜志, 2011, 18(8):898-901.
23.	Ali SZ.Thyroid cytopathology:Bethesda and beyond[J]. Acta Cytol, 2011, 55(1):4-12.
24.	Bongiovanni M, Spitale A, Faquin WC, et al.The Bethesda System for Reporting Thyroid Cytopathology:a meta-analysis[J]. Acta Cytol, 2012, 56(4):333-339.
25.	Krane JF, Vanderlaan PA, Faquin WC, et al.The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio:a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology[J]. Cancer Cytopathol, 2012,120(2):111-116.

1. 閻玉芹.全球甲狀腺結節及甲狀腺癌的流行趨勢及其原因分析[J]. 中華地方病學雜志, 2013, 32(3):239-240.
2. 車煥永, 尤巧英, 婁偉英, 等.體檢人群中成年人常見甲狀腺疾病發病情況調查[J]. 中華健康管理學雜志, 2013, 7(6):415-416.
3. Gharib H, Papini E.Thyroid nodules:clinical importance, assessment, and treatment[J]. Endocrinol Metab Clin North Am, 2007, 36(3):707-735.
4. Mazzaferri EL.Management of a solitary thyroid nodule[J]. N Engl J Med, 1993, 328(8):553-559.
5. Ezzat S, Sarti DA, Cain DR, et al.Thyroid incidentalomas. Prevalence by palpation and ultrasonography[J]. Arch Intern Med, 1994, 154(16):1838-1840.
6. Tan GH, Gharib H.Thyroid incidentalomas:management approaches to nonpalpable nodules discovered incidentally on thyroid imaging[J]. Ann Intern Med, 1997, 126(3):226-231.
7. Hegedüs L.Clinical practice.The thyroid nodule[J]. N Engl J Med, 2004, 351(17):1764-1771.
8. Mandel SJ.A 64-year-old woman with a thyroid nodule[J]. JAMA, 2004, 292(21):2632-2642.
9. Popoveniuc G, Jonklaas J.Thyroid nodules[J]. Med Clin North Am, 2012, 96(2):329-349.
10. 李曉明.重視甲狀腺癌手術治療的規范化[J]. 中華耳鼻咽喉頭頸外科雜志, 2009, 44(4):265-267.
11. 蔡曉頻.甲狀腺細針穿刺診斷的臨床研究[D]. 北京:北京協和醫學院, 2011.
12. 吳亮, 楊順實, 江學慶, 等.超聲引導下甲狀腺結節細針穿刺細胞學檢查的術前診斷價值[J]. 中國臨床醫學影像雜志, 2014, 25(1):17-20.
13. Ali SZ, Cibas ES.The Bethesda system for reporting thyroid cytopathology:definitions, criteria and explanatory notes[M]. New York:Springer New York Dordrecht Heidelberg London, 2010:2-3.
14. Jo VY, Stelow EB, Dustin SM, et al.Malignancy risk for fineneedle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology[J]. Am J Clin Pathol, 2010, 134(3):450-456.
15. Theoharis CG, Schofield KM, Hammers L, et al.The Bethesda thyroid fine-needle aspiration classification system:year 1 at an academic institution[J]. Thyroid, 2009, 19(11):1215-1223.
16. Bohacek L, Milas M, Mitchell J, et al.Diagnostic accuracy of surgeon-performed ultrasound-guided fine-needle aspiration of thyroid nodules[J]. Ann Surg Oncol, 2012, 19(1):45-51.
17. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al.Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2009, 19(11):1167-1214.
18. Eedes CR, Wang HH.Cost-effectiveness of immediate specimen adequacy assessment of thyroid fine-needle aspirations[J]. Am J Clin Pathol, 2004, 121(1):64-69.
19. 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[J]. Cancer, 2009, 117(3):195-202.
20. 鄒秀和, 孫映荷, 朱信心, 等.2000~2012年期間華西醫院甲狀腺疾病構成的變化分析[J]. 中國普外基礎與臨床雜志, 2013, 20(9):987-991.
21. Park JY, Lee HJ, Jang HW, et al.A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J]. Thyroid, 2009, 19(11):1257-1264.
22. 馬步云, Sundar PS, 彭玉蘭, 等.甲狀腺影像報告和數據系統在超聲檢查甲狀腺結節中的應用[J]. 中國普外基礎與臨床雜志, 2011, 18(8):898-901.
23. Ali SZ.Thyroid cytopathology:Bethesda and beyond[J]. Acta Cytol, 2011, 55(1):4-12.
24. Bongiovanni M, Spitale A, Faquin WC, et al.The Bethesda System for Reporting Thyroid Cytopathology:a meta-analysis[J]. Acta Cytol, 2012, 56(4):333-339.
25. Krane JF, Vanderlaan PA, Faquin WC, et al.The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio:a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology[J]. Cancer Cytopathol, 2012,120(2):111-116.

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The Bethesda System for Reporting Thyroid Cytopathology: A Single-Center Experience of 2 257 Thyroid Nodules

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