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

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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.
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10.	李晓明.重视甲状腺癌手术治疗的规范化[J]. 中华耳鼻咽喉头颈外科杂志, 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.	邹秀和, 孙映荷, 朱信心, 等.2000~2012年期间华西医院甲状腺疾病构成的变化分析[J]. 中国普外基础与临床杂志, 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.	马步云, Sundar PS, 彭玉兰, 等.甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用[J]. 中国普外基础与临床杂志, 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. 阎玉芹.全球甲状腺结节及甲状腺癌的流行趋势及其原因分析[J]. 中华地方病学杂志, 2013, 32(3):239-240.
2. 车焕永, 尤巧英, 娄伟英, 等.体检人群中成年人常见甲状腺疾病发病情况调查[J]. 中华健康管理学杂志, 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. 李晓明.重视甲状腺癌手术治疗的规范化[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(4):265-267.
11. 蔡晓频.甲状腺细针穿刺诊断的临床研究[D]. 北京:北京协和医学院, 2011.
12. 吴亮, 杨顺实, 江学庆, 等.超声引导下甲状腺结节细针穿刺细胞学检查的术前诊断价值[J]. 中国临床医学影像杂志, 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. 邹秀和, 孙映荷, 朱信心, 等.2000~2012年期间华西医院甲状腺疾病构成的变化分析[J]. 中国普外基础与临床杂志, 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. 马步云, Sundar PS, 彭玉兰, 等.甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用[J]. 中国普外基础与临床杂志, 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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