Utilización del sistema Bethesda para el diagnóstico citológico de nódulos tiroideos / Use of the Bethesda system for the cytologic diagnosis of thyroid nodules: en

Introducción: El nódulo tiroideo es un hallazgo común en la actualidad y, por sus características ecográficas, constituye una lesión distinta al parénquima glandular, con una prevalencia alta en la población general. Objetivo: Describir el uso del sistema Bethesda como método de diagnóstico de nódulos tiroideos y el grado de malignidad. Métodos: Se efectuó un estudio descriptivo y retrospectivo de 1771 pacientes con diagnóstico de nódulo tiroideo, a quienes se les realizó citología por aspiración con aguja fina en el Departamento de Anatomía Patológica del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba durante el cuatrienio 2016-2019. Resultados: En la serie predominó el grupo etario de 41-50 años y la edad media fue de 49,51±13,14 años. Asimismo, sobresalió la categoría II del sistema Bethesda (73,8 %); en tanto, de los 204 diagnosticados correspondientes a la categoría III, 111 fueron intervenidos quirúrgicamente y 29 de estos presentaron neoplasias malignas (27,6 %). El grado de malignidad osciló entre 22,8 y 36,0 %. Conclusiones: La aplicación del sistema Bethesda fue muy útil para el diagnóstico citopatológico de nódulos tiroideos y el grado de malignidad se correspondió con cifras adecuadas.

Introduction: The thyroid nodule is a common finding nowadays and, for its echographic characteristics, it constitutes a lesion different to the glandular parenchyma, with a high prevalence in the general population. Objective: To describe the use of the Bethesda system as diagnostic method of thyroid nodules and the degree of malignancy. Methods: A descriptive and retrospective study of 1 771 patients with diagnosis of thyroid nodule was carried out, who underwent fine needle aspiration cytology, in the Pathology Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during 2016-2019. Results: In the series there was a prevalence of the 41-50 age group and the mean age was of 49,51±13,14 years. Also, the category II of the Bethesda system was notable (73.8 %); as long as, of the 204 diagnosed corresponding to the category III, 111 were surgically intervened and 29 of them presented mlignancy (27.6 %). The degree of malignancy oscillated between 22.8 and 36.0 %. Conclusions: The application of the Bethesda system was very useful for the cytopathologic diagnosis of thyroid nodules and the degree of malignancy corresponded with appropriate figures.

Correlation of fine needle aspiration cytology and cell block study of category III, IV, and V (TBSRTC-2017) thyroid lesions with special reference to cytokeratin-19 immunohistochemical staining

Context: Ascertaining the role of cytokeratin-19 (CK19) and its staining pattern helps to differentiate papillary carcinoma from other thyroid lesions. Aims: To correlate fine needle aspiration cytology (FNAC) and cell block study of equivocal cases (Category III, IV, and V) with the role of CK19 staining in it. Settings and Design: A hospital-based cross-sectional observational study was designed and conducted at North Bengal Medical College and Hospital, Shusrutnagar, Darjeeling. Methods and Material: The FNAC performed and reported as per TBSRTC-2017.50 cases of Category III, IV, and V was selected for cell block study and CK19 staining followed by immunohistochemical scoring. Results: Out of 50 cases, 17 were follicular neoplasm, 21 papillary carcinoma, 6 lymphocytic thyroiditis, 1 Hürthle cell adenoma, 1 medullary carcinoma, 1 lymphoma, and 3 undifferentiated carcinomas. Among cases of papillary carcinoma, 10 showed 4+ positivity, 9 showed 3+ positivity, 2 showed focal 1+ and 2+ positivity. In the case of follicular neoplasm, 1 showed 3+ positivity, 3 cases had 1+ 2+ positivity, and 13 cases revealed negative staining. Conclusion: Role of CK19 in distinguishing papillary carcinoma of thyroid from other lesions in cytologically diagnosed Category III, IV, and V (TBSRTC-2017) cases can be demonstrated.

Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo en un centro universitario (Hospital de Clínicas) de Uruguay, diez años de experiencia / Performance of the Bethesda SYSTEM in the cytopathological diagnosis of the thyroid nodule in a university center (Hospital de Clínicas) in Uruguay, ten years of experience / Desempenho do sistema Bethesda no diagnóstico citopatológico de nódulos tireoidianos em um centro universitário (Hospital de Clínicas) no Uruguai, dez anos de experiencia

Resumen: Introducción: el estudio citológico por punción ecoguiada se caracteriza por ser rápido, confiable, mínimamente invasivo y rentable. Permite reducir procedimientos quirúrgicos innecesarios y clasifica apropiadamente a los pacientes con nódulos sospechosos o malignos para una intervención quirúrgica oportuna. Objetivo: el objetivo del presente estudio es evaluar la correlación citológica-anatomopatológica del sistema Bethesda en un centro universitario (Hospital de Clínicas) de Uruguay. Metodología: se realizó un estudio de tipo observacional, retrospectivo, descriptivo, basado el análisis de historias clínicas de pacientes sometidos a cirugía tiroidea en el Hospital de Clínicas, en el período comprendido entre enero de 2008 y diciembre de 2018. Resultados: del total inicial de 119 pacientes, 93 cumplieron los criterios de inclusión. El rango de edad de la muestra fue entre 15 y 79 años. Del total de puncionados 49,5% (46) fueron informados como benignos y 50,5% (47) como malignos. Se calculó en forma global una sensibilidad de 96% (0,96) con IC 1,0-0,90, especificidad de 98% (0,97) con IC 1,0-0,93, un VPP de 98% y VPN de 96%. La sensibilidad diagnóstica para la categoría IV, V y VI fue de 96%, con una especificidad de 100, 94 y 100% respectivamente. Conclusiones: el sistema Bethesda aplicado a las PAAF de nódulos tiroideos potencia la certeza diagnóstica y asiste en la decisión terapéutica. En nuestra institución contamos con una buena correlación citopatológica, similar a otros trabajos reportados en la literatura, lo que permite predecir adecuadamente el riesgo de malignidad y facilitar la toma de decisiones.

Summary: Introduction: the ultrasound-guided fine needle aspiration biopsy (FNAB) study is characterized by being fast, reliable, minimally invasive, and cost-effective. It reduces unnecessary surgical procedures and appropriately classifies patients with suspicious or malignant nodules for timely surgical intervention. Objective: the objective of this study is to evaluate the cytological-pathological correlation of the Bethesda System in a university center (Hospital de Clínicas) in Uruguay. Methodology: an observational, retrospective, descriptive study was carried out, based on the analysis of medical records of patients undergoing thyroid surgery at the Hospital de Clínicas, in the period between January 2008 and December 2018. Results: of the initial total of 119 patients, 93 met the inclusion criteria. The age range of the sample was between 15 and 79 years. Of the total of punctured, 49.5% (46) were reported as benign and 50.5% (47) as malignant. A sensitivity of 96% (0.96) with CI 1.0-0.90, specificity of 98% (0.97) with CI 1.0-0.93, a PPV of 98% and NPV of 96%. The diagnostic sensitivity for categories IV, V and VI was 96% with a specificity of 100, 94 and 100% respectively. Conclusions: the Bethesda system applied to FNA of thyroid nodules enhances diagnostic certainty and assists in the therapeutic decision. In our institution we have a good cytopathological correlation, similar to other works reported in the literature. This makes it possible to adequately predict the risk of malignancy and facilitate decision-making.

Resumo: Introdução: o estudo citológico por punção guiada por ultrassom caracteriza-se por ser rápido, confiável, minimamente invasivo e de baixo custo. Permite reduzir procedimentos cirúrgicos desnecessários e classificar adequadamente pacientes com nódulos suspeitos ou malignos para intervenção cirúrgica oportuna. Objetivo: avaliar a correlação citológico-patológica do Sistema Bethesda em um centro universitário (Hospital de Clínicas) no Uruguai. Metodologia: foi realizado um estudo observacional, retrospectivo, descritivo, baseado na análise de prontuários de pacientes submetidos à cirurgia de tireoide no Hospital de Clínicas, no período janeiro de 2008-dezembro de 2018. Resultados: do total inicial de 119 pacientes, 93 preencheram os critérios de inclusão. A faixa etária da amostra foi entre 15 e 79 anos. Do total de punções, 49,5% (46) foram relatadas como benignas e 50,5% (47) como malignas. No geral, uma sensibilidade de 96% (0,96) com IC 1,0-0,90, uma especificidade de 98% (0,97) com IC 1,0-0,93, um VPP de 98% e VPN de 96%. A sensibilidade diagnóstica para as categorias IV, V e VI foi de 96% com especificidade de 100, 94 e 100%, respectivamente. Conclusões: o sistema Bethesda aplicado à PAAF de nódulos tireoidianos aumenta a certeza diagnóstica e auxilia na decisão terapêutica. Em nossa instituição temos uma boa correlação citopatológica, semelhante a outros trabalhos relatados na literatura. Isso permite prever adequadamente o risco de malignidade e facilitar a tomada de decisão.

Preventing Uterine Cervix Cancer: The Clinical Meaning of Atypical Glandular Cells / Prevenção do câncer do colo uterino: Significado clínico das células glandulares atípicas

Abstract Objective To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. Methods Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. Results A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. Conclusion The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.

Resumo Objetivo Determinar a prevalência de citologia com laudo de células glandulares atípicas (AGCs, na sigla em inglês) e analisar a significância clínica nas diferentes faixas etárias Métodos Estudo observacional retrospectivo, usando os dados arquivados no sistema do Instituto Nacional de Câncer no Brasil, que incluiu mulheres rastreadas entre janeiro de 2002 a dezembro de 2008. As mulheres incluídas tinham citologia com resultado de AGCs, que foram acompanhadas com colposcopia e nova citologia Resultados Um total de132,147 exames citopatológicos foram incluídos durante o período de estudo. Quinhentas e trinta e três mulheres com citologia de AGC foram identificadas e destas, 69.41% (370) foram encaminhadas para colposcopia e nova citologia. A prevalência de citologia de AGC na população estudada foi 0.4%. A maioria das mulheres (79.22%) com resultado citológico de AGC tinham idade entre 25 e 54 anos. A segunda citologia demonstrou 67.56% (250/370) de normalidade, 24.5% (91/370) de atipias escamosas, e 6.2% (23/370) de AGC. Na biopsia das mulheres com a 2ª citologia de AGC, 43.4% (10/23) tinham histologia normal, 43.4% (10/23) tinha lesões escamosas, 8.7% (2/23) tinha adenocarcinoma invasor e 1.2% (1/23) tinha laudo inconclusivo. Todas as mulheres com lesões intraepiteliais escamosas de alto grau (HSIL, na sigla em inglês) ou adenocarcinoma invasor (respectivamente 5 e 2pacientes), após a 2ª citologia com AGC, tinham 25 anos de idade ou mais. Conclusão A prevalência de citologia com AGC foi baixa na população estudada. Muitos casos de citologia com AGC apareceram em mulheres adultas, entre 25 e 54 anos de idade. Embora a maioria das pacientes tiveram histologia normal após seguimento, várias apresentaram lesões intraepiteliais escamosas ou glandulares invasoras.

Study of cytomorphological features of thyroid lesions and its correlation with thyroid function tests.

Background: Fine needle aspiration cytology along with ultrasound and assessment of thyroid function status remains the mainstay of evaluation of thyroid swellings. According to the guidelines put forth by American Thyroid Association, serum estimation of TSH should be part of initial assessment of thyroid swellings. Present study aims to assess the cytomorphological features of various thyroid lesions, classify them in different categories based on The Bethesda System of Reporting Thyroid Cytology and correlate them with thyroid hormone status of patients. Methods: 165 cases of thyroid lesions were subjected to FNAC, smears were categorised according to The Bethesda System of Reporting Thyroid Cytopathology and cases were also assessed for T3, T4, TSH hormone levels. Results: On interpretation of FNAC non-neoplastic lesions outnumbered the neoplastic lesions and Colloid goitre accounted for the majority of the cases (40.6%). Among the neoplastic lesions, follicular neoplasms were most common. Cytologically majority of the lesions belonged to category II (benign) as per the Bethesda System. On evaluation of thyroid function majority of the cases (69.1%) were euthyroid and were interpreted as either colloid goitre or adenomatoid nodule, whereas most patients of lymphocytic thyroiditis presented with either hypo or hyperthyroidism. Majority of malignant cases also turned out to be hypothyroid (9/12 Cases). None of the malignant case presented with hyperthyroidism. Conclusions: Thyroid cytology proves to be a reliable, simple and cost-effective first line diagnostic procedure. FNAC together with thyroid function test can be used for early and accurate diagnosis of various thyroid lesions, and reduces unnecessary intervention.

Comportamiento del cáncer de tiroides en la Unidad de Cirugía Adulto del Hospital Clínico Herminda Martín de Chillán: período 2017 al 2019 / Thyroid cancer behavior in the adult surgery unit of the Herminda Martin de Chillan Clinical Hospital: period from 2017 to 2019

Resumen Objetivo: Describir las características demográficas del cáncer de tiroides en la Región de Ñuble en pacientes operados en el servicio de cirugía del Hospital Clínico Herminda Martin del 2017 al 2019. Materiales y Método: Mediante estudio descriptivo, se revisaron las historias clínicas de los pacientes operados en la Unidad de Cirugía de Adultos del hospital entre enero de 2017 y diciembre de 2019, tabulando las variables demográficas, clínicas e histopatológicas y método diagnóstico. Resultados: Se operaron 124 pacientes con afecciones tiroideas, 58 resultaron tener cáncer. Predominó el sexo femenino (50 pacientes). Se realizaron 43 tiroidectomías totales como primera cirugía y 15 disecciones cervicales. El carcinoma papilar fue el más diagnosticado (93,1%). Hubo discrepancias entre las categorías Bethesda II y IV en cuanto al diagnóstico definitivo. En mujeres el 36% de los tumores tuvo extensión extra tiroidea y el 54% tenían un diámetro mayor a 1 cm. Discusión: La prevalencia en el sexo femenino corresponde con los datos que se aportan a nivel mundial y en Chile. La discrepancia en el sistema Bethesda pudo corresponder a errores de la toma de muestra o su interpretación citológica. Los hallazgos de extensión y tamaño tumoral pueden estar en relación con el tiempo de espera para la cirugía. Conclusiones: El cáncer tiroideo es más frecuente en el sexo femenino. El carcinoma papilar fue el más diagnosticado. La asociación de tiroiditis con cáncer tiroideo fue de 98%. No se realizó ninguna cirugía conservadora.

Aim: To describe the demographic characteristics of thyroid cancer in the Ñuble Region in patients operated on by the Herminda Martín de Chillán Clinical Hospital surgery service from 2017 to 2019. Materials and Method: Through a descriptive study, the medical records of the patients operated on in the Adult Surgery Unit of the hospital between January 2017 and December 2019 were reviewed, tabulating the demographic, clinical and histopathological variables and method diagnosis. Results: 124 patients with thyroid conditions were operated on, 58 had cancer. The female sex predominated (50 patients). 43 total thyroidectomies were performed as the first surgery and 15 cervical dissections. Papillary carcinoma was the most diagnosed (93.1%). There were discrepancies between Bethesda categories II and IV regarding the definitive diagnosis. In women, 36% of the tumors had an extra-thyroid extension and 54% had a diameter greater than 1 cm. Discussion: The prevalence in the female sex corresponds to the data provided worldwide and in Chile. The discrepancy in the Bethesda system could correspond to errors in the sampling or its cytological interpretation. The findings of tumor extension and size may be related to the waiting time for surgery. Conclusions: Thyroid cancer is more frequent in females. Papillary carcinoma was the most diagnosed. The association of thyroiditis with thyroid cancer was 98%. No conservative surgery was performed.

Cytomorphological Study of Thyroid Lesions Using the Bethesda System for Reporting Thyroid Cytology and Its Correlation with Thyroid Function Test.

Fine-needle aspiration cytology of thyroid is a simple, minimally invasive, cost effective, readily available, reliable, time saving and an easy to perform outpatient procedure.1 The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a six category scheme of thyroid cytopathology reporting.2 FNAC in conjunction with thyroid hormonal profile helps in assessing stage of the disease as hyperthyroid, hypothyroid or euthyroid3. It is very helpful in deciding the treatment options for the patient.METHODSThis is a prospective study of 125 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnosis were classified according to age and gender, cytological findings and TBSRTC categories. All TBSRTC categories were correlated with thyroid function test results.RESULTSThe distribution of various categories from 125 evaluated thyroid nodules was as follows: 6.4% Non-Diagnostic or Unsatisfactory (ND/UNS), 80% benign, 2.4% Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS/FLUS), 4% Follicular Neoplasm (FN), 4% Suspicious for Malignancy (SFM), and 3.2% Malignant. Maximum cases with altered TFT were found in category II. Whereas in category V (5/5) & in category VI (4/4), all cases were euthyroid & not a single case of altered Thyroid Function Test (TFT) was found. Among the 16 cases of thyroiditis, majority of the cases was hypothyroid.CONCLUSIONSTBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNAC or surgery. Diagnostic challenges arise when aspirate samples are quantitatively or qualitatively suboptimal and, in such situations, clinical and TFT correlations are immensely helpful. Alteration in thyroid function tests is associated with benign conditions mostly in thyroiditis in which hypothyroid state can aid in the diagnosis of the benign lesions.

The spectrum of thyroid lesions on fine needle aspiration cytology

Background: Fine Needle Aspiration Cytology (FNAC) of thyroid gland is the most common preoperative investigation for diagnosis of thyroid lesions. Though various tests like thyroid profile, ultrasonography and radionuclide scan are available, they are used as adjuvant diagnostic modalities. FNAC is simple, easy to perform, non-invasive and cost-effective procedure. Primary aim is to study the spectrum of various thyroid lesions on FNAC. Also, the study is aimed to categorise the thyroid lesions according to the Bethesda system for Reporting Thyroid Cytopathology (2017).Methods: This is a retrospective observational study carried out in the pathology department at tertiary care academic institute for a period of three years. FNAC was done in a patient with thyroid swelling by non-aspiration technique. Slides were prepared, fixed in 95% ethyl alcohol and processed with routine stains.Results: Out of 210 cases, 150 cases (71.42%) were benign lesions, 15 cases (7.14%) were Follicular neoplasm/Suspicious for follicular neoplasm, 14(6.66%) cases were reported as Atypia of undetermined significance, 13 cases (6.19%) were Unsatisfactory/Nondiagnostic, 11 cases (5.2%) were malignant and 7 cases (3.3%) were suspicious for malignancy.Conclusions: FNAC is the most effective tool for the diagnosis of thyroid lesions. The Bethesda system is used to categorise the thyroid lesions and helps in better communication between clinicians and pathologists for the best surgical and medical management. The number of benign cases were higher and the number of cases in the category of suspicious for malignancy were lower with female preponderance.

Utility of Papanicolaou’s smears in the diagnosis of premalignant and malignant lesions of the cervix in a tertiary care centre of South Gujarat, India

Background: "Preventable but not prevented", this is the reality of cervical cancer today, at least in developing countries. 80% of all the cases of cervical cancer occur in these developing countries. In India, cervical cancer is the leading cause of cancer related deaths in women. The Papanicolaou test is simple, quick, and painless. It is capable of detecting cervical cancer at an early stage and is used widely in developed countries, where it has decreased both the incidence and mortality of cervical cancer. Objective of the study was conducted to determine the importance of conventional Pap smears for the diagnosis of inflammatory, premalignant and malignant lesions of the cervix.Methods: This cross-sectional study was conducted from January 2017 to June 2018 on 2000 women coming for a Pap smear examination in Government Medical College attached to New Civil Hospital, Surat. After doing Pap stain, all cases were reported as per the 2014 Bethesda system.Results: A total of 2000 cases of Pap smears were received out of which 1914(95.7%) cases were satisfactory for evaluation, 86(4.3%) cases were unsatisfactory. The frequency of epithelial abnormalities was 3.66%. The age group of 51-60 years showed the highest epithelial abnormalities. The frequency of epithelial abnormalities in asymptomatic women was 2.3%. Out of the 1844 cases, 103(5.6%) showed changes of atrophy, 1011(54.8%) cases showed inflammatory/reactive changes, whereas organisms were seen in 558(30.3%) cases.Conclusions: Pap smear happens to be an economical, safe and pragmatic diagnostic tool for early detection of cervical cancer.

A study of cervical cytology in females above 21 years of age

Background: Cancer cervix is the leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities or due to the lack of awareness amongst the women of developing countries. Worldwide, cervical cancer is the second most common and 5th deadliest cancer in women. This study was conducted in department of obstetrics and Gynaecology, Umaid hospital, Dr. S. N. Medical College, Jodhpur Rajasthan, India. The objective of this study was to study the various high risk factors involved in premalignant and malignant lesions of cervix. To study the incidence of different epithelial abnormalities of cervix in females above 21 years of age. To study premalignant and malignant lesions of the cervix in relation to the presenting complaintMethods: The study was conducted in 500 females above 21 years of age and who were not pregnant, who had been attending Umaid Hospital, Jodhpur for various gynaecological complaints, of different parity, residential status and socioeconomic class. Detailed history was taken and thorough examination was done. Pap smear was prepared and all smears were reported as per the Bethesda system.Results: Maximum numbers of patients were in the age group of 21-40 years (70.2%). Majority of patients were from rural area (52.4%) and from lower socioeconomic class (30.2%). Most of women were found to have duration of marriage between 10 to 30 years (63.4%). Most of the women in our study had age at marriage between 17 to 19 years (49.4%). Multiparity was seen in 84.2% of cases. The commonest presenting complaint was white discharge (46.8%). On Pap smear, maximum cases were of inflammatory smear (91.4%), 1.4% had ASCUS, 1.2% AGC, 1.4% LSIL, 1% HSIL and 0.4% had SCC.Conclusions: Cervical cytology is an important tool for early detection of premalignant and malignant lesions of cervix. Regular pap smear screening should be conducted in vulnerable age groups.

Aumento de la capacidad diagnóstica de la ecografía (informada con clasificación t-rads) cuando se agrega una punción aspirativa con aguja fina (informada con sistema bethesda) / Increase of the diagnostic yield of thyroid sonogram (reported with t-rads clasification) when a fine needle aspiration cytology (reported with bethesda system) is added

Cuando un nódulo tiroideo muestra características ecográficas sospechosas de malignidad (informada con clasificación T-RADS) casi no se discute que debe completarse el diagnóstico con una punción aspirativa con aguja fina (PAAF) (informada con sistema Bethesda). Pero cuando la ecografía sólo muestra características consideradas de benignidad, la indicación de PAAF es cuestionable y debe ser justificada. ¿Podrá la clasificación T-RADS determinar eficientemente cuáles nódulos tiroideos requieren una PAAF y cuáles no? Esta decisión está vinculada a determinar si un paciente deberá ser sometido o no a una cirugía tiroidea. Objetivo: Analizar la capacidad de la clasificación T-RADS, con y sin el agregado de sistema Bethesda para optimizar el diagnóstico de patología tiroidea. Material y métodos: se incluyeron 139 nódulos que requirieron cirugía, previamente evaluados con ecografía y con PAAF. Fueron realizadas por un mismo operador las ecografías (SMB), las punciones (OBM) y las cirugías (JLN). Se homogeneizaron las definiciones: T-RADS II-III-IVa y Bethesda II-III: Baja sospecha de malignidad; T-RADS IVb-V-VI y Bethesda IV-V-VI: Alta sospecha de malignidad. Conslusiones: se comprobó que cuando las características ecográficas de un nódulo tienen baja sospecha de malignidad (T-RADS II-III-IVa), indicar una PAAF no aporta al diagnóstico en forma estadísticamente significativa. Cuando la ecografía indica alta sospecha de malignidad (T-RADS IVb-V-VI), la realización de una PAAF incrementa significativamente la certidumbre del diagnóstico (AU)

When a thyroid nodule shows ultrasonographic characteristics of malignancy suspicion (informed with T-RADS classification), almost nobody discusses to complete diagnosis with a fine needle aspiration biopsy (FNAB) (informed with Bethesda system). But when ultrasonography only shows characteristics compatible with benignity, a FNAB indication is questionable and that must be justified. Could T-RADS classification efficiently identify which nodule requires a FNAB and which does not? That decision will linked to which patients should be undergo a thyroid surgery. Objective: to analyze T-RADS capability with and without Bethesda system to optimize the diagnosis of thyroid pathology. Material and methods: a total of 139 nodules which required surgery were included. They were previously evaluated with ultrasonography and FNAB. A same operator classified the T-RADS (SMB), the Bethesda system (OMB) and performed the surgeries (JLN). For this work, definitions were homogenized as follows: T-RADS II-III-IVa and Bethesda II-III: Low suspicion of malignancy; T-RADS IVb-V-VI and Bethesda IV-V-VI: High suspicion of malignancy. Conclusions: the evidence suggested that when a thyroid nodule shows low suspicion of malignancy by ultrasonography (T-RADS II-III-IVa), the indication of a FNAB did not add statistically significant diagnostic benefit. When a thyroid nodule shows high suspicion of malignancy (T-RADS IVb-V-VI), a FNAB added significant diagnostic accuracy (AU)

Fine Needle Aspiration Cytopathology (FNAC) Of Thyroid Lesions Reporting As Per Guidelines Of Recent Bethesda System At A Tertiary Care Teaching Medical College & Hospital

Introduction: Estimation of accuracy of ne needle aspiration cytopathology (FNAC) of thyroid in diagnosis of different thyroid lesions, and evaluation of the value of reporting FNAC per guidelines of Bethesda system in reducing the number of un necessary thyroidectomies. This is a case control prospective study conducted on 54 patients with thyroid nodules. Patient were recruited to Cytopathology Department, KIMS Teaching Hospital in the period from January 2017 to December 2018. Results of FNAC were reported per recent Bethesda System for Reporting of Thyroid Cytopathology (TBSRTC). Reporting of Thyroid Cytopathology (TBSRTC) diagnoses were determined to be very useful for surgical removal thyroid tissues. Methods: The current study was a retrospective study on 54 patients with thyroid swelling referred to the Department of Pathology, Karpaga Vinayaga Hospital in the period from January 2017 to Dec 2018. Cases included in the present study were those with preoperative FNAC and The data of 54 cases with enlarged thyroid glands that were referred to our cytolaboratory in this period. Thyroid swellings were aspirated using disposable needles using standard procedures. The aspirated contents of needles were expelled onto the glass slides. Slides were immediately xed in methanol and smears were stained with papanicolau and hematoxlin and eosin stains whereas slides were air dried before staining it with giemsa Results: Out of 54 cases, Bethesda category I included 3 cases (5.5%), category II constituted 42 cases(77.7%) out of which 22 cases (52.38%) were benign follicular nodule type II, 13 cases(30.95%) were colloid nodule, 7 cases (16.7%) were hashimoto thyroiditis, category III (AUS) included 2 cases (3.70%), category IV (Follicular Neoplasm) had 4 cases(7.40%), category V (Suspicious of malignancy) included 2 cases (3.70%), category VI (malignant) constituted 1 case (1.85%). Male to female ratio was 1:6.9. Highest prevalence was noted in 30-40 years of age. Conclusion: Fine needle aspiration cytopathology from thyroid nodule(s) is a safe, quick outpatient, cost effective and easy procedure if done by expert hands, but it needs a unied system of interpretation, reporting language and guidelines for proper categorization and management. Bethesda System for Reporting Thyroid Cytopathology is a comprehensive system for cytopathological diagnosis of thyroid nodule(s) and with strict diagnostic criteria for each category, predicting risk of malignancy and guidelines for planning of further management. Thyroid Fna can play a pivotal role in the management of patients with thyroid nodules by Bethesda system directly confers risk of malignancy in each category which in turn prompts the recommended clinical management of that category thus establishing an excellent clinico-pathological corelation. providing clinicians with a clear and comprehensible cytopathology reports. The Bethesda system is very useful for a standardized system of thyroid cytopathology reporting, best communication between clinicians and cytopathologists , leading to more consistent management approaches

Importancia del sistema de Bethesda en el diagnóstico citológico de lesiones precancerosas del cérvix / The importance of Bethesda system in the cytological diagnosis of the cervix pre-cancerous lesions

RESUMEN El cáncer cérvico uterino, causa alrededor de 250 000 muertes anuales en el mundo y alrededor de 400 en Cuba, a pesar del esfuerzo que realiza el MINSAP, a través del Programa de Pesquisaje. Con el mismo se puede obtener el diagnóstico de lesiones precursoras del cáncer de cuello uterino, este diagnóstico citológico se realiza en Cuba a través del método de Richard y Barron que demuestra que existe un progreso citológico aparente hasta llegar al cáncer, que comienza con neoplasia intraepitelial (NICI a NICIII y carcinoma in situ), hasta finalmente el cáncer invasor. Por otro lado existe el método de Bethesda que responde casi todas las interrogantes que la citología plantea para su enfrentamiento, evidentemente los mayores aportes y revisiones se enfocan al manejo de las citologías atípicas de significado incierto, ya que no sólo presentan un mayor número de posibles evaluaciones, sino que representan el mayor porcentaje de citologías alteradas y la inclusión del VPH en las lesiones de bajo grado. En Cuba todavía se clasifica por el método de Richard y no se utiliza el Bethesda. Por la alta incidencia de esta entidad el propósito de este trabajo es emitir consideraciones sobre la implementación del sistema de Bethesda en el diagnóstico citológico de lesiones precancerosas del cérvix.

ABSTRACT The cervical-uterine cancer causes almost 250 000 death a year around the world and around 400 in Cuba in spite of the efforts made by the Public Health Ministry through the Screening Program. With it, the diagnosis of lesions that are predecessors of the cervical cancer could be reached. This cytological diagnosis is carried out through the Richard and Barron method, showing that there is an apparent cytological progress leading to the cancer that begins with intraepithelial neoplasia (NICI and NICIII and carcinoma in-situ) and ends in the invasive cancer. From the other hand there is the Bethesda methods answering to all the questions cytology ask for confronting it. Obviously the biggest contributions and reviews are focused in the management of the atypical cytologies with uncertain significance since they not only have a higher number of possible evaluations, but also represent the highest percent of the altered cytologies and the inclusion of the HPV in low grade lesions. The classification in Cuba is still made by the Richard method and the Bethesda one is not used. Due to the high incidence of this entity, the aim of this article is exposing considerations on the implementation of the Bethesda system in the cytological diagnosis of cervix pre-cancerous lesions.

Spectrum Of Cervical Lesions By Papaincolau (PAP) Smears, Screening In A Tertiary Care Hospital In Jammu. A 3 Year Retrosceptive Study.

Background:Cervical cancer is the second most common cancer world wide. It is preventable and curable if detected at early stages. Conventional cervical cytology using pap smears is most commonly used cervical screening method throughout the world. The aim of the study is to evaluate and interpret the cervical pap smear cytology in a tertiary care hospital . The interpretation and reporting of the cervical pap smears is based on the Bethesda system. Material and methods: This is a retrosceptive study conducted in a tertiary care hospital in Jammu over a period of 3 years. All the cervical pap smears received in the Department of Pathology, GMC Jammu, in the study period were included (expect menstruating women, pregnant women and women who had undergone hysterectomy). Results: A total of 300 cases were reported in the Cytology section of the Department of Pathology in the study period of three years. Majority of the cases were Negative for Intraepithelial lesions or malignancy(79%). Reactive cellular changes associated with inflammation were the most common finding (71.6%) followed by bacterial vaginosis(3.33%), candiasis(2%) and trichomanas(2%). Epithelial cell abnormality (6.33%) comprised of ASCUS, LSIL,HSIL& SCC. Conclusion : Pap smears is a simple and cost effective screening method to detect various preinvasive cervical lesions. It should be done routinely in all women in reproductive age group.

A Study On Utility Of Pap Smear Screening For Prevention Of Cervical Cancer In North Telangana

Background:Cancer cervix is a leading cause of mortality and morbidity among women worldwide. According to National Cancer Registry Program of India, cancers of cervix and breast are leading malignancies in Indian women. Themorbidity and mortality could be significantly reduced with an active cervical smear screening programme.Materials & Methods:The present study is a retrospective and prospective study conducted in department of Pathology. Atotal of one hundred Pap smears were examined for a period of one year. All the pap smears were examined and reported .Detailed history was taken for the required cases. Results:Out of total 100 cases inflammatory smear was the most common abnorrmality followed by normal study. Only 4 cases were diagnosed as unsatisfactory and 06 cases were diagnosed as Squamous cell carcinoma (SCC).Conclusion : Incidence of malignancy can be prevented by pap screening programmes. Pap smear helps in early detection and management of malignancies hence reducing mortality and morbidity. Pap smear studies are cost effective, doesn't need experts and specialists for collection. Therefore, till today it is the most useful screening procedure for malignant and pre-malignant conditions.

Correlación entre resultados de citología y anatomía patológica en nódulos tiroideos intervenidos quirúrgicamente / Correlation between cytology results and pathological anatomy in surgically treated thyroid nodules / Correlação entre resultados de citologia eanatomia patológica em nódulos tireoidianos tratados cirurgicamente

INTRODUCCIÓN: Los nódulos tiroideos son habituales y pueden ser detectados por ultrasonido hasta en el 60% de la población general. La punción aspiración con aguja fina (PAAF) es una herramienta imprescindible en la actualidad para evaluar nódulos tiroideos. El objetivo de este estudio es describir la correlación entre la citología de un nódulo tiroideo y la histología luego de la exéresis quirúrgica, y así evaluar el valor diagnóstico de la PAAF. MATERIAL Y MÉTODO: Estudio observacional, descriptivo y retrospectivo. Se incluyeron todos los pacientes que fueron sometidos a tiroidectomía en el período comprendido entre enero de 2014 y diciembre de 2016. Se excluyeron a los pacientes cuya intervención estuvo motivada por un mal manejo del perfil hormonal, refractario al tratamiento médico, ya que no presentaban nódulos tiroideos, y los pacientes de edad pediátrica...

INTRODUCTION: Thyroid nodules are common and can be detected by ultrasound in up to 60% of the general population. Fine-needle aspiration citology (FNAC) is currently an essential tool for evaluating thyroid nodules. The aim of this study is to describe the correlation between cytology of a thyroid nodule and histology after surgical excision, and thus to evaluate the diagnostic value of FNAC. MATERIAL AND METHOD: Observational, descriptive and retrospective study. All patients who underwent thyroidectomy in the period between January 2014 and December 2016 were included. Patients whose intervention was motivated by poor hormonal profile management, refractory to medical treatment, were excluded because they had no nodules thyroid, and pediatric patients…

INTRODUÇÃO: Os nódulos tireoidianos são comuns e podem ser detectados por ultrasom em até 60% da população em geral. A aspiração com agulha fina (FNAP) é atualmente uma ferramenta essencial para avaliar os nódulos tireoidianos. O objetivo deste estudo é descrever a correlação entre citologia de um nódulo tireoidiano e histologia após a excisão cirúrgica, e assim avaliar o valor diagnóstico de FNAB. MATERIAL E MÉTODO: Estudo observacional, descritivo e retrospectivo. Todos os pacientes que foram submetidos a tireoidectomia no período entre janeiro de 2014 e dezembro de 2016. Foram incluídos os pacientes cuja intervenção foi motivada por uma má gestão do perfil hormonal, refratária ao tratamento médico, porque não possuíam nódulos tireóide e pacientes pediátricos...

Updates in the Bethesda System for Reporting Thyroid Cytopathology, Version 2 / 中华内分泌代谢杂志

The Bethesda System for Reporting Thyroid Cytopathology ( TBSRTC ) was firstly proposed in 2007. Its first edition was published in 2009. It has been widely adopted as the standardized reporting system. Based on tremendous advancements in the field of thyroidology after the introduction, the second edition of TBSRTC was officially published in October of 2017. Herein, we list and interpret its major changes in the new edition.

Study on the relationship between thyroid imaging reporting and data system and the Bethesda system for reporting thyroid cytopathology / 中国医师进修杂志

Objective To compare effect between thyroid imaging reporting and data system (TI-RADS) and the Bethesda system for reporting thyroid cytopathology (TBSRTC) in the qualitative diagnosis of thyroid nodule. Methods The clinical data of 665 patients with thyroid nodule (1 598 nodules) from April 2013 to October 2016 were retrospectively analyzed. TBSRTC and TI-RADS were used for qualitative diagnosis of thyroid nodule before operation. Pathological diagnosis was performed after the operation. The diagnostic effect of TI-RADS and TBSRTC were assessed, and the factors leading to the diagnostic errors were analyzed. Results Of 1 598 thyroid nodules, the pathological diagnosis showed that benign nodules were in 202, and malignant thyroid nodules were in 1 396. The diagnostic sensitivity and 85.64%(173/202) vs. 74.75%(151/202) and specificity of malignant nodules by TBSRTC were significantly higher than that by TI-RADS: 91.76% (1 281/1 396) vs. 87.11% (1 216/1 396), and there was statistical difference (P＜0.01). The diagnosis positive rate of malignant nodules with diameter＜1 cm by TBSRTC was significantly higher than that by TI-RADS: 77.63% (59/76) vs. 47.37% (36/76), and there was statistical difference (P＜0.01); there was no statistical difference in diagnosis positive rate of malignant nodules with diameter ≥ 1 cm between 2 methods (P＞0.05). Univariate analysis result showed that the diameter of thyroid nodules in patients with TI-RADS false negative was significantly smaller than that in patients with benign thyroid nodules: (1.01 ± 0.48) cm vs. (1.51 ± 0.45) cm, the incidence of malignant thyroid nodules combined with other thyroid diseases was significantly higher than that in patients with benign thyroid nodules: 41.18% (21/51) vs. 11.32% (158/1 396), and there were statistical differences (P＜0.05); the rate of thyroid dysfunction in patients with TBSRTC false positive was significantly higher than that in patients with malignant thyroid nodules: 18.26% (21/115) vs. 6.93% (14/202), and there was statistical difference (P＜0.05). Conclusions The qualitative diagnosis of thyroid nodule requires the cross-reference of TI-RADS and TBSRTC, and the combination of other clinical indicators of patients can improve the detection rate of malignant thyroid nodules.

Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features and Its Impact on the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience

BACKGROUND: This study was performed to analyze cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and its impact on the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). METHODS: Five thousand five hundred and forty-nine cases of thyroid fine-needle aspiration cytology (FNAC) diagnosed between 2012 and 2014 were included in this study. Diagnostic categories based on TBSRTC were compared with final surgical diagnoses, and the ROM in each category was calculated both when NIFTP was included in malignant lesions and when excluded from malignant lesions. RESULTS: Of the 5,549 thyroid FNAC cases, 1,891 cases underwent surgical resection. In final diagnosis, 1,700 cases were revealed as papillary thyroid carcinoma (PTC), and 25 cases were reclassified as NIFTP. The cytologic diagnoses of NIFTP were non-diagnostic in one, benign in five, atypia of undetermined significance (AUS) in 14, follicular neoplasm in two, and suspicious for malignancy in three cases. Collectively, NIFTP/encapsulated follicular variant of PTC (EFVPTC) were more frequently classified as benign, AUS, or follicular neoplasm and less frequently categorized as malignant compared to conventional PTCs. Exclusion of NIFTP from malignant diagnoses resulted in a slight decrease in malignancy rates in non-diagnostic, benign, AUS, follicular neoplasm, and suspicious for malignancy categories without any statistical significance. CONCLUSIONS: The decrease in the ROM was not significant when NIFTP was excluded from malignant lesions. In thyroid FNACs, NIFTP/EFVPTCs were mostly classified into indeterminate categories. Therefore, it might be feasible to separate NIFTP/EFVPTC from conventional PTC on FNAC to guide clinicians to conservative management for patients with NIFTP/EFVPTC.

Actualización en el reporte de citología cervicovaginal basado en el Sistema Bethesda 2014

El cáncer cervical representa la segunda causa de mortalidad en la mujer venezolana. La pesquisa de esta neoplasia fue mejorada significativamente desde que Papanicolaou introdujera la citología como prueba para seleccionar pacientes de alto riesgo. La citología es una pieza fundamental en el diagnóstico del cáncer cervical y sus lesiones precursoras, aparte de su indiscutible valor en la orientación etiológica de infecciones e inflamaciones, y en casos muy puntuales realiza una valoración hormonal indirecta. A través de los años se han utilizado diferentes reportes citológicos, desde Papanicoloau hasta el Sistema Bethesda, siendo este último el más aceptado y utilizado a nivel mundial. Desde su creación en 1988, el mismo ha sido objeto de modificaciones, siendo la última actualización en 2014, con miras a facilitar la comunicación entre los citólogos y el clínico, mejorar la correlación cito-histológica y ofrecer al clínico una terminología adecuada para el tratamiento y pronóstico de la patología cervical.

Cervical cancer is the second leading cause of mortality in women in reproductive age in Venezuela. The research of this neoplasia was improved significantly since introduced PAP cytology as a test to select patient at high risk. Cytology is a fundamental part in the diagnosis of cervical cancer and its precursor lesions, apart from their undeniable value in etiologic orientation of infections and inflammations, and very specific cases made a hormonal assessment in an indirect way. Over the years, different ways to perform cytology report, from Papanicoloau to the Bethesda system, this last being the most have been accepted and used worldwide. Since its creation in 1988, it has undergone modifications, the last update in 2014, with a view to facilitating communication between cytologists and the clinician, improving the cyto-histological correlation and providing the clinician with adequate terminology for treatment and prognosis of cervical pathology.