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.

The Bethesda system for reporting thyroid cytology: a prospective study in a tertiary care institute along with review of literature

Background: The Bethesda system for reporting thyroid cytology (TSBRTC) was devised by the National Cancer Institute (NCI) to obtain uniformity, reproducibility and a defined management protocol while dealing with thyroid lesions. This study was undertaken with the aim to see the benefits of adopting TBSRTC in the diagnosis of thyroid FNAC, and identify the malignancy risk of each category.Methods: This cross-sectional study was conducted in Indira Gandhi Medical College, Shimla, Himachal Pradesh from June 2016 to July 2017 on 181 thyroid FNACs which were reported according to the Bethesda system for reporting thyroid cytopathology (TBSRTC) under six categories: (I) non-diagnostic/unsatisfactory (II) benign (III) atypia of undetermined significance/follicular lesion of undetermined significance (IV) follicular neoplasm/suspicious for follicular neoplasm (specify if Hurthle cell (oncocytic) type (V) suspicious for malignancy (VI) malignant. Histopathological diagnosis was available for 65 cases where thyroidectomy was performed. Malignancy risk was calculated for each category. Sensitivity, specificity, positive and negative predictive values for TBSRCT were also calculated. All the data was analyzed in SPSS software version 22.0 (IBM, USA).Results: Benign lesions constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases.Conclusions: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.

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.

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

Thyroid Fine-Needle Aspiration Practice in the Philippines

Fine-needle aspiration (FNA) is a well accepted initial approach in the management of thyroid lesions. It has come a long way since its introduction for nearly a century ago. In the Philippines, FNA of the thyroid was first introduced 30 years ago and has been utilized until now as a mainstay in the diagnosis of thyroid malignancy. The procedure is performed by pathologists, endocrinologists, surgeons, and radiologists. Most pathologists report the cytodiagnosis using a combination of the aspiration biopsy cytology method that closely resembles the histopathologic diagnosis of thyroid disorders and the six-tier nomenclature of The Bethesda System for Reporting Thyroid Cytopathology. Local endocrinologists and surgeons follow the guidelines of the 2015 American Thyroid Association in the management of thyroid disorders. There is still a paucity of local research studies but available data deal with cytohistologic correlations, sensitivity, specificity, and accuracy rates as well as usefulness of ultrasound-guided FNA. Cytohistologic correlations have a wide range of sensitivity from 30.7% to 73% and specificity from 83% to 100%. The low sensitivity can be attributed to poor tissue sampling since a majority of the thyroid FNA is done by palpation only. The reliability can be improved if FNA is guided by ultrasound as attested in both international and local studies. Overall, FNA of the thyroid has enabled the diagnosis of thyroid disorders with an accuracy of 72.8% to 87.2% and it correlates well with histopathology.

Current Status of Thyroid Fine-Needle Aspiration Practice in Thailand

Thyroid carcinoma is one of the leading malignancies in Thailand increasingly prevalent in the female population. Fine-needle aspiration (FNA) cytology is a widely used diagnostic tool for evaluation of thyroid nodules and thyroid cancer. Thyroid FNA is a routine procedure universally performed in Thai hospitals by a variety of clinical specialists. Manual guidance is the first-line choice complemented by ultrasound assistance in selected cases. Despite national guidelines recommendations, the diagnostic criteria and terminology of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was slowly adopted in the local settings. Currently, the Bethesda system is actively promoted by the local professional societies as a uniform reporting system. Experience with thyroid FNA has been rarely reported to date—only a handful of publications are available in local journals. Our review, in addition to presenting various aspects of thyroid FNA in Thailand, established for the first time national references for a certain statistical outputs of TBSRTC based on the original multi-institutional cohort. The risk of malignancy in 2,017 operated thyroid nodules collected from three tertiary thyroid cancer centers was 21.7%, 14.7%, 35.9%, 44.4%, 76.7%, and 92.6% for categories I to VI, respectively. The malignancy risk in several diagnostic categories (II to IV) was higher than the risk estimated by TBSRTC and recent meta-analysis studies. We endorse the use of uniform terminology of the Bethesda system in Thailand, which will help facilitate communication among diverse medical professionals involved in the management of patients with thyroid nodules, to share local experience with the international audience.

Bethesda System Of Reporting Thyroid Cytopathology – A Study Of 100 Cases.

Background & Objective: Thyroid nodules are common clinical occurrence . More than 50% of the world ‘s population harbours at least 1 thyroid nodule and the frequency of nodular thyroid diseases increases with age . It is therefore no surprise that thyroid fine needle aspiration cytology (FNAC) is one of the most commonly practiced areas in non gynaecologic cytopathology. Objective is to study cytopathology of various Thyroid lesions to Differentiate and classify them according to the Bethesda System. To determine accuracy of the Bethesda classification system for reporting. Methodology: This study was conducted in department of pathology BRIMS Bidar , around 100 thyroid FNAC reported cases retrospectively. Hand E , Geimsa and Pap stains were used. All smears were screened and cytomorphological features were ascertained the diagnostic categories according to Bethesda System for reporting thyroid cytopathology . In our study the age group were from 15 to 80 yrs and female prepondence was reported . Non diagnostic (N D)confined 5 cases, Benign category were diagnosed in 75 cases, Atypia of Undetermined Significance ( AUS) was diagnosed in 3 cases, Suspicious for Follicular Neoplasm (SFN) in 4 cases , Suspicious for malignancy ( SFM )in 4 cases and Malignant 9 cases. Results & Conclusion: A definite morphological diagnosis can be made on FNAC which annuls the need of diagnostic biopsies . Surgery can be avoided in benign lesions diagnosed on FNAC. TBSRTC has an excellent diagnostic specificity and accuracy in evaluation of thyroid nodules.

Evaluation of thyroid lesions by FNAC among youth and children: A hospital based observational study.

Introduction: Thyroid lesions are rare in children and youth. compared to adult, they show high mlignancy rate. peak incedence is between 20 to 24 years of age. Objectives: To evaluate the utility of Fine Needle Aspiration Cytology (FNAC) of thyroid lesions in children and youth by “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)" . Materials and Methods: A prospective study was conducted over a period of 18 months. FNAC was performed on 106 children and youth of 1 year to 24 years age and classified according to TBSRTC.Results: Median age was 18.9 years. Majority (57.5%) were females in 20 years to 24 years age group. Out of 106 patients, 4.7%, 85.8%, 4.7%, 1.9%, 0.9% and 2% were distributed among diagnostic categories I, II, III, IV, V and VI of TBSRTC respectively. Six (5.6%) patients underwent. surgery and histopathological study was done. The sensitivity, specificity and accuracy rates were 100%, 97.8% and 98% respectively. Conclusion: TBSRTC for FNAC of thyroid is a definitive diagnostic test to triage patients on the requirement of surgery and to differentiate maligant from non-malignant lesions in children and youth.