Impact of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on Revised Bethesda System Malignancy Rates at a Single Institution.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). METHODS: This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. RESULTS: Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. CONCLUSIONS: A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC.

Evolution of the Academic Health Department through public health academic and practice collaborations.

In 1997, the Office of Public Health Practice was chartered at Northeast Ohio Medical University (NEOMED). Through this office, public health practitioners and academics have engaged in informal collaborations, formal collaborations, and formal agreements. Projects that have helped public health practitioners included a sanitarian preparation course, educational opportunities, and shared faculty arrangements. The academic programs have benefited through support in accreditation activities, teaching and precepting of public health and medical students, and advice on community-oriented curriculum. Formal affiliation agreements have been developed between the medical school and 5 local health departments, and public health practitioners have been given faculty appointments. Factors that have resulted in the longevity of Academic Health Department relationships through the Office of Public Health Practice include individuals dedicated to these relationships, agencies willing to support collaborative efforts, mutually beneficial activities, and a culture conducive to continued engagement.