Dr. Gulhane Sushma R, Dr.Ghanghurde Swati B., Dr. Kate Madhuri S., Dr. Akhtar Javed M


Thyroid nodules are commonly encountered in clinical practice. Fine needle aspiration (FNA) of these nodules is   widely accepted, cost-effective and simple method for diagnosis. This study aims at determining the distribution of diagnostic categories according to The Bethesda system for reporting thyroid cytopathology (TBSRTC), to analyze cytological features and correlate them with histopathology.

We report retrospective and prospective analysis of 869 FNA of thyroid nodules using the Bethesda system. FNA were performed in prospective cases (554), whereas in retrospective cases (315) all smears were reviewed. All cases were categorized into six Bethesda categories. The sensitivity, specificity, positive predictive value, negative predictive value was calculated.

The distribution of 869 evaluated thyroid nodules was as follows: 3.68% Nondiagnostic / unsatisfactory, 86.77% benign, 1.73% atypia of undetermined significance, 3.2% follicular neoplasm, 2.53% suspicious for malignancy and 2.07% malignant. In 141 cases, histopathological correlation was available and of these cytohistological concordance was found in 94% cases. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 76%, 96%, 84%, 95% and 93% respectively. The risk of malignancy in categories II, III, IV, V and VI was 1.8%, 25%, 29%, 70%, & 100% respectively. Use of TBSRTC in well-defined and consistent manner especially in grey zone areas of thyroid cytopathology, allow appropriate evaluation of thyroid lesions cytologically.


Thyroid cytopathology, TBSRTC, Sensitivity, Specificity

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Sukumaran R, Kattoor J, Pillai KR, Ramadas PT, Nayak N, Somanathan T, George NA& Sebastian P. Fine Needle Aspiration Cytology of Thyroid Lesions and its Correlation with Histopathology in a Series of 248 Patients. Indian J Surg Oncol 2014; 5(3):237–241.

Choudhary PK, Nepal N, Mainali N, Meenakshi B. Implementation of Bethesda system in thyroid aspirate: A cyto-histopathological correlation study. Journal of Pathology of Nepal 2016;6: 902-905.

Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658-65. [PubMed: 19846805]

Sinna EA, Ezzat N. Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions. J Egypt Natl Cancer Inst 2012;24:63-70.

De Palma M, Rosato L, Zingone F et al. Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy. Am J Surg. 2016;212:116-21.

Mehra P and Verma AK. Thyroid Cytopathology Reporting by the Bethesda System: A Two-Year Prospective Study in an Academic Institution. Pathology Research International. 2015; Article ID 240505, 11 pages.

Khadatkar AS, Dhume VM, Kavishwar V. Cytopathological evaluation of various thyroid lesions based on Bethesda system for reporting thyroid lesions. Int J Res Med Sci. 2017;5(4):1339-1343.

Bhartiya R, Mallik M, Nawanita K and Prasad BN. Evaluation of thyroid lesions by fine-needle aspiration cytology based on Bethesda system for reporting thyroid cytopathology classification among the population of South Bihar. Indian J Med Paediatr Oncol. 2016;37(4):265-270.

Ali SZ. Thyroid cytopathology: Bethesda and beyond. Acta Cytol. 2011;55:4-12.

Garg S, Desai NJ, Mehata D, Vaishnav M. To establish Bethesda system for diagnosis of thyroid nodules on the basis of FNAC with histopathological correlation. Journal of clinical and diagnostic research. 2105;9(12):17-21.

Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2010;134:450-56.

Nayar R, Ivanovic M. The indeterminate thyroid FNA: Experience from an academic center using terminology similar to that proposed in the 2007 NCI Thyroid Fine Needle Aspiration State of the Science Conference. Cancer Cytopathol.2009;117:195-202.


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