1
|
Upadhyaya P, Dhakal S, Adhikari P, Adhikari B, Khadka D, Niraula SR. Histopathological Review of Diagnostic Categories of the Bethesda System for Reporting Thyroid Cytopathology - An Institutional Experience of 5 Years. J Cytol 2019; 36:48-52. [PMID: 30745740 PMCID: PMC6343391 DOI: 10.4103/joc.joc_64_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Context: Fine needle aspiration (FNA) plays a crucial role in the evaluation of patients with thyroid lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was designed with a mission to standardize the process of diagnosis and management of thyroid lesions by FNA cytology (FNAC). Aim: We aim to see the benefits of adopting TBSRTC, seek the cytological pitfalls in the diagnosis of thyroid FNAC, and identify the spectrum of thyroid lesions in our setup. Settings and Design: This is a hospital-based cross-sectional study conducted from June 2009 to June 2014 of all thyroid FNACs with available histopathology reports. Cases were designated a specific diagnostic category according to TBSRTC. Materials and Methods: A total of 109 cases were included in the study. Sixty-eight cases had been reported without using TBSRTC and were reviewed and reclassified according to TBSRTC seeking the common reasons for interpretative errors. Statistical Analysis Used: Data were analyzed using SPSS ver. 11.5. Results: In both pre- and post-TBSRTC era, benign neoplasms 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, decline in the suspicious category, and an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases except the nondiagnostic or unsatisfactory category. Conclusion: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.
Collapse
Affiliation(s)
- Paricha Upadhyaya
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Sushil Dhakal
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Purbesh Adhikari
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Bindu Adhikari
- Department of Pathology, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| | - Dibika Khadka
- Department of Pathology, Province Hospital, Karnali Province, Nepal
| | - Surya R Niraula
- Department of Community Medicine, BP Koirala Institute of Health Sciences, Karnali Province, Nepal
| |
Collapse
|
2
|
Paajanen I, Metso S, Jaatinen P, Kholová I. Thyroid FNA diagnostics in a real-life setting: Experiences of the implementation of the Bethesda system in Finland. Cytopathology 2017; 29:189-195. [DOI: 10.1111/cyt.12513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 12/30/2022]
Affiliation(s)
- I. Paajanen
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - S. Metso
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - P. Jaatinen
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
- Division of Internal Medicine; Seinäjoki Central Hospital; Seinäjoki Finland
| | - I. Kholová
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Pathology; Fimlab Laboratories; Tampere Finland
| |
Collapse
|
3
|
Ozdemir D, Bestepe N, Faki S, Kilicarslan A, Parlak O, Ersoy R, Cakir B. Comparison of thyroid fine needle aspiration biopsy results before and after implementation of Bethesda classification. Cytopathology 2017; 28:400-406. [DOI: 10.1111/cyt.12437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 01/21/2023]
Affiliation(s)
- D. Ozdemir
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - N. Bestepe
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - S. Faki
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - A. Kilicarslan
- Department of Pathology; Ataturk Education and Research Hospital; Ankara Turkey
| | - O. Parlak
- Department of General Surgery; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - R. Ersoy
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| | - B. Cakir
- Department of Endocrinology and Metabolism; School of Medicine; Ankara Yildirim Beyazit University; Ankara Turkey
| |
Collapse
|
4
|
Najafian A, Kahan S, Zeiger MA, Olson MT. Unusual findings in thyroid cytology and histology. Diagn Cytopathol 2017; 45:185-190. [PMID: 28160441 DOI: 10.1002/dc.23655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/24/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Although cytology and histopathology of thyroid lesions generally fall into common, well-defined categories, there are uncommon cases with unusual fine needle aspiration (FNA) findings or histology. Herein, we review the prevalence and characteristics of rare thyroid cytology and histopathology findings at a tertiary hospital. METHODS Institutional data from >31,000 patients with a thyroid pathology from 1995 to 2013 were queried. Both cytology and histology were available in 6,693 patients. After exclusion of the common cytological categories detailed by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and common histopathology categories, 90 patients with either an unusual FNA, histopathology, or both were identified. RESULTS A total of 90 cases were included (19: only unusual FNA; 25: only unusual histology; 46: both unusual cytology and histopathology). The positive predictive value of an unusual FNA for discovering an unusual lesion was 71% (95% CI: 58%-81%). The majority (66%) were females and median age was 59 years. On histopathology, 80 (88%) cases were malignant, 72 (90%) of which were initially diagnosed as malignant on FNA. Of the 10 benign lesions, 8 (80%) also had a benign FNA. Patients with unusual malignant lesions were significantly older than those with unusual benign lesions (62 vs. 44 years; P: 0.004). CONCLUSION Unusual cytopathological and histopathological findings in thyroid comprise a varied group of tumors that are individually rare but collectively common. A preoperative FNA with an unusual cytopathology is likely to lead to an unusual histopathological diagnosis; however, its diagnostic accuracy in differentiating benign from malignant is lower than the accuracy of cytopathology of conventional TBSRTC. Diagn. Cytopathol. 2017;45:185-190. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Alireza Najafian
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Stacie Kahan
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Martha A Zeiger
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Matthew T Olson
- Division of Cytopathology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| |
Collapse
|
5
|
Abstract
The detection of thyroid nodules, consisting of different diseases, represents a common finding in population. Their evaluation and diagnosis are mostly achieved with fine-needle aspiration cytology (FNAC). Even though the majority of thyroid nodules are correctly diagnosed, a total of 25% to 30% of them are classified "indeterminate" comprising lesions with varying risk of malignancy and different types of management. Although the number of thyroid FNACs, including small lesions, is increasing due to the reliance upon sonographic and cytologic interpretations, there are issues concerning cytomorphologic interpretation and interobserver reproducibility. Different classification systems have tried to better define the criteria for inclusion in specific categories and to therefore reduce the rate of indeterminate diagnoses such as atypia of undetermined significance, follicular neoplasms, and suspicious for malignancy. However, the support of ancillary techniques (eg, immunocytochemistry and molecular analysis) are reshaping morphologic diagnoses made on materials obtained from FNAC.
Collapse
|
6
|
Abu-Ghanem S, Cohen O, Raz Yarkoni T, Fliss DM, Yehuda M. Intraoperative Frozen Section in “Suspicious for Papillary Thyroid Carcinoma” after Adoption of the Bethesda System. Otolaryngol Head Neck Surg 2016; 155:779-786. [DOI: 10.1177/0194599816653114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 01/21/2023]
Abstract
Objective To evaluate the accuracy and utility of intraoperative frozen section examination (iFSE) in patients with a preoperative fine-needle aspiration (FNA) cytology of “suspicious for malignancy” (SFM)–Bethesda V, after the adoption of the Bethesda System for Reporting Thyroid Cytopathology. Study Design Case series with chart review. Setting Tertiary medical center. Subjects and Methods All patients with SFM–Bethesda V who underwent thyroid surgery with iFSE between 2010 and 2015 were included. In cases where the iFSE was reported to be malignant, a total thyroidectomy was performed; otherwise, thyroid lobectomy (hemithyroidectomy) was performed. Results The current series included 47 patients diagnosed preoperatively with FNA cytology of SFM–Bethesda V. The malignancy rate was 74.5% (35 of 47). Twenty-four patients with nonmalignant iFSE results underwent lobectomy during their initial surgery: 12 were subsequently found with benign final histology and did not undergo completion thyroidectomy; the other 12 patients had malignant results on final histology, but only 4 of them underwent completion thyroidectomy. iFSE resulted in a sensitivity and specificity of 65.7% and 100%, respectively, with a positive predictive value of 100% (23 of 23) and a negative predictive value of 50% (12 of 24). Accuracy of the iFSE methodology was 74.5% (35 of 47). Conclusions With no significant preoperative clinical or sonographic predictors for thyroid malignancy and given the high specificity of iFSE, our results support the use of iFSE for patients with preoperative FNA cytology of SFM–Bethesda V who are undergoing thyroid surgery, to determine the extent of required surgery.
Collapse
Affiliation(s)
- Sara Abu-Ghanem
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - Tom Raz Yarkoni
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University, Rehovot, Israel
| | - Dan M. Fliss
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Yehuda
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
7
|
Fazeli R, VandenBussche CJ, Bishop JA, Ali SZ. Cytological Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma before and after the Bethesda System for Reporting Thyroid Cytopathology. Acta Cytol 2016; 60:14-8. [PMID: 27007511 DOI: 10.1159/000444669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary carcinoma after the classical variant. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been introduced to standardize the practice of thyroid fine needle aspiration (FNA) reporting. We evaluated the impact of TBSRTC on the FNA interpretation of histologically proven FVPTCs. METHOD Cytology reports of 455 histologically proven FVPTCs were reviewed. The rate of each TBSRTC category was compared between pre- and post-TBSRTC eras. RESULTS The distribution of FNA diagnoses for pre-TBSRTC cases included suspicious for follicular neoplasm (SFN; n = 51, 28.7%), papillary thyroid carcinoma (PTC; n = 47, 26.4%), suspicious for malignancy (SFM; n = 32, 18%), atypia of undetermined significance (AUS; n = 23, 13%), benign (n = 18, 10.1%), and nondiagnostic (ND; n = 7, 4%). Post-TBSRTC diagnoses were: AUS (n = 68, 24.6%), PTC (n = 64, 23.1%), SFM (n = 50, 18%), SFN and benign (n = 42, 15.2%) and ND (n = 11, 4%). SFN rate decreased significantly from 28.7 to 15.2% (p = 0.001) and AUS increased from 12.9 to 24.5% (p = 0.003). CONCLUSION Following implementation of TBSRTC, the frequency of AUS diagnoses on FNA prior to surgical resection increased. Given that the rate of FVPTC diagnoses on thyroidectomy increased over the same period, this suggests that the use of AUS has resulted in greater surgical resection of FVPTC.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adult
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Cytodiagnosis/methods
- Cytodiagnosis/standards
- Cytodiagnosis/statistics & numerical data
- Diagnosis, Differential
- Female
- Humans
- Male
- Middle Aged
- Practice Guidelines as Topic/standards
- Reproducibility of Results
- Sensitivity and Specificity
- Thyroid Gland/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
Collapse
Affiliation(s)
- Roghayeh Fazeli
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Md., USA
| | | | | | | |
Collapse
|
8
|
Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, Fadda G. A meta-analytic review of the Bethesda System for Reporting Thyroid Cytopathology: Has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol 2015; 123:713-22. [DOI: 10.1002/cncy.21605] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Chiara Brunelli
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Federica Cianfrini
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Domenico Damiani
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University; Rome Italy
| |
Collapse
|
9
|
Fazeli R, Schneider EB, Ali SZ, Zeiger MA, Olson MT. Diagnostic Frequency Ratios Are Insufficient to Measure Laboratory Precision with The Bethesda System for Reporting Thyroid Cytopathology. Acta Cytol 2015; 59:225-32. [PMID: 26022342 DOI: 10.1159/000379738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Diagnostic frequency ratios such as the atypia of undetermined significance (AUS):malignant ratio are touted to be useful for laboratory precision benchmarking. We therefore sought to examine their reproducibility and usefulness at a tertiary hospital. METHODS We reviewed thyroid fine-needle aspirates (FNA) submitted to our institution from outside laboratories and evaluated the ability of diagnostic frequency ratios to capture the complexity of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Specifically, we evaluated the ability of the AUS:malignant ratio to describe the frequencies of the other TBSRTC diagnoses. RESULTS A total of 2,784 cases from 19 laboratories were included. The use of the AUS category varied the most. There was insufficient reflection of the non-AUS nonmalignant TBSRTC diagnostic frequencies in our analysis, and these results do not appear to arise from observer variability in the outside laboratories. CONCLUSION Diagnostic frequency ratios are not reproducible in our experience and fail to describe the other TBSRTC categories. As such, they are unlikely to prove sufficient for benchmarking laboratory precision with TBSRTC.
Collapse
Affiliation(s)
- Roghayeh Fazeli
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., USA
| | | | | | | | | |
Collapse
|
10
|
Nagarajan N, Schneider EB, Ali SZ, Zeiger MA, Olson MT. How do liquid-based preparations of thyroid fine-needle aspiration compare with conventional smears? An analysis of 5475 specimens. Thyroid 2015; 25:308-13. [PMID: 25420135 DOI: 10.1089/thy.2014.0394] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) plays a pivotal role in the initial evaluation of patients with thyroid nodules. Traditionally, aspirated material is expelled directly onto the microscope slide to make a conventional smear (CS). Recently, liquid-based preparations (LBP) have gained in popularity. This study compares the accuracy of these two preparation techniques in diagnosing thyroid nodules. METHODS A clinical database containing 5475 thyroid cytology consults from 2009 to 2013 was queried to identify 5169 CS and 306 LBP cases. Cytological diagnostic frequency rendered before and after second review were compared between LBP and CS. Correlation with the histology diagnosis was also calculated for each preparatory technique. RESULTS Age, sex, and nodule size were comparable between patients who had FNA processed by LBP and CS. More LBP cases than CS cases were inadequate (17% vs. 10%; p<0.001). LBP cases had fewer benign diagnoses (39% vs. 47%; p=0.003) and tended to have more malignant diagnoses (16% vs. 12%; p=0.09) when compared to CS. Indeterminate and suspicious categories were comparable between LBP and CS. Correlation with histology was also comparable between both techniques. CONCLUSION LBP was associated with a significantly higher proportion of inadequate and a lower proportion of benign diagnoses. Thus, universal adoption of LBP may introduce more inadequate samples. Future investigations should explore the lack of on-site evaluation with LBP as a potential source for the high inadequate rate.
Collapse
Affiliation(s)
- Neeraja Nagarajan
- 1 Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland
| | | | | | | | | |
Collapse
|
11
|
Kapila K, Qadan L, Ali RH, Jaragh M, George SS, Haji BE. The Bethesda System for Reporting Thyroid Fine-Needle Aspiration Cytology: A Kuwaiti Experience - A Cytohistopathological Study of 374 Cases. Acta Cytol 2015; 59:133-8. [PMID: 25676743 DOI: 10.1159/000371538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 12/15/2014] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) identifies 6 diagnostic categories in which the risk of malignancy increases respectively. The aim of our study was to assess TBSRTC reporting in our hospital and to evaluate its specificity based on cytohistological correlation. METHODS A histological diagnosis was available in 374 (110 males and 264 females) out of 7,809 thyroid aspirates examined at Mubarak Al-Kabeer Hospital, Kuwait, from 2004 to 2012. The aspirates were classified in accordance with TBSRTC. RESULTS Thyroid aspirates were classified as nondiagnostic (n = 18; 4.8%), benign (n = 114; 30.5%); atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; n = 59; 15.8%), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; n = 17; 4.5%), suspicious for malignancy (SM; n = 80; 21.4%), or malignant (n = 86; 23.0%). In 75 of 86 malignant cases, a papillary carcinoma was detected. There were 3 (1.6%) false-positive aspirates and the sensitivity, specificity, negative predictive value, and positive predictive value were 91.0, 61.9, 84.2, and 75.3%, respectively. CONCLUSIONS Our results are fairly comparable to those of various previous studies in the SM, AUS/FLUS, and SFN categories. The higher rates observed in the nondiagnostic and benign categories were possibly due to limited guided aspirations and a lack of on-site evaluation for all cases.
Collapse
Affiliation(s)
- Kusum Kapila
- Cytology Laboratory, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | | | | | | | | | | |
Collapse
|
12
|
Mathur A, Najafian A, Schneider EB, Zeiger MA, Olson MT. Malignancy risk and reproducibility associated with atypia of undetermined significance on thyroid cytology. Surgery 2014; 156:1471-6; discussion1476. [DOI: 10.1016/j.surg.2014.08.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/11/2014] [Indexed: 12/30/2022]
|
13
|
Kholová I, Ludvíková M. Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable Bethesda 2010 diagnostic category or waste garbage? Acta Cytol 2014; 58:319-29. [PMID: 25195864 DOI: 10.1159/000366498] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/07/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was introduced in thyroid cytology in 2007 and is now generally accepted. BSRTC categories include a morphologic description and risk of malignancy as well as follow-up suggestions in each group. However, the category entitled 'atypia of undetermined significance or follicular lesion of undetermined significance' (AUS/FLUS) is problematic. This category is heterogeneous and has been overused so far. STUDY DESIGN Twenty-six studies were included in a meta-analysis. In addition to AUS/FLUS percentage, we analysed repeated AUS/FLUS percentage, cytological and histological correlations, and risk of malignancy and neoplasm for AUS/FLUS. Furthermore, stratification, inter- and intra-observer variability, and the possibility of a switch to another category and its clinical consequences were reviewed. RESULTS Out of a total of 81,833 cases, AUS/FLUS accounted for 10.9%, with a 34% risk of malignancy. Persistent AUS/FLUS was found in 21.6% in repeated cytology. Cytohistological correlation was analysed from 16 studies (4,964 cases), revealing 10.4% as AUS/FLUS and a 21.5% risk of malignancy. CONCLUSIONS An AUS/FLUS category seems to be currently reasonable with clearly defined cytomorphological criteria which do not correspond unequivocally with those of the other categories. An AUS/FLUS category is justified and possible means of its improvement with immunohistochemistry, molecular analysis and imaging are discussed.
Collapse
Affiliation(s)
- Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | | |
Collapse
|
14
|
Olson MT, Novak A, Boonyaarunnate T, Trotter J, Sachs S, Kelly D, Ford S, Cornish TC, Toll A, Tatsas AD, Maleki Z, Erozan YS, Rosenthal DL. Reproducibility of the Johns Hopkins Hospital template for urologic cytology samples. J Am Soc Cytopathol 2014; 3:156-164. [PMID: 31051740 DOI: 10.1016/j.jasc.2014.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Cytologic screening for urothelial carcinoma is fraught with low sensitivity, a high indeterminate rate, and until recently, poor standardization of terminology. The Johns Hopkins Hospital John K. Frost Cytopathology Laboratory has recently developed and published a template for reporting urine cytopathology; herein, we evaluate its interobserver reproducibility. MATERIALS AND METHODS Two sets of 100 cases each were deidentified; each set was reviewed by 5 of 10 observers in a randomized order at the direction of computerized data collection software that tracked observation time as well as observer classification of the atypia-no atypia, atypia (AUC-US), or atypia suggestive of high-grade urothelial carcinoma (AUC-H). Specific morphologic features were also recorded. Cases were grouped into low-, intermediate-, and high-agreement based on the number of observers who made the assessment. The findings were correlated against clinical outcomes. RESULTS High agreement among observers about the presence or absence of high-grade features was possible in approximately two-thirds of indeterminate urine cases. Time and order did not factor significantly into observer propensity for identifying atypical features or favoring either AUC-US or AUC-H, and cases with high agreement about the presence of high-grade features were more likely to have a malignant follow-up. Furthermore, AUC-H diagnoses based on 2 or more high-grade features had a significantly higher malignancy risk than AUC-US diagnoses did. CONCLUSIONS AUC-H is a valid diagnostic category with specific, reproducibly identified features that portend a higher risk of malignancy than the findings of AUC-US.
Collapse
Affiliation(s)
- Matthew T Olson
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Anna Novak
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Thiraphon Boonyaarunnate
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland; Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jessi Trotter
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Sharon Sachs
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Deidra Kelly
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Sterling Ford
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Toby C Cornish
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Adam Toll
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Armanda D Tatsas
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Yener S Erozan
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Dorothy L Rosenthal
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland; Department of Obstetrics and Gynecology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|