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The bethesda system for reporting thyroid cytopathology- experience at b. J. Medical College, Ahmedabad

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Author: 
Dr. Hiren Mundiya and Nishith Thakor
Abstract: 

Background: FNAC is a crucial primary screening investigation for thyroid lesions nowadays. It is critical that the cyto-pathologist communicate thyroid FNA interpretations to the referring physician in terms that are succinct, unambiguous, and helpful clinically. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) functions as a link between pathologist and physician/surgeon to understand the reporting and helpful to avoid any misunderstanding. It also provides diagnostic categories according to which treatment of the patient will be undertaken to avoid unnecessary surgery in certain lesions.
Aims and Objectives: To assess the efficacy of Thyroid cytology on the basis of The Bethesda System for Reporting Thyroid Cytology (TBSRTC), to know the implied risk of malignancy in a particular category and a rational clinical management guideline on the basis of Tbsrtc. Materials and Methods: In this prospective study, 105 FNAs were carried out on patients with thyroid swelling at Pathology Department, Ahmedabad over period of 6 months and reported using TBSRTC guidelines. All the results were noted and compared with the other international studies. RESULTS: In the present study, patient presented with the thyroid swelling. The mean age of presentation was 34 years (10-82) and the Male to Female ratio was 1:9. The commonest cytological diagnosis was Category II-benign follicular lesion of thyroid followed by the malignant thyroid lesions (papillary carcinoma being the commonest one). In DC V and DC VI, all cases were of papillary carcinomas which were confirmed on histo-pathological follow up. Measures of a diagnostic accuracy of FNAC thyroid includes sensitivity and specificity which are 85% and 100% respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 92.8% respectively.
Conclusion: As evidenced by its high sensitivity and high NPV, TBSRTC has proven to be an effective and robust thyroid FNA classification scheme to guide the clinical management of patients with thyroid nodules. TBSTRC reduces inter-observer variability and provides good communication between the surgeon and pathologist. It implicates guidelines for cancer risk and clinical management to the surgeons avoiding unnecessary surgery.

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