The Cytomorphological Appraisal of Fine- Needle Aspiration of Thyroid Gland Lesions utilizing The Bethesda System for Reporting Thyroid Cytopathology

Abstract

Background:  Thyroid nodules are most commonly encountered endocrine abnormalities and Fine Needle Aspiration Cytology (FNAC) has emerged as the first-line diagnostic modality in the evaluation. To avoid confusion and to standardize the reporting system National Cancer Institute (NCI) proposed The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). TBSRTC helps in better understanding of the borderline cases where decision of surgical intervention over medical management is crucial.

Aim: To evaluate the distribution of thyroid lesions according to The Bethesda System for Reporting Thyroid Cytopathology.  To correlate the cytomorphological spectrum of thyroid lesions with histopathological findings.

Material and Methods:  This retrospective study included 96 cases presented in cytology section with thyroid nodule were subjected to FNAC using 22-gauge needle under all aseptic precautions. Detailed clinical history was taken. FNAC smears were reported using TBSRTC. The histopathology correlation was available for 35cases. The cytological diagnosis was compared with histopathological diagnosis and diagnostic performance was assessed.

Result: In present study, female preponderance is noted with female-to-male ratio of 3:1. The most common age group was 3^rd decade followed by 4^th decade.  The most common category according to TBSRTC was Cat II Benign (76.2%) followed by Cat VI malignant (6.1%) followed by Cat V (5.4%), I (4.8%), IV, (4.7%) III (2.8) respectively. Cytomorphological and histopathological correlation was seen in 33 cases of total 35 cases. While the 02 cases were cytomorphological features are not correlating with histopathology findings were included in discordant cases. We have reported Sensitivity: 92.31%, Specificity:95.45%, PPV:92.31%, NPV:95.45%, Diagnostic accuracy of the test:94.29%.

Conclusion: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is simple, has clear diagnostic criteria hence provides uniformity of reporting by cytopathologist and increases the understanding and uniformity in assessment by the treating clinician which help in improving the communication between cytopathologist and treating clinician which in turns help in better and appropriate treatment of patient.

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