Critical Appraisal of the 2017 Bethesda System for Reporting Thyroid Cytopathology with Cytohistological Concordance and Estimation of Risk of Malignancy - An Institutional Study

Sayika Hameed; Sabina Khan; Mohd Jaseem Hassan; Musharraf Husain; Arun Prakash

doi:10.1007/s12070-024-04744-2

Critical Appraisal of the 2017 Bethesda System for Reporting Thyroid Cytopathology with Cytohistological Concordance and Estimation of Risk of Malignancy - An Institutional Study

Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):3930-3935. doi: 10.1007/s12070-024-04744-2. Epub 2024 May 24.

Authors

Sayika Hameed¹, Sabina Khan¹, Mohd Jaseem Hassan², Musharraf Husain³, Arun Prakash⁴

Affiliations

¹ Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062 India.
² Department of Pathology, JN Medical College AMU, Aligarh, India.
³ Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062 India.
⁴ Department of Otorhinolaryngology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062 India.

PMID: 39376356
PMCID: PMC11455697 (available on 2025-10-01)
DOI: 10.1007/s12070-024-04744-2

Abstract

Aim: Bethesda System for reporting thyroid cytopathology established in 2009 was updated for the first time in 2017. Since its introduction very few studies have been done on the utility of recently introduced "The 2017 Bethesda System for Reporting Thyroid Cytopathology" (TBSRTC II) and estimation of risk of malignancy in various categories.

Material and methods: This was a prospective study done on thyroid lesions in which lesions were evaluated cytologically and classified according to TBSRTC II. Histopathological correlation was done, wherever possible. ROM was calculated for each Bethesda category in both ways as per TBSRTC II i.e. with NIFTP and excluding NIFTP from the malignant category.

Results: Using 2017 TBSRTC, 190 cases of thyroid FNACs were classified into 6 diagnostic categories. Cytohistological correlation was available in 60 cases. ROM was calculated which changed only in category III and V as only these two categories showed one case each of NIFTP. However there was an overestimation of ROM in category II and III as there are selection biases and not all thyroid nodules underwent surgical resections.

Conclusion: To conclude, the risk of malignancy calculated in two ways in the recent 2017 Bethesda system may have higher clinical relevance as those lesions with high ROM are defined for surgical excision. Thus we recommend that "The 2017 Bethesda system for Reporting Thyroid Cytopathology" should be implemented uniformly in our country as it provides a homogenous and standardised terminology resulting in better management of patients with thyroid nodular disease.

Keywords: Cytohistological correlation; Risk of malignancy; The 2017 Bethesda system; Thyroid cytopathology.

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