Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB)

Authors

  • Leticia Mosca Universidade de Sao Paulo; Departamento de Cirurgia, Faculdade de Medicina FMUSP; Disciplina de Cirurgia de Cabeca e Pescoco
  • Luiz Fernando Ferraz da Silva Universidade de Sao Paulo; Faculdade de Medicina FMUSP; Departamento de Patologia
  • Paulo Campos Carneiro Universidade de Sao Paulo; Faculdade de Medicina FMUSP; Departamento de Patologia
  • Danielle Azevedo Chacon Universidade de Sao Paulo; Faculdade de Medicina FMUSP; Departamento de Patologia
  • Vergilius Jose Furtado de Araujo-Neto Universidade de Sao Paulo; Departamento de Cirurgia, Faculdade de Medicina FMUSP; Disciplina de Cirurgia de Cabeca e Pescoco
  • Vergilius Jose Furtado de Araujo-Filho Universidade de Sao Paulo; Departamento de Cirurgia, Faculdade de Medicina FMUSP; Disciplina de Cirurgia de Cabeca e Pescoco
  • Claudio Roberto Cernea Universidade de Sao Paulo; Departamento de Cirurgia, Faculdade de Medicina FMUSP; Disciplina de Cirurgia de Cabeca e Pescoco

DOI:

https://doi.org/10.6061/clinics/2018/e370

Keywords:

Thyroid, Ultrasound, Fine Needle Aspiration Biopsy, Bethesda

Abstract

OBJECTIVES: Most thyroid diseases are nodular and have been investigated using ultrasound-guided fine needle aspiration biopsy (FNAB), the reports of which are standardized by the Bethesda System. Bethesda category III represents a heterogeneous group in terms of lesion characteristics and the malignancy rates reported in the literature. The objective of the present study was to evaluate the differences in the malignancy rates among Bethesda III subcategories. METHODS: Data from 1,479 patients who had thyroid surgery were reviewed. In total, 1,093 patients (89.6% female, mean age 52.7 (13-89) years) were included, and 386 patients were excluded. FNAB results (based on Bethesda Class) and histopathological results (benign or malignant) for coincident areas were collected. Bethesda III patients were subcategorized according to cytopathological characteristics (FLUS: follicular lesion of undetermined significance, Bethesda IIIA; AUS: atypia of undetermined significance, Bethesda IIIB). Data were correlated to obtain the malignancy rates for each Bethesda category and the newly defined subcategory. RESULTS: FNAB results for these patients were as follows: Bethesda I: 3.1%; Bethesda II: 18.6%; Bethesda III: 35.0%; Bethesda IV: 22.1%; Bethesda V: 4.1%; and Bethesda VI: 17.1%. The malignancy rates for Bethesda Class IIIB were significantly higher than those for Bethesda Class IIIA (p<0.001) and Bethesda Class IV (p<0.001). Bethesda Class IIIA showed significantly lower malignancy rates than Bethesda Class III overall (p<0.001) CONCLUSIONS: Improvements of the Bethesda System should consider this subcategorization to better reflect different malignancy rates, which may have a significant impact on the decision-making process.

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Published

2018-01-01

Issue

Section

Original Articles

How to Cite

Mosca, L., Silva, L. F. F. da, Carneiro, P. C., Chacon, D. A., Araujo-Neto, V. J. F. de, Araujo-Filho, V. J. F. de, & Cernea, C. R. (2018). Malignancy rates for Bethesda III subcategories in thyroid fine needle aspiration biopsy (FNAB). Clinics, 73, e370. https://doi.org/10.6061/clinics/2018/e370