Title: Study of cytomorphological spectrum of various thyroid lesions and reporting under bethesda system in tertiary care centre

Authors: Dr Debaleena Dev Barman, Dr Alpana Banerjee

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.96

Abstract

Background: This study has attempted to standardize reporting and cytological criteria in aspiration smears of thyroid swellings with the help of Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). 

Aims: The objective of this study is to categorise the thyroid cytology smears by TBSRTC, to analyze cytological features in details and to correlate the cytopathology with histopathology, wherever surgery is done. 

Materials and Methods: This was a retrospective study of 617 fine needle aspirations (FNA) of thyroid swellings. All fine needle aspiration cytology (FNAC) diagnoses were classified according to the features given in the monograph of TBSRTC into non diagnostic/unsatisfactory (ND/UNS), benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious of a follicular neoplasm (FN/SFN), suspicious for malignancy (SFM), and malignant. Cytohistological correlation was done, when surgical material was available. 

Results: The distribution of various categories from 619 evaluated thyroid swellings was as follows: 9.5% ND/UNS, 74% benign, 4.9% AUS/FLUS, 3.2% FN, 0.6% SFM, and 6.1% malignant. 

Conclusion: TBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNA or surgery and also the extent of surgery. Thyroid cytology can provide a definite diagnosis of malignancy, with tumour type, enabling appropriate therapeutic surgery in one stage.

References

  1. P , Verma A.K .Thyroid Cytopathology Reporting by the Bethesda System: A Two-Year Prospective Study in an Academic Institution .Pathology Research International Volume 2015, Article ID 240505, 11 pages.
  2. Hamberger B, Gharib H, Melton LJ III, et al. Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care. Am J Med. 1982;73:381-384.
  3. Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111:508-516.
  4. A. Gopinathan ,* A.Hegde, and F.H. V.Chong. Thyroid nodules: risk stratification for malignancy with ultrasound and guided biopsy.2011; 11(1): 209–223.
  1. Z. Ali and E. S. Cibas, Eds., The Bethesda System for Reporting Thyroid Cytopathology. Definitions, Criteria and Explanatory Notes, Springer, New York, NY, USA, 2010.
  2. Zajdela, M. A. de Maublanc, P. Schlienger, and C. Haye, “Cytologic diagnosis of orbital and periorbital palpable tumors using fine-needle sampling without aspiration,” Diagnostic Cytopathology, vol. 2, no. 1, pp. 17–20, 1986. 
  3. Bibbo M. Comprehensive Cytopathology. 2nd Philadelphia, PA: W.B. Saunders Company; 1997. p. 673.
  4. S., Jayaprakash H. T., Sasidharan. A, Nagaraj T, Santosh H. N., Balraj .L. Cytological study of thyroid lesions by fine-needle aspiration cytology. Journal of Medicine, Radiology, Pathology & Surgery (2016), 2, 12–15
  5. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2010;134:450-6.
  6. Bommanahalli BP, Bhat RV, Rupanarayan R. A cell pattern approach to interpretation of fine needle aspiration cytology of thyroid lesions: A cyto-histomorphological study. J Cytol 2010;27:127-32.
  7. Parikh UR, Goswami HM, Shah AM, Mehta NP, Gonsai RN. Fine needle aspiration cytology (FNAC) study of thyroid lesions (study of 240 cases). Gujarat Med J 2012;67:25-30.
  8. Singh DK, Kumar R, Paricharak SD, Nigam N, Nigam SK. Role of fine needle aspiration cytology in solitary thyroid nodules. J Evol Med Dent Sci 2013;36:6903-14.
  9. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;111:508-16.
  10. Silverman JF, West RL, Larkin EW, Park HK, Finley JL, Swanson MS, et al. The role of fine-needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer 1986;57:1164-70.
  11. Gupta M, Gupta S, Gupta VB. Correlation of fine needle aspiration cytology with histopathology in the diagnosis of solitary thyroid nodule. J Thyroid Res 2010;2010:379051.
  12. Guhamallick M, Sengupta S, Bhattacharya NK. Cytodiagnosis of thyroid lesions-usefulness and pitfalls: A study of 288 cases. J Cytol 2008;25:6-9.
  13. Handa U, Garg S, Mohan H, Nagarkar N. Role of fine needle aspiration cytology in diagnosis and management of thyroid lesions: A study of 434 patients. J Cytol 2008;25:13-7.
  14. Binesh F, Salari AA. Comparative evaluation of the diagnosis results of fine-needle aspiration cytology and pathology in the assessment of thyroid nodules. Pak J Med Sci 2008;24:382-5.
  15. Rajwanshi Arvind, Radharaman J D, Mittal BR, Saxena AK, Bhatia A.Lymphocytic thyroiditis – is cytological grading significant? A correlation of grades with clinical, biochemical, ultraso-nographic and radionuclide parameters.
  16. Wu HH, Rose C, Elsheikh TM. The Bethesda system for reporting thyroid cytopathology: An experience of 1,382 cases in a community practice setting with the implication for risk of neoplasm and risk of malignancy. Diagn Cytopathol 2012;40:399-403.
  17. Mondal SK, Sinha S, Basak B, Roy DN, Sinha SK. The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up. J Cytol 2013;30:94-9.
  18. Jo VY et al, Stelow EB, Dustin SM, Hanley KZ. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2010;134:450-6.
  19. Gomez et al,Ramirez et al.Cytologic Criteria of Cystic Papillary Carcinoma of the Thyroid. 47(4):590-4 · July 2003.
  20. Chandanwale S.S et al, Kumar H et al, Buch A et al, Soraisham.P et al. Papillary thyroid carcinoma, a diagnostic approach in fine needle aspiration: Review of literature.Year : 2013 | Volume : 2 | Issue : 4 | Page : 339-343
  1. Green I et al, .Syed Z. Ali et al. Elizabeth A. A et al, Zakowski M F et al .A spectrum of cytomorphologic variations in medullary thyroid carcinoma.
  2. Bose S et al, Kusum K et al, verma k et al. Medullary carcinoma of the thyroid: A cytological, immunocytochemical, and ultrastructural study. Volume8,Issue1. January 1992.Pages 28-32.
  3. Ghosh et al, Nepal et al, Gharti et al, Basnet et al, Baxi et al, Talwar et al.anaplastic carcinoma of thyroid-clinicomorphological spectrum and review of literature.Journal of Pathology of Nepal (2011) Vol. 1,45-48.
  4. Carcangiu ML, Steeper T, Zampi G, Rosai J. Anapalstic thyroid carcinoma: A study of 70 cases. Am J Clin pathol 1985;83:135-58.
  5. Nel CJ, van Heerden JA, Goellner JR. Anaplastic carcinoma of the thyroid: a clinicopthologic study of 82 cases. Mayo Clin Proc 1985;60:51-8.
  6. Halbhavi SN, GanjigattiM, Kuntoji SB, Mohammedgouse A. Karikazi. Clinicopathological study of thyroid swellings in HSK hospital in Karnataka, India . Int Surg J. 2018 Feb;5(2):420-425.

Corresponding Author

Dr Debaleena Dev Barman

Tutor, Department of Pathology, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura (west)