Evaluation of thyroid nodules classified as Bethesda category III on FNAC
Background: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5-15%, however, the probability of malignancy remains variable. Aim: To evaluate category III with respect to its rate and risk of malignancy and substratify it. Settings and Design: Atypia of undetermined signifi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2017-01-01
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| Series: | Journal of Cytology |
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| Online Access: | http://www.jcytol.org/article.asp?issn=0970-9371;year=2017;volume=34;issue=1;spage=5;epage=9;aulast=Garg |
| _version_ | 1828464181427306496 |
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| author | Shiwani Garg Leena P Naik Kanchan S Kothari Gwendolyn C Fernandes Mona A Agnihotri Jagruti C Gokhale |
| author_facet | Shiwani Garg Leena P Naik Kanchan S Kothari Gwendolyn C Fernandes Mona A Agnihotri Jagruti C Gokhale |
| author_sort | Shiwani Garg |
| collection | DOAJ |
| description | Background: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5-15%, however, the probability of malignancy remains variable.
Aim: To evaluate category III with respect to its rate and risk of malignancy and substratify it.
Settings and Design: Atypia of undetermined significance/Follicular lesion of undetermined significance (AUS/FLUS) percentage, cytohistological correlation, and risk of malignancy were analyzed and substratification was done.
Material and Methods: Category III cases over a 2-year period were analyzed retrospectively.
Statistical Analysis: Two-tailed Fisher exact test, with a level of significance set at 0.05, was performed for data analysis.
Results: Of 1169 thyroid fine needle aspirations (FNAs), 76 (6.5%) were category III. A total of 48 patients had follow up; 24 patients underwent surgery, 12 repeat FNA, and 12 were clinically followed. Repeat FNA cytology was unsatisfactory in 8.3%, benign in 66.7%, AUS in 8.3%, and follicular neoplasm in 16.7%. Of the 24 operated, 8 (33.3%) were malignant (follicular variants of papillary thyroid carcinoma), 5 (20.8%) were follicular adenomas, and 11 (45.8%) were non-neoplastic. Among all AUS/FLUS nodules with follow-up, malignancy was confirmed in 16.7% (8/48) whereas with nodules triaged to surgery only, the malignancy rate was 33.3% (8/24). Substratification into categories of "cannot exclude PTC" and "favor benign" helped detect malignancy better, as 85.7% cases in the first subcategory (P < 0.001) and none (P < 0.02) in the last proved malignant.
Conclusion: Though the rate of Category III in our study is in accordance to BSRTC, the risk of malignancy in AUS/FLUS nodules is higher. Substratification of AUS/FLUS may help better patient management. |
| first_indexed | 2024-12-11T03:08:08Z |
| format | Article |
| id | doaj.art-923830a189d4451fb0808c94b8e8273e |
| institution | Directory Open Access Journal |
| issn | 0970-9371 |
| language | English |
| last_indexed | 2024-12-11T03:08:08Z |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Cytology |
| spelling | doaj.art-923830a189d4451fb0808c94b8e8273e2022-12-22T01:22:55ZengWolters Kluwer Medknow PublicationsJournal of Cytology0970-93712017-01-013415910.4103/0970-9371.197590Evaluation of thyroid nodules classified as Bethesda category III on FNACShiwani GargLeena P NaikKanchan S KothariGwendolyn C FernandesMona A AgnihotriJagruti C GokhaleBackground: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5-15%, however, the probability of malignancy remains variable. Aim: To evaluate category III with respect to its rate and risk of malignancy and substratify it. Settings and Design: Atypia of undetermined significance/Follicular lesion of undetermined significance (AUS/FLUS) percentage, cytohistological correlation, and risk of malignancy were analyzed and substratification was done. Material and Methods: Category III cases over a 2-year period were analyzed retrospectively. Statistical Analysis: Two-tailed Fisher exact test, with a level of significance set at 0.05, was performed for data analysis. Results: Of 1169 thyroid fine needle aspirations (FNAs), 76 (6.5%) were category III. A total of 48 patients had follow up; 24 patients underwent surgery, 12 repeat FNA, and 12 were clinically followed. Repeat FNA cytology was unsatisfactory in 8.3%, benign in 66.7%, AUS in 8.3%, and follicular neoplasm in 16.7%. Of the 24 operated, 8 (33.3%) were malignant (follicular variants of papillary thyroid carcinoma), 5 (20.8%) were follicular adenomas, and 11 (45.8%) were non-neoplastic. Among all AUS/FLUS nodules with follow-up, malignancy was confirmed in 16.7% (8/48) whereas with nodules triaged to surgery only, the malignancy rate was 33.3% (8/24). Substratification into categories of "cannot exclude PTC" and "favor benign" helped detect malignancy better, as 85.7% cases in the first subcategory (P < 0.001) and none (P < 0.02) in the last proved malignant. Conclusion: Though the rate of Category III in our study is in accordance to BSRTC, the risk of malignancy in AUS/FLUS nodules is higher. Substratification of AUS/FLUS may help better patient management.http://www.jcytol.org/article.asp?issn=0970-9371;year=2017;volume=34;issue=1;spage=5;epage=9;aulast=GargBethesda system; Category III; substratification; thyroid nodules |
| spellingShingle | Shiwani Garg Leena P Naik Kanchan S Kothari Gwendolyn C Fernandes Mona A Agnihotri Jagruti C Gokhale Evaluation of thyroid nodules classified as Bethesda category III on FNAC Journal of Cytology Bethesda system; Category III; substratification; thyroid nodules |
| title | Evaluation of thyroid nodules classified as Bethesda category III on FNAC |
| title_full | Evaluation of thyroid nodules classified as Bethesda category III on FNAC |
| title_fullStr | Evaluation of thyroid nodules classified as Bethesda category III on FNAC |
| title_full_unstemmed | Evaluation of thyroid nodules classified as Bethesda category III on FNAC |
| title_short | Evaluation of thyroid nodules classified as Bethesda category III on FNAC |
| title_sort | evaluation of thyroid nodules classified as bethesda category iii on fnac |
| topic | Bethesda system; Category III; substratification; thyroid nodules |
| url | http://www.jcytol.org/article.asp?issn=0970-9371;year=2017;volume=34;issue=1;spage=5;epage=9;aulast=Garg |
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