Correlating the Bethesda System for Reporting Thyroid Cytopathology with Histology and Extent of Surgery: A Review of 21,746 Patients from Four Endocrine Surgery Registries Across Two Continents

William B. Inabnet, Fausto Palazzo, Julie Ann Sosa, Joshua Kriger, Sebastian Aspinall, Marcin Barczynski, Gerard Doherty, Maurizio Iacobone, Erik Nordenstrom, David Scott-Coombes, Goran Wallin, Lauren Williams, Rachel Bray, Anders Bergenfelz

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: The Bethesda system for cytopathology (TBSRTC) is a 6-tier diagnostic framework developed to standardize thyroid cytopathology reporting. The aim of this study was to determine the risk of malignancy (ROM) for each Bethesda category. Methods: Thyroidectomy-related data from 314 facilities in 22 countries were entered into the following outcome registries: CESQIP (North America), Eurocrine (Europe), SQRTPA (Sweden) and UKRETS (UK). Demographic, cytological, pathologic and extent of surgery data were mapped into one dataset and analyzed. Results: Out of 41,294 thyroidectomy patient entries from January 1, 2015, to June 30, 2017, 21,746 patients underwent both thyroid FNA and surgery. A comparison of cytology and surgical pathology data demonstrated a ROM for Bethesda categories 1 to 6 of 19.2%, 12.7%, 31.9%, 31.4%, 77.8% and 96.0%, respectively. Male patients had a higher rate of malignancy for every Bethesda category. Secondary analysis demonstrated a high ROM in male patients with Bethesda 3 category aged 31–35 years (52.1%, 95% confidence interval (CI) 37.9–66.2%), aged 36–40 years (55.9%, 95% CI 39.2–72.6%) and aged 41–45 years (46.9%, 95% CI 33–60.9%). Patients with Bethesda 5 and 6 scores were more likely to undergo total thyroidectomy (65.9% and 84.6%); for patients with Bethesda scores 2 and 3, a higher percentage of females underwent total thyroidectomy compared to males in spite of a higher ROM for males. Conclusions: These data demonstrate that Bethesda categories 1–4 are associated with a higher ROM compared to the first edition of TBSRTC, especially in male patients, and validate findings from the second edition of TBSRTC.

Original languageEnglish
Pages (from-to)426-435
Number of pages10
JournalWorld Journal of Surgery
Volume44
Issue number2
DOIs
StatePublished - Feb 1 2020

Bibliographical note

Funding Information:
The investigators would like to acknowledge and thank Bruce Levin for his expert assistance with the statistical analysis of the data. CESQIP and the hospitals participating in CESQIP are the source of the CESQIP data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The conclusions, findings and opinions expressed by the authors do not necessarily reflect the official position of the American Association of Endocrine Surgeons or CESQIP. Use of CESQIP data does not imply endorsement by any of the groups named above.

Publisher Copyright:
© 2019, Société Internationale de Chirurgie.

ASJC Scopus subject areas

  • Surgery

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