Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance

Joung-teak Jang M.D.; Kwang-Min Kim M.D.; Beom Park M.D.; Keum-Seok Bae M.D.; Mee-Yon Cho M.D.; Sung-Joon Kang M.D.

doi:10.16956/kjes.2010.10.4.240

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M.D., M.D., M.D., M.D., M.D., and M.D.: Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance

Review Article

Korean J Endocrine Surg 2010;10(4):240-244.

Published online: 18 December 2010

DOI: https://doi.org/10.16956/kjes.2010.10.4.240

Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance

Joung-teak Jang M.D., Kwang-Min Kim M.D., Beom Park M.D., Keum-Seok Bae M.D., Mee-Yon Cho M.D.¹, Sung-Joon Kang M.D.

Departments of Surgery and Wonju College of Medicine, Yonsei University, Wonju, Korea

¹Departments of Surgery and Pathology, Wonju College of Medicine, Yonsei University, Wonju, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication.

Methods:

Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study.

Results:

According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant.

Conclusion:

A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an inter-mediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment. (Korean J Endocrine Surg 2010;10:240-244)

Keywords: Fine needle aspiration cytology, Bethesda classification, Atypical cells of undetermined sig-

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Table 1.

Frequency of categories according to Bethesda classifications of FNAB results

Cytology category	By nodules
Nondiagnostic or Unsatisfactory	101 (15.8%)
Cyst fluid only	38 (5.9%)
Virtually acellular specimen	63 (9.9%)
Benign	419 (65.5%)
Consistent with a benign follicular nodule	370 (57.8%)
Consistent with Hashimoto thyroiditis	45 (7.0%)
Consistent with subacute thyroiditis	4 (0.6%)
Atypical cells of undetermined significance	56 (8.8%)
Follicular neoplasmor suspicious for a	14 (2.2%)
follicular neoplasm
Suspicious for malignancy	13 (2.0%)
Suspicious for papillary carcinoma	13 (2.0%)
Positive for malignancy	37 (5.8%)
Papillary thyroid carcinoma	37 (5.8%)
Total	640

Table 2.

Histologic correspondences according to FNAB results

Cytology category	Histologic follow-up
Cytology category	AH	HT	ST	FA	PTC	FC	Total
Cyst fluid only	2	0	0	2	0	0	4
Virtually acellular specimen	6	1	0	0	0	0	7
Consistent with a benign follicular nodule	30	1	0	0	1	0	32
Consistent with Hashimoto thyroiditis	0	1	0	0	0	0	1
Atypical cells of undetermined significance	7	0	1	1	9	1	19
Follicular neoplasm or suspicious for a Follicular neoplasm	4	0	0	1	0	0	5
Suspicious for papillary carcinoma	1	0	1	0	5	0	7
Papillary thyroid carcinoma	0	0	0	0	27	0	27
Total	50	3	2	4	42	1	102

AH = adenomatous hyperplasia; HT = hashimoto thyroiditis; ST = subacute thyroiditis; FA = follicular and Hurthle cell adenoma; PTC = papillary thyroid carcinoma; FC = follicular and Hurthle cell carcinoma.

Table 3.

Final surgical pathology of ACUS (n=40)

Surgical pathology	Histologic follow-up
Surgical pathology	AH	AHC	AHO	AHCO	HT	FA	PTC	PCF	FC	Total
ACUS (%)	7 (17.5)	5 (12.5)	5 (12.5)	2 (5)	2 (5)	3 (7.5)	11 (27.5)	2 (5)	3 (7.5)	40 (100)

ACUS = atypical cells of undetermined significance; AH = adenomatous hyperplasia; AHC = adenomatous hyperplasia with calcification; AHO = adenomatous hyperplasia with oncocystic change; AHCO = adenomatous hyperplasia with calcification with oncocystic change; HT = hashimoto thyroiditis; FA = follicular and Hurthle cell adenoma; PTC = papillary thyroid carcinoma; PCF = papillary carcinoma with follicular variant; FC = follicular and Hurthle cell carcinoma.

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