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Thyroid FNAC

The Bethesda system for reporting Thyroid cytopathology

The Bethesda system..

FNAC is an important test for Triaging patients with Thyroid Nodules. The 2007 National cancer Institute Thyroid FNA Conference has proposed The Bethesda System for Reporting thyroid cytopathology. 6 Recommended diagnostic categories.

I) Nondiagnostic or Unsatisfactory II) Benign III) Atypia of undetermined significance IV) Follicular neoplasm V) Suspicious for malignancy. VI) Malignant.

I) Nondiagnostic or Unsatisfactory a) Cyst fluid only b) Virtually acellular c) Others : Predominantly blood Absence of colloid / few Follicular cells

II) Benign ; a) Consistent with a benign Follicular nodule eg : Colloid nodule / Adenomatoid nodule b) C/W lymphocytic/ Hashimoto thyroiditis c) C/W Hemorrhagic colloid nodule.

III) Atypia of Undetermined significance / Follicular lesion of Undetermined significance Adequate aspirate but indefinite diagnoses Eg : Scattered clusters of atypical follicular cells & scant colloid Cannot exclude a neoplasm.

IV) Follicular neoplasm / Suspicious for follicular neoplasm ( SFN ) Moderate / High cellularity Scant / Absent colloid Microfollicular / trabecular pattern Specify if Hurtle cell type

V) Suspicious for malignancy susp. for Papillary carcinoma susp. for Medullary carcinoma susp. for Metastatic carcinoma susp. for lymphoma.

V) Malignant Papillary carcinoma Poorly differentiated carcinoma Medullary thyroid carcinoma Undifferentiated / Anaplastic thy. Ca Squamous cell carcinoma Carcinoma with mixed features Metastatic

Implied Risk of Malignancy &b recommended clinical management

Benign AFLUS Susp. For Foll. Neoplasm Susp. For Malignancy

Risk of Malignancy Usual management

--0 to 3 % 5 15 % 15 30 % 60 75 %

Repeat FNA with usg

Clinical Follow up Repeat FNAC Surgical Lobectomy Near Total Thy / Surg. lobectomy

Malignant 97 to 99 % Near total thyroidectomy