journal presentation of Dr kunjan acharya and teams article on bethesda system validating in nepalese population for thyroid nodule

1. JOURNAL
CLUB- HEAD
AND NECK

3. Introduction

4. Thyroid nodules
• Very common pathology encountered
• Reported in 5% of the general population by palpation
• Up to 50% by ultrasound or autopsy
• USA (

5. FNAC
• Modality of investigation
• Throughout the world
• Pioneered by Martin et al. in 1930.
• Help diagnosing thyroid malignancies requiring surgery,
• Reduces the burden of unnecessary surgery and its associated morbidities.

6. The Bethesda System for Reporting
Thyroid Cytopathology .

7. The Bethesda System for Reporting
Thyroid Cytopathology .
Compared TBSRTC with the histological outcomes
effective and robust classification scheme
Guide the clinical management

8. Bethesda category Definition ROM
(%)
Recommendation
I. Nondiagnostic or
unsatisfactory
(ND)
Cyst fluid only ; virtually acellular specimen;
other (obscuring blood, clotting artifact, etc.)
Repeat USG guided
FNAC
II. Benign (BN) Consistent with a benign follicular nodule
(includes adenomatoid nodule, colloid nodule,
etc.); consistent with lymphocytic
(Hashimoto) thyroiditis in the proper clinical
context; consistent with granulomatous
(subacute) thyroiditis ; others
0-3% Clinical follow-up
III. Atypia of
undetermined
significance
or follicular lesion of
undetermined
significance (AUS)
5-15% Repeat FNAC under
image guidance
Cont…

9. Bethesda category Definition ROM
(%)
Recommendation
IV. Follicular neoplasm
(FN) or Suspicious
for a follicular neoplasm
(SFN)
15–
30%
Surgical lobectomy
V. Suspicious for
malignancy (SM)
Suspicious for papillary carcinoma;
suspicious
for medullary carcinoma; suspicious for
metastatic carcinoma; suspicious for
lymphoma; others
60-
75%
Near-total thyroidectomy
or surgical lobectomy
VI. Malignant (MGT) Papillary thyroid carcinoma ; poorly
differentiated carcinoma; medullary
thyroid carcinoma; undifferentiated
(anaplastic) carcinoma; squamous cell
carcinoma;carcinoma with mixed features;
metastatic carcinoma;non-Hodgkin
lymphoma;others
97-
99%
Near Total
Thyroidectomy
Cont ….

10. Objective

11. Methods
• Descriptive cross-sectional study
• Conducted - department of ENT and the Department of Pathology.
• Study period - 1.5 year (May 2018 to November 2019).

12. Study design
OPD- THYROID SWELLING
USG neck TFT FNAC
Bethesda category
• USG guided FNAC
• Bethesda I and
III lesions
• very small and
posteriorly
located lesions.
Cont….

13. How bethesda category assigned ?
4 to 10 air-dried and alcohol-fixed
smears
Geimsa stain Papanicolaou stain
examined by 2 pathologists
Bethesda category

14. Study design cont…
• Total or hemithyroidectomy with or without neck dissection done
• Based on the American Thyroid Association (ATA) guidelines
• Final histopathological report.
• Inclusion criteria
• Total case studied- 134.

15. Methods

16. Definitions used
+ -
+ True positive False positive PPV
- False negative True negative NPV
Sensitivity specificity total
HPE malignancy
Bethesda V and VI
Bethesda II
HPE benign

17. Methods

18. Result
• 134 thyroidectomy – total (53) + hemi (81)

19. Final histopathological

20. Implied risk of
malignancy

21. Excluding bethesda III and IV
+ _
+ True positive-51 False positive-8 PPV-86.4
_ False negative-6 True negative-45 NPV-88
Sensitivity-84.9 Specificity –89.4 Total-110
ACCURACY-
87.3
Bethesda V and VI
Bethesda II
HPE malignancy HPE benign

22. Comparison of the ROM

23. Discussion

24. Nondiagnostic FNAC. When?

25. Discussion

26. Discussion

27. Discussion

28. Discussion

29. Category III

30. Discussion

31. Limitations

32. Conclusions
• FNAC - a well-accepted screening modality for thyroid nodules in a multidisciplinary setup.
• FNAC can guide clinical management.
• FNAC reporting high sensitivity and specificity in detecting thyroid cancer.
• TBSRTC diagnostic categories helps triaging patients for clinical management .
• Discrepancy between ROM results for Bethesda category III from other studies.

33. Refrences

34. Thank you