ArticleJournal of cytology
Application of the Newer 2023 Bethesda System for Reporting Cytopathology of Thyroid Nodules and Estimating their Risk of Malignancy.
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Abstract
Introduction: Thyroid swellings are among the most common clinical presentations, yet not all cases necessitate surgical intervention. Fine-needle aspiration cytology (FNAC) is a widely accepted, minimally invasive diagnostic method that reduces the need for unnecessary surgeries and guides appropriate clinical management. This study is important as it provides population-specific data on the diagnostic accuracy of FNAC and evaluates the risk of malignancy (ROM) and risk of neoplasm (RON) in thyroid nodules (TNs) using the latest Bethesda System for Reporting Thyroid Cytopathology (2023 edition). By systematically categorizing thyroid lesions, the study offers insights into effective risk stratification and supports evidence-based, cost-efficient approaches to patient care. Materials and Methods: A retro-prospective study was conducted over 2 years, enrolling 111 patients with TNs, after obtaining approval from the institutional ethical committee. FNAC was performed on all cases. Smears were stained with Papanicolaou and Giemsa stains and categorized according to the Bethesda classification. Statistical analysis was conducted using IBM Statistical Package for the Social Sciences statistics (version 21.0), and Fisher's exact test was applied. Results: This study demonstrated a sensitivity of 83.33%, specificity of 100%, and diagnostic accuracy of 90.24%. The positive predictive value was 100%, and the negative predictive value was 80.95%. ROM was 0% in Category I, 19.4% in Category II, and 100% in Categories IV, V, and VI. The overall RON was 21.62%. Papillary thyroid carcinoma was the most common malignancy observed. Conclusion: FNAC remains a highly effective and accessible tool for diagnosing thyroid lesions, particularly when combined with rapid on-site evaluation and cell block preparation. It enables accurate categorization, risk stratification, and a more individualized, cost-effective approach to the management of TNs.
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