Introduction: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) identifies 6 diagnostic categories in which the risk of malignancy increases respectively. The aim of our study was to assess TBSRTC reporting in our hospital and to evaluate its specificity based on cytohistological correlation. Methods: A histological diagnosis was available in 374 (110 males and 264 females) out of 7,809 thyroid aspirates examined at Mubarak Al-Kabeer Hospital, Kuwait, from 2004 to 2012. The aspirates were classified in accordance with TBSRTC. Results: Thyroid aspirates were classified as nondiagnostic (n = 18; 4.8%), benign (n = 114; 30.5%); atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; n = 59; 15.8%), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN; n = 17; 4.5%), suspicious for malignancy (SM; n = 80; 21.4%), or malignant (n = 86; 23.0%). In 75 of 86 malignant cases, a papillary carcinoma was detected. There were 3 (1.6%) false-positive aspirates and the sensitivity, specificity, negative predictive value, and positive predictive value were 91.0, 61.9, 84.2, and 75.3%, respectively. Conclusions: Our results are fairly comparable to those of various previous studies in the SM, AUS/FLUS, and SFN categories. The higher rates observed in the nondiagnostic and benign categories were possibly due to limited guided aspirations and a lack of on-site evaluation for all cases.

Keywords:
Thyroid, Fine-needle aspiration cytology, Bethesda system reporting, Kuwait
1.
Ko HM, Jhu IK, Yang SH, Lee JH, Nam JH, Juhng SW, et al: Clinicopathologic analysis of fine needle aspiration cytology of the thyroid: a review of 1,613 cases and correlation with histopathologic diagnoses. Acta Cytol 2003;47:727-732.
2.
Cibas ES, Ali SZ: The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2009;132:658-665.
3.
Ali SZ: Thyroid cytopathology: Bethesda and beyond. Acta Cytol 2011;55:4-12.
4.
Archuletta PA, Gidwani R, Husain M, Johnson T, Shidham V, Alzohaili O, Bandyopadhyay S, Feng J, Shi D, Geng L, Tranchida P, Giorgadze T: The Bethesda System thyroid diagnostic categories in the African-American population in conjunction with surgical pathology follow-up. Cyto J 2012;9:7.
5.
Lee K, Jung CK, Lee KY, Bae JS, Lim DJ, Jung SL: Application of Bethesda System for Reporting Thyroid Aspiration Cytology. Korean J Pathol 2010;44:521-527.
6.
Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW: The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol 2012;56:333-339.
7.
McElroy MK, Mahooti S, Hasteh F: A single institution experience with the New Bethesda System for Reporting Thyroid Cytopathology: correlation with existing cytologic, clinical, and histological data. Diagn Cytopathol 2014;42:564-569.
8.
Firat P, Cochand-Priollet B: The Bethesda System for Reporting Thyroid Fine Needle Aspiration Cytology: a study comparing the results of two centers from two different countries. Ann Pathol 2012;32:415-420.
9.
Onder S, Firat P, Ates D: The Bethesda System for Reporting Thyroid Cytopathology: an institutional experience of the outcome of indeterminate categories. Cytopathology 2014;25:177-184.
10.
Al-Abbadi M, Shareef SQ, Ali JA, Yousef MM: Application of the Bethesda System for Reporting Thyroid Cytopathology in the eastern province of Saudi Arabia: phase I pilot retrospective analysis. Acta Cytol 2013;57:481-488.
11.
Al-Shraim MM, Kaood OM, Hussein MR, Al-Ahmary AM, Al-Shebri GY, Jastania RA, Mahfouz AA, Abu-Eshy SA: Assessment of malignancy rate in thyroid nodules according to the Bethesda system of fine-needle aspiration: report from a tertiary center in the southwestern region of Saudi Arabia. Saudi Med J 2012;33:167-171.
12.
Gocun PU, Karakus E, Bulutay P, Akturk M, Akin M, Poyraz A: What is the malignancy risk for atypia of undetermined significance? Three years' experience at a University Hospital in Turkey. Cancer Cytopathol 2014;122:604-610.
13.
Tepeoglu M, Bilezikci B, Bayraktar SG: A histological assessment of the Bethesda system for reporting thyroid cytopathology (2010) abnormal categories: a series of 219 consecutive cases. Cytopathology 2014;25:39-44.
14.
Wang CC, Friedman L, Kennedy GC, Wang H, Kebebew E, Steward DL, et al: A large multicenter correlation study of thyroid nodule cytopathology and histopathology. Thyroid 2011;21:243-251.
15.
Yang J, Schnadig V, Logrono R, Wasserman PG: Fine-needle aspiration of thyroid nodules: a study of 4,703 patients with histologic and clinical correlations. Cancer 2007;111:306-315.
16.
Nayar R, Ivanovic M: The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer Cytopathol 2009;117:195-202.
17.
Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al: Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;111:508-516.
18.
Srbova L, Gabalec F, Ryska A, Cap J: Results of retrospective classification of thyroid FNAs according to the Bethesda system: would this have improved accuracy? Cytopathology 2014, DOI: 10.1111/cyt.12171.
19.
Haberal AN, Toru S, Ozen O, Arat Z, Bilezikci B: Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology 2009;20:103-108.
20.
Pandey P, Dixit A, Mahajan NC: Fine-needle aspiration of the thyroid: a cytohistologic correlation with critical evaluation of discordant cases. Thyroid Res Pract 2012;9:32-39.
21.
Likhar KS, Hazari RA, Gupta SG, Shukla U: Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions: a hospital-based study. Thyroid Res Pract 2013;10:68-71.
22.
Olson MT, Boonyaarunnate T, Atlinboga AA, Ali SZ: ‘Suspicious for papillary thyroid carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology. Acta Cytol 2014;58:15-22.
23.
Boonyaarunnate T, Olson MT, Ali SZ: ‘Suspicious for a follicular neoplasm' before and after the Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology. Acta Cytol 2013;57:455-463.
24.
Kholova I, Ludvikova M: Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable Bethesda 2010 diagnostic category or waste garbage? Acta Cytol 2014;58:319-329.
25.
Raab SS, Vrbin CM, Grzybicki DM, Sudilovsky D, Balassanian R, Zarbo RJ, Meier FA: Errors in thyroid gland fine-needle aspiration. Am J Clin Pathol 2006;125:873-882.
26.
Davidov T, Trooskin SZ, Shanker B-A, Yip D, Eng O, Crystal J, et al: Routine second-opinion cytopathology review of thyroid fine needle aspiration biopsies reduces diagnostic thyroidectomy. Surgery 2010;148:1294-1301.
27.
Park JH, Kim HK, Kang S-W, Jeong JJ, Nam K-H, Chung W-Y, et al: Second opinion in thyroid fine needle aspiration biopsy by the Bethesda system. Endocr J 2012;59:205-212.
28.
Olson MT, Boonyaarunnate T, Han PA, Umbricht CB, Ali SZ, Zeiger MA: A tertiary center's experience with second opinion review of 3,885 thyroid cytopathology specimens. J Clin Endocrinol Metab 2013;98:1450-1457.
29.
Baloch ZW, Hendreen S, Gupta PK, LiVolsi VA, Mandel SJ, Weber R, et al: Interinstitutional review of thyroid fine-needle aspirations: impact on clinical management of thyroid nodules. Diagn Cytopathol 2001;25:231-234.
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2015
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