The Bethesda System of Reporting Thyroid Cytopathology: A Hospital Based Study of Eastern UP

Background: Fine needle aspiration cytology is a well-established first line diagnostic tool for the evaluation of palpable thyroid swellings. It is one of the diagnostic investigations for the Evaluation of solitary thyroid nodule (distinguish neoplastic from non -neoplastic), Evaluation of diffuse thyroid lesions (distinguish inflammatory/ autoimmune from nodular goiter), Confirmation and categorisation of clinically obvious thyroid malignancy. Thyroid FNAC is the most accurate and cost-effective tool for guiding the clinical management of patients with thyroid nodules. The role of cytology in thyroid swellings is important for the pre-operative diagnosis of benign or malignant lesions. Aims: To assess the thyroid swelling by fine needle aspiration cytology and classify the FNAC findings according to the Bethesda system of reporting thyroid cytopathology 2017 at a tertiary care hospital. Materials & Methods: It is an observational study done from January 2019 to November 2022. FNAC was performed in 92 cases. Smears stained with Giemsa, Haematoxylin and Eosin and Papanicolaou stain. Result: In present study commonest indication of FNAC was swelling in neck. Among 92 cases, non-neoplastic category II lesions were the major proportion constituting 78.26%%, category I unsatisfactory smears were 4.34%%, category III 3.26%%, next highest percentage of cases were in category IV with 8.69%, category V 4.34% and category VI had 1.08% of cases. Majority of the patients (78.26%) presented with Category II lesions. Among the benign lesion goiter was the most common lesion (64.12%). Nodular goiter formed maximum cases (57.60%) rest were of (6.52%). Next common lesions was thyroiditis in which lymphocytic thyroiditis was common (8.69%) followed by Hashimoto thyroiditis (3.26%) and Dequervain’s thyroiditis (2.17%). Conclusion: In conclusion the present study shows that TBSRTC helps standardize cytology reports thereby improving the quality of reporting, reducing the diagnostic in accuracies and bringing about an interlaboratory agreement on an objective basis. Furthermore it improves the communication between cytopathologists and clinicians, helping them to triage the patient for the appropriate line of management.      背景：细针吸取细胞学（Fine Needle Aspiration Cytology, FNAC）是评估可触及甲状腺肿物的成熟一线诊断工具。其可用于孤立性甲状腺结节的诊断排查（区分肿瘤性与非肿瘤性病变）、弥漫性甲状腺病变的评估（区分炎性/自身免疫性病变与结节性甲状腺肿），以及临床明确的甲状腺恶性肿瘤的确诊与分类。甲状腺FNAC是指导甲状腺结节患者临床诊疗的最精准且具成本效益的工具，细胞学检查在甲状腺肿物诊疗中的核心价值在于实现良恶性病变的术前诊断。 研究目的：本研究旨在某三级医院中，通过细针吸取细胞学检查评估甲状腺肿物，并依据2017版甲状腺细胞病理学Bethesda报告系统（Bethesda System for Reporting Thyroid Cytopathology）对FNAC结果进行分类。 材料与方法：本研究为2019年1月至2022年11月开展的观察性研究，共纳入92例行FNAC检查的病例。涂片分别采用吉姆萨（Giemsa）染色、苏木精-伊红（Haematoxylin and Eosin）染色及巴氏（Papanicolaou）染色。 结果：本研究中，FNAC最常见的检查指征为颈部肿物。92例病例中，非肿瘤性II类病变占比最高，达78.26%；I类涂片不满意病例占4.34%，III类占3.26%；次高占比为IV类病例，占8.69%；V类占4.34%，VI类占1.08%。大部分患者（78.26%）表现为II类病变。良性病变中，甲状腺肿最为常见，占64.12%；其中结节性甲状腺肿占比最高（57.60%），其余良性病变占6.52%。其次常见的病变为甲状腺炎，以淋巴细胞性甲状腺炎最为多见（8.69%），依次为桥本甲状腺炎（Hashimoto thyroiditis，3.26%）及德奎尔万甲状腺炎（De Quervain thyroiditis，2.17%）。 结论：综上，本研究表明，甲状腺细胞病理学Bethesda报告系统可实现细胞学报告的标准化，从而提升报告质量、降低诊断误差，并在客观基础上达成实验室间的一致性共识。此外，该系统可改善细胞病理学家与临床医师之间的沟通，协助医师对患者进行分流，选择恰当的诊疗方案。