Thyroid Diseases

Question 1

The Bethesda System for Reporting Thyroid Cytopathology :

Answer 1

I. Nondiagnostic or Unsatisfactory:

* Cyst fluid only
* Virtually acellular specimen
* Other (obscuring blood, clotting artifact, etc)

II. Benign:

* 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

III. Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance.

IV. Follicular Neoplasm or Suspicious for a Follicular Neoplasm.

V. Suspicious for Malignancy:

 * Suspicious for papillary carcinoma 
 * Suspicious for  medullary carcinoma 
 * Suspicious for metastatic carcinoma 
 * Suspicious for lymphoma

VI. Malignant

* Papillary thyroid carcinoma
* Poorly differentiated carcinoma 
* Medullary thyroid carcinoma 
* Undifferentiated (anaplastic) carcinoma 
* Squamous cell carcinoma
* Carcinoma with mixed features (specify) 
* Metastatic carcinoma
* Non-Hodgkin lymphoma

Question 2

In The Bethesda System for Reporting Thyroid Cytopathology, What is the risk of malignancy and the management in each Diagnostic Category ?

Answer 2

Nondiagnostic or Unsatisfactory:

• Risk of malignancy: 1-4
• Mx: Repeat FNA with ultrasound guidance.

Benign:

• Risk of malignancy: 0-3
• Mx:Clinical follow-up.

Atypia of Undetermined Significance or Follicular Lesion
of Undetermined Significance:
- Risk of malignancy:~5-15
- Mx : Repeat FNA.

Follicular Neoplasm or Suspicious for a Follicular Neoplasm:

• 15-30
• Mx: Surgical lobectomy.

Suspicious for Malignancy:
- 60-75
- Near-total thyroidectomy or surgical
lobectomy.

Malignant:

• 97-99
• Near-total thyroidectomy.