Authors: Dr. Hiran Kattilaprambil RavindranSpecialist Pathologist, Universal Hospital Abu Dhabi.

Dr. Juliet George TeddySpecialist Pathologist, Universal Hospital Abu Dhabi.

Objective

Methods

Results

To implement Bethesda and RCPath reporting guide-lines in thyroid FNAC in Universal hospital. To compare the statistics of published literature to our own data.

All cases came for FNAC between Jan 2017 and December 2018 were included in the study. All cases were reported in Bethesda as well as RCPath format sub classified according to the guidelines. A brief outline was given to the key stakeholders before imple-menting the changes. The results were categorized into 5 or 6 subgroups according to the classification system used. The percentages falling into each cate-gory was compared to that of published literature. Follow up of cases are also recorded and analyzed.

A total of 192 Thyroid FNACs were performed and all cases were subcategorized according to the Bethesda as well as RCPath classification.  In the Bethesda I, II, III, IV, V and VI categories we had 47 (25%) cases, 98 cases (51%), 4 cases (2%), 25 (13%), 14 (7%) and 4 (2%) respectively. The Bethesda 1 was subcategorized into 1 and 1c 14 (7%) cases in RCPath classification and there was no discordance in the other groups between the classification systems.

Implementing The Bethesda and RCPath Guidelines in Thyroid FNAC Institutional Experience

Thy 1c / Bethesda 2 (Pap X200)

Different classi�cation schemes availableRCPath Bethesda Italian Australian

Thy1. Non‐diagnostic for cytological diagnosisThy1c. Non‐diagnostic for cytological diagnosis–cystic lesion

Thy2. Non‐neoplasticThy2c. Non‐neoplastic–cystic lesion

Thy3a. Neoplasm possible–atypia/non‐diagnostic

Thy3f. Neoplasm possible,suggesting follicular neoplasm

Thy4. Suspicious for malignancy

Thy5. Malignant

I. Non‐diagnostic or unsatisfactory

II. Benign

III. AUS/FLUS

IV.Follicular neoplasm orsuspicious for a follicularneoplasm

V. Suspicious for malignancy

VI. Malignant

TIR 1. Non‐diagnosticTIR 1c. Non‐diagnostic–cystic

TIR 2. Non‐malignant

TIR 3A. LRIL

TIR 3B. HRIL

TIR 4. Suspicious for malignancy

TIR 5. Malignant

1. Non‐diagnostic

2. Benign

3. Indeterminate or follicular lesion of undetermined significance

4. Suggestive of follicular neoplasm

5. Suspicious for malignancy

6. Malignant

Microfollicles

Nucleargroove

Intranuclear inclusion

Bethesda classi�cation – Comparison data Value given in percentages

BTA/RCPath Classi�cation - Comparison data Value given inpercentages

25

51

2

137

2

11

78

2 3 15

0

10

20

30

40

50

60

70

80

90

Bethesda 1 Bethesda 2 Bethesda 3 Bethesda 4 Bethesda 5 Bethesda 6

Chart Title

Universal Gupta et Al

17

8

51

2

137

26 5

78

2 3 15

0

10

20

30

40

50

60

70

80

90

Thy 1a Thy 1c Thy 2 Thy 3a Thy 3f Thy 4 Thy 5

Chart Title

Universal Gupta et al

BTA/RCP – Bri�sh Thyroid associa�on / Royal College of Pathologist

Discussion and conclusions

Thy 2 / Bethesda 2 (MGG X200) Thy 3f / Bethesda 4 (MGG X400) Thy 4 / Bethesda 5 (Pap X400) Thy 5 / Bethesda 6 (Pap X400)

1. Alshaikh, S., Harb, Z., Aljufairi, E. and Almahari, S. (2018). Classification of thyroid fine-needle aspiration cytology into Bethesda categories: An institutional experience and review of the literature. CytoJournal, 15(1), p.4.

2. Gupta V, Bhake A, Dayal S. Better thyroid cytopathology reporting and interpretation using different classification systems. Thyroid Res Pract 2016;13:110-4

References

• This study was performed evaluate the feasibility to incorporate Bethesda and RCPath reporting system and to compare the reporting standards to the published data.

• The two reporting pathologist did not feel any discordance between the two system of classifications.

• While comparing our data with the published papers the rate of Bethesda category 1 and 4 are high1,2.

• The high rate of unsatisfactory specimens might be attributed as the radiolo-gist does the FNAC and onsite cellularity checks are not being carried out.

• We received thyroidectomies on 4/25 cases of Bethesda 4 category and 2 cases were follicular carcinomas, 1 was follicular adenoma and one case was colloid nodule.

• A follow up of all these cases with histopathology correlation was done, whenever the biopsy was done in Universal Hospital.