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Related Experiment Video

Updated: Apr 17, 2026

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Reducing indeterminate thyroid FNAs.

Andrew A Renshaw1, Edwin W Gould

  • 1Department of Pathology, Baptist Hospital, Miami, Florida.

Cancer Cytopathology
|February 4, 2015
PubMed
Summary
This summary is machine-generated.

Modifying thyroid fine-needle aspiration (TFNA) criteria reduced indeterminate diagnoses without impacting malignancy risk. This approach also eliminated false positives, unlike standard Bethesda criteria.

Keywords:
cytologydiagnosisfine-needle aspirationindeterminateneoplasiaresectionrisk of malignancythyroid

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Area of Science:

  • Cytopathology
  • Surgical Pathology
  • Endocrinology

Background:

  • The Bethesda System for Reporting Thyroid Cytopathology aims to reduce indeterminate diagnoses.
  • Limited evidence exists on effective strategies to decrease indeterminate thyroid fine-needle aspirations (TFNAs) and their clinical impact.

Purpose of the Study:

  • To evaluate the impact of modifying Bethesda criteria on the rate of indeterminate TFNAs.
  • To assess the correlation between modified criteria and histologic follow-up outcomes, including malignancy risk and false-positive rates.

Main Methods:

  • Authors revised Bethesda criteria, reassigning indeterminate cases to "suspicious for papillary carcinoma" or "favor benign" categories.
  • This modification was applied over an 18-month period.
  • Results were correlated with subsequent histologic findings.

Main Results:

  • The indeterminate TFNA rate significantly decreased from 14.4% (Bethesda) to 8.2% (modified Bethesda; P < .001).
  • No significant difference in malignancy risk was observed between the groups (23.6% vs 17.3%; P = .39).
  • The modified criteria group had no false-positive diagnoses, unlike the Bethesda group (P = .06).

Conclusions:

  • Modifying Bethesda criteria effectively reduces indeterminate TFNA diagnoses.
  • This modification does not compromise the assessment of malignancy risk.
  • The modified criteria demonstrate independence from the overall malignancy rate, unlike the standard Bethesda criteria.