The 2017 Bethesda System for Reporting Thyroid Cytopathology

Area of Science:

• Cytopathology
• Oncology
• Endocrinology

Background:

• The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a standardized framework for thyroid fine-needle aspiration (FNA) specimen analysis.
• The 2017 revision maintains the established six diagnostic categories, ensuring consistent reporting.
• Each category is associated with a specific risk of malignancy, guiding clinical decisions.

Purpose of the Study:

• To present the key updates and reaffirmations of the 2017 revision of the TBSRTC.
• To detail the updated malignancy risk stratification for each diagnostic category.
• To outline the evidence-based clinical management recommendations linked to these categories.

Main Methods:

• Review and reaffirmation of the six diagnostic categories of the TBSRTC.
• Updating malignancy risk estimates based on post-2010 data.
• Integrating updated clinical management guidelines and considerations for NIFTP.

Main Results:

• The six TBSRTC categories remain unchanged: Nondiagnostic/Unsatisfactory, Benign, AUS/FLUS, Follicular Neoplasm/Suspicious for FN, Suspicious for Malignancy, and Malignant.
• Malignancy risks for each category have been updated using recent data.
• Clinical management recommendations are now evidence-based and aligned with updated risk stratification.

Conclusions:

• The 2017 TBSRTC revision ensures standardized thyroid FNA reporting with updated risk stratification and management guidelines.
• The classification of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is incorporated, impacting malignancy risk assessment.
• Consistent application of the TBSRTC categories and associated guidelines aids in optimal patient management.