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Related Concept Videos

Synthesis and Regulation of Thyroid Hormones01:20

Synthesis and Regulation of Thyroid Hormones

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Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
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Updated: May 1, 2026

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
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Modified Bethesda criteria for thyroid aspirates significantly decrease nondiagnostic rates without decreasing

Andrew A Renshaw1, Brian J Schiro2, Neeta Erinjeri3

  • 1Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida.

Journal of the American Society of Cytopathology
|May 21, 2024
PubMed
Summary
This summary is machine-generated.

Modified Bethesda criteria improve thyroid nodule diagnosis by reducing nondiagnostic rates. This study shows altered criteria lower inadequate samples without compromising cancer detection sensitivity.

Keywords:
AdequacyAfirmaCytologyFine-needle aspirationMolecularThyroid

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Area of Science:

  • Cytopathology
  • Thyroid Fine Needle Aspiration (FNA)
  • Diagnostic Accuracy

Background:

  • Thyroid nodule evaluation relies on fine needle aspiration (FNA) cytology.
  • The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) defines adequacy criteria.
  • Previous studies suggest modifying TBSRTC adequacy criteria can improve aspirate adequacy rates.

Purpose of the Study:

  • To prospectively evaluate the performance of modified Bethesda System adequacy criteria.
  • To assess the impact of altered criteria on nondiagnostic rates and diagnostic accuracy.
  • To determine if modifications affect the sensitivity of subsequent molecular testing.

Main Methods:

  • A 6-year prospective study classifying thyroid aspirates with 1-59 follicular cells as "nondiagnostic, favor benign" or "scant but adequate".
  • Scant but adequate cases were categorized as benign (Bethesda category 2) or atypia of undetermined significance (AUS) (Bethesda category 3).
  • Bethesda category 3 cases underwent Afirma molecular testing.

Main Results:

  • Modified criteria reduced the overall nondiagnostic rate from 22% to 10% (P <0.001).
  • The rate of "nondiagnostic, favor benign" was 3%, with a 2.6% risk of malignancy upon follow-up.
  • The rate of "scant but adequate" and benign was 8% (0% risk of malignancy), and "scant but adequate" with AUS was 4% (18% suspicious rate, 50% risk of malignancy).
  • No significant difference in the "suspicious" rate or risk of malignancy was observed compared to standard adequate cases.

Conclusions:

  • Modified Bethesda adequacy criteria effectively decrease nondiagnostic rates in thyroid aspirates.
  • These modifications do not compromise the diagnostic sensitivity for malignancy.
  • Altered criteria offer a valuable approach to improve thyroid FNA sample adequacy.