Impact of thyroid Bethesda category IV (follicular neoplasm) terminology unification on atypia of undetermined significance reporting patterns in thyroid fine-needle aspiration
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View abstract on PubMed
Summary
This summary is machine-generated.The 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) update did not increase atypia of undetermined significance (AUS) diagnoses. Thyroid fine-needle aspiration (FNA) cases showed no overall change in AUS incidence after the terminology unification.
Area Of Science
- Cytopathology
- Thyroid Pathology
- Diagnostic Accuracy
Background
- The 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) unified Category IV terminology, replacing "suspicious for a follicular neoplasm" with "follicular neoplasm (FN)."
- Concerns existed that this change might lead to under-calling FN and increased use of the atypia of undetermined significance (AUS) category, especially since many FN diagnoses are benign upon resection.
- This study aimed to evaluate the impact of the 2023 TBSRTC terminology change on FN and AUS diagnoses in thyroid fine-needle aspiration (FNA) cases.
Purpose Of The Study
- To investigate the influence of the 2023 TBSRTC terminology change on the distribution of follicular neoplasm (FN) and atypia of undetermined significance (AUS) diagnoses.
- To assess whether the unification of Category IV terminology led to an increased assignment of cases to the AUS category.
Main Methods
- A retrospective review of 3173 thyroid FNAs at Johns Hopkins Hospital was performed.
- Cases were categorized into "Pre-2023 TBSRTC" and "Post-2023 TBSRTC" groups based on the implementation date.
- Incidences of AUS and FN diagnoses were compared between the two groups using Z-tests.
Main Results
- Overall AUS incidence remained statistically unchanged post-2023 TBSRTC implementation (16.2% pre vs. 14.2% post; P = 0.1554).
- Within the AUS category, there was a significant increase in AUS-nuclear atypia diagnoses (33.0% to 50.3%; P = 0.0002).
- Conversely, AUS-Other diagnoses (architectural or mixed atypia) significantly decreased (56.4% to 41.0%; P = 0.0014).
Conclusions
- The 2023 TBSRTC terminology unification did not lead to an increased overall incidence of AUS diagnoses.
- Contrary to initial concerns, the study observed a significant decrease in AUS-Other diagnoses, not an increase.
- The updated nomenclature and subclassification framework of the 2023 TBSRTC did not negatively impact diagnostic distribution towards the AUS category.
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