Comparison of thyroid fine needle aspiration biopsy results before and after implementation of Bethesda classification

Ozdemir D., Bestepe N., Faki S., Kilicarslan A., Parlak Ö., Ersoy R., ...More

Cytopathology, vol.28, no.5, pp.400-406, 2017 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 28 Issue: 5
  • Publication Date: 2017
  • Doi Number: 10.1111/cyt.12437
  • Journal Name: Cytopathology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.400-406
  • Keywords: Bethesda, diagnostic value, fine needle aspiration biopsy, pre-Bethesda
  • Ankara Yıldırım Beyazıt University Affiliated: Yes


© 2017 John Wiley & Sons LtdObjective: The Bethesda classification was introduced in 2008 to provide standardisation in the evaluation of thyroid fine needle aspiration cytology (FNAC). We compared the diagnostic value of pre-Bethesda and Bethesda classification systems in the differentiation of benign and malignant thyroid nodules. Methods: Medical records of patients who underwent a thyroidectomy between June 2007 and June 2014 were reviewed retrospectively. Nodules evaluated with FNAC before March 2010 were classified as pre-Bethesda (non-diagnostic, benign, indeterminate, suspicious for malignancy and malignant), and those evaluated after March 2010 were considered Bethesda (non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the two classification systems were calculated. Results: There were 1810 nodules in the pre-Bethesda and 5115 nodules in the Bethesda group. The non-diagnostic rate was significantly higher, and benign and suspicious for malignancy rates were lower in Bethesda compared with the pre-Bethesda group (P<.001 for each). When benign cytology was considered negative, and indeterminate, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant cytologies were considered positive, results for pre-Bethesda and Bethesda were as follows: sensitivity, 78.9% and 78.5%; specificity, 86.6% and 97.0%; PPV, 42.8% and 72.6%; NPV, 97% and 97.8%; and accuracy, 85.7% and 95.3%, respectively. Conclusions: Among operated nodules, percentages of benign and suspicious for malignancy cytologies decreased, and percentages of non-diagnostic and uncertain cytologies increased with the implementation of Bethesda. The diagnostic value of FNAC seems to have increased with the use of Bethesda classification.