What is the Bethesda system for thyroid cytopathology used in the diagnosis of papillary thyroid carcinoma (PTC)?

Updated: Jun 18, 2020
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

Cytological analysis of FNAB specimens is used to estimate malignancy risk. The most appropriate cytological classification of malignancy risk is the Bethesda system for thyroid cytopathology, which comprises the following categories [68] :

  • Malignant (risk 97-99%)
  • Suspicious for malignancy (risk 60-75%)
  • Follicular neoplasm or suspicious for follicular neoplasm (risk 15-30%)
  • Atypia of undetermined significance or follicular lesion of undetermined significance (risk 5-15% based on repeated atypicals)
  • Non-diagnostic or unsatisfactory (risk 1-4%)
  • Benign (risk 0-3%)

For cytology “diagnostic of” or “suspicious for” papillary thyroid cancer, surgery is recommended. If FNAB cytology is indeterminate, the use of molecular markers such as BRAF, RAS, RET/PTC, Pax8-PPARɣ, or galectin-3 may be considered to guide management. [65]


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