The Bethesda System for Reporting Thyroid Cytopathology (BSRTC)

Abstract

To address terminology and other issues related to thyroid fine-needle aspiration (FNA), the National Cancer Institute (NCI) hosted the NCI Thyroid FNA State of the Science Conference. The conclusions regarding terminology and morphologic criteria from the NCI meeting led to the Bethesda Thyroid Atlas Project and form the framework for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). For clarity of communication, TBSRTC recommends that each report begin with 1 of 6 general diagnostic categories. The project participants hope that the adoption of this flexible framework will facilitate communication among cytopathologists, endocrinologists, surgeons, radiologists, and other health care providers; facilitate cytologic-histologic correlation for thyroid diseases; facilitate research into the epidemiology, molecular biology, pathology, and diagnosis of thyroid diseases; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. Fine-needle aspiration (FNA) has an essential role in the evaluation of euthyroid patients with a thyroid nodule. It reduces the rate of unnecessary thyroid surgery for patients with benign nodules and appropriately triages patients with thyroid cancer to appropriate surgery. Before the routine use of thyroid FNA, the percentage of surgically resected thyroid nodules that were malignant was 14%. 1 With current thyroid FNA practice, the percentage of resected nodules that are malignant surpasses 50%. 2 It is critical that cytopathologists communicate thyroid FNA interpretations to referring physicians in terms that are succinct, unambiguous, and clinically helpful. Historically, terminology for thyroid FNA has varied significantly from one laboratory to another, creating confusion in some cases and hindering the sharing of clinically meaningful data among multiple institutions. served as chair of the Terminology and Morphologic Criteria committee. Preparations for the conference began 18 months earlier with the designation of a steering committee, coordination with cosponsoring organizations, and the establishment of a dedicated, permanent Web site. Literature reviews were limited to English language publications dating back to 1995, using PubMed as the search engine, with key words determined by the committee members. The first draft of the committees' summary documents