Bethesda Categorization of Thyroid Nodule Cytology and Prediction of XXXX Type and Prognosis.

@entity1 @entity3557 @entity5 @entity259 @entity3 @entity14764 @entity204
BACKGROUND: Since its inception, the Bethesda System for Reporting Thyroid Cytopathology ( @entity14764 ) has been widely adopted. Each category conveys a risk of @entity5 and recommended next steps, though it is unclear if each category also predicts the type and extent of @entity5 . If so, this would greatly expand the utility of the @entity14764 by providing prognostic information in addition to baseline @entity5 risk. METHODS: All @entity1 prospectively enrolled into the authors' thyroid nodule database from 1995 to 2013 with histologically proven @entity5 were analyzed. The primary ultrasound-guided fine-needle aspiration cytology (AUS, atypia of unknown significance; @entity5 ; SUSP, suspicious; M, malignant) was correlated with the type of @entity259 and histological features known to impact prognosis and recurrence, including lymph node @entity3 (LNM), @entity3 , and extrathyroidal extension (ETE). Primary cytology was separately correlated with higher risk @entity5 . RESULTS: A total of 1291 @entity5 were identified, with primary cytology AUS in 130 cases, FN in 241 cases, SUSP in 411 cases, and M in 509 cases. AUS, SUSP, and M cytology were progressively associated with an increasing risk of high-risk disease (p   <   0.001), LNM (p   <   0.001), ETE (p   <   0.001), and margin positivity (p   <   0.001). Notably, 71% of @entity5 with AUS cytology were follicular variants of @entity3557 compared with 63% with SUSP cytology and only 20% with M cytology. In contrast, high-risk @entity5 were diagnosed in only 4% with AUS cytology, but 9% and 27% with SUSP and M cytology, respectively. FN conveyed a significantly increased risk of @entity259 compared with all other types (28% vs. 2%; p   <   0.001). A composite endpoint of recurrence, distant metastases, and @entity204 similarly increased as cytology progressed from AUS to SUSP to M (p   <   0.001). CONCLUSION: In addition to predicting @entity5 prevalence, the @entity14764 also imparts important prognostic information about @entity5 type, variant, and risk of recurrence. These data extend the utility of @entity14764 classification by fostering an improved understanding of the risk posed by any confirmed @entity5 .
