4.6 Article

The 2023 Bethesda System for Reporting Thyroid Cytopathology

Journal

THYROID
Volume -, Issue -, Pages -

Publisher

MARY ANN LIEBERT, INC
DOI: 10.1089/thy.2023.0141

Keywords

thyroid; cytopathology; fine-needle aspiration; terminology; bethesda; follicular neoplasm; cancer; molecular testing

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Since its first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has provided a standardized reporting system for thyroid fine needle aspirations. The third edition offers key updates, including a single name for each diagnostic category, updated risk of malignancy data, and additional discussion on pediatric thyroid disease and molecular testing. The nomenclature has been aligned with the 2022 World Health Organization Classification of Thyroid Neoplasms, and new chapters on molecular testing and clinical perspectives have been added.
Since the publication of the first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has allowed cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations. The third edition builds on the success of the 2 earlier editions and offers several key updates. The most important is the assignment of a single name for each of the 6 diagnostic categories: (i) nondiagnostic; (ii) benign; (iii) atypia of undetermined significance; (iv) follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. Each of the categories has an implied risk of malignancy (ROM), which has been updated and refined based on data reported after the second edition. The third edition offers an average ROM for each category, in addition to the expected range of cancer risk. The atypia of undetermined significance subcategorization is simplified into 2 subgroups based on the implied ROM and molecular profiling. A discussion of pediatric thyroid disease has been added, and pediatric ROMs and management algorithms are discussed in the relevant sections. Nomenclature has been updated to align with the 2022 World Health Organization Classification of Thyroid Neoplasms. Two new chapters have been added: one that addresses the significant and expanded use of molecular and ancillary testing in thyroid cytopathology, and another that summarizes clinical perspectives and imaging findings in thyroid disease.

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