The 2023 Bethesda System for Reporting Thyroid Cytopathology
- Study type
- Clinical guideline
- Study name
- Bethesda 2023 (TBSRTC)
- Design
- Third edition of a standardised reporting system (guideline) for thyroid fine-needle aspiration cytopathology
- Source
- Thyroid® · 2023
In plain words
When a nodule is found in your thyroid, a sample may be taken from it with a thin needle. A pathologist looks at the sample under a microscope and reports the result in one of 6 standard groups. Each group carries a known chance of cancer, and your doctor uses it to decide the next step. In the new edition, the group names are more uniform and a section on thyroid disease in children has been added.
Key points
Key guideline recommendations
- Level of evidence not stated in the abstract
Each of the 6 diagnostic categories has been given a single name: (1) nondiagnostic; (2) benign; (3) atypia of undetermined significance; (4) follicular neoplasm; (5) suspicious for malignancy; (6) malignant.
- Level of evidence not stated in the abstract
Each category has an implied risk of malignancy (ROM). For each category the third edition gives the average ROM in addition to the expected range of cancer risk.
- Level of evidence not stated in the abstract
Subcategorisation of atypia of undetermined significance has been simplified into 2 subgroups based on implied ROM and molecular profile.
- Level of evidence not stated in the abstract
ROMs and management algorithms for paediatric thyroid disease are discussed in the relevant sections, and the nomenclature has been aligned with the 2022 World Health Organization classification of thyroid neoplasms.
Study population
This document is not a clinical trial. It applies to thyroid fine-needle aspiration (FNA) specimens, and this edition also includes a section dedicated to paediatric thyroid disease.
Endpoints
Not a trial with a defined endpoint. The system defines an implied risk of malignancy (ROM) for each of the 6 diagnostic categories. In the third edition, these risks have been updated and refined on the basis of data published since the second edition.
Safety and side effects
According to the abstract, this document does not address safety or treatment-related adverse events.
Clinical significance and place in guidelines
This edition makes the language of thyroid cytopathology reporting more uniform and pairs each diagnostic category with an updated risk of malignancy to better support clinical decision-making. The abstract also covers paediatric management algorithms and the role of molecular testing. The management recommendations for each category are not detailed in the abstract and should be checked in the full paper. Its adoption in other clinical guidelines should also be checked separately.
Limitations
The abstract does not report quantitative data (such as the ROM values for each category) or the levels of evidence of the recommendations. The full text must be consulted for exact figures and management recommendations.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.