Implementation of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) Has Little Impact on the Rate of Diagnostic Errors or the Rate of Frozen Sections Requested for Thyroid Lesions
O Hameed, A Linder, C Salih, J Roberson, I Eltoum. University of Alabama at Birmingham, Birmingham, AL
Background: The Bethesda System for reporting thyroid cytopathology (BSRTC) has been suggested to make the cytology report “concise, clear, consistent and clinically relevant”. In this study, we assessed whether improvement in quality of reporting has an impact on the rate of frozen sections requested during surgery.
Design: The study included all patients who underwent thyroid fine needle aspiration (FNA) from April 2006 to April 2009. Before implementation of BSRTC, we used generic categories for all non-gynecologic cytology: unsatisfactory, benign, reactive, atypical, and suspicious or positive for malignancy with a generous use of free text. Diagnoses before implementation were reconstructed to fit BSRTC. The rates of frozen section requested during surgery before and after implementation of BSRTC were compared using Chi-square and Fisher's exact test. Differences were considered significant at p < 0.05.
Results: We received 1671 FNAs (957 before and 714 after implementation of BSRTC) from 1339 patients, with 256 FNAs obtained from more than one site and 86 follow-up FNAs. 301 patients (191 before and 110 after implementation) had surgical resection. The rate of surgery after diagnosis remained the same, 72% before vs. 76% after implementation. The rate of frozen section before, 13.6% (26/191) was not statistically different than after, 20% (22/110), implementation of BSRTC. Within cases that had frozen section, 27% (13/48) were incorrectly diagnosed on cytologic examination compared to 13% (6/48) frozen section examinations. The difference was not statistically significant. There was no difference in these errors before or after implementation of BSRTC.
Conclusions: Implementation of BSRTC improves the quality of reporting but has little impact on frozen section rates or diagnostic errors for cases that are subjected to intra-operative consultation.
Tuesday, March 23, 2010 1:00 PM
Platform Session: Section D, Tuesday Afternoon