A Comparisson of the Bethesda Thyroid Criteria: Academic and Community Hospital Experiences
Johann Hertel, Sara Wobker, Keith Volmer, Keith Nance, Susan Maygarden. University of North Carolina at Chapel Hill, Chapel Hill, NC; Rex Healthcare, Raleigh, NC
Background: In 2008 the Bethesda criteria were introduced to standardize the nomenclature for the interpretation and reporting of thyroid fine needle aspirations (FNA). Since its introduction, the Bethesda criteria have gained wide spread acceptance. While its use has standardized the terminology for reporting thyroid FNAs, the application, specifically, the use of atypia of undetermined significance (AUS) has been controversial and reported rates and usage vary. As a quality control measure we compared retrospective data from the initial use of the Bethesda Criteria and malignancy rates at a tertiary academic center and an affiliated community practice.
Design: The electronic databases for each institution were searched for all fine needle aspirates of the thyroid since the Bethesda criteria were adopted at the respective institution. Rates for each Bethesda category were determined for each institution and all cases were correlated with subsequent surgical resections if performed. Statistical analysis comparing the rates of Bethesda category usage and malignancy rates was performed using a Z-test for proportions.
Results: A total of 1038 thyroid FNA's were performed at the community hospital and 997 were performed at the academic medical center. The rates of use for all Bethesda categories except category VI (positive for malignancy) showed statistical significance. The most notable absolute differences were in the use of AUS significance and benign thyroid nodule (BTN). The community practice demonstrated a significantly lower rate of AUS (2.7% versus 14.2%, p<0.05) with a significantly higher rate of BTN (75.4% versus 63.6%, p<0.05). Despite the significantly higher rates of BTN at the community practice, there were more surgeries (p<0.05)with a trend lower malignancy rate at the community hospital (p<0.10) on cases with a diagnosis of BTN. The higher use of AUS at the academic center resulted in a lower rate of surgeries for cases with a diagnosis of AUS.
Conclusions: While there was, a higher rate of BTN use in the community setting there was no increased malignancy rate in the corresponding resections, implying that more liberal use of AUS at the academic center may not help identify additional malignant cases. However, it was also noted that there were significantly more surgical resections in the BTN category at the community hospital, indicating that a more conservative use of the AUS category may not reduce the number of surgical excisions.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 290, Tuesday Morning