Thyroid nodule classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

  • Bethesda System for Reporting Thyroid Cytopathology
    19888858
classification FNA cytology Predicted risk of malignancy
Benign
  • Macrofollicular
  • Adenomatoid/hyperplastic nodules
  • Colloid adenomas (most common)
  • Nodular goiter
  • Lymphocytic thyroiditis
  • Granulomatous thyroiditis
0–3 %
Follicular lesion of undetermined significance
  • Mixed macro- and microfollicular nodules
5–15 %
Atypia of undetermined significance
  • Atypical cells
Follicular neoplasm
  • Microfollicular nodules
    • Hurthle cell lesions
15–30 %
Suspicious for a follicular neoplasm
  • Suspicious for Hurthle cell neoplasm
Malignant
  • PTC (most common)
  • MTC
  • Anaplastic carcinoma
  • High-grade metastatic cancers
97–99 %

The risk of malignancy development based on the FNA result in case of indefinite diagnosis are as below:

  • Nondiagnostic or Unsatisfactory: 1–4 % predicted risk of malignancy.
  • Suspicious for malignancy: 60–75 % predicted risk of malignancy

References

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