Prediction of cytology–histology discrepancy when Bethesda cytology reports benign results for thyroid nodules in women: with special emphasis on pregnancy

ABSTRACT

Objectives: Benign category of Bethesda classification is generally well known to carry a false-negative rate of 0–3%. The current study was designed to investigate the rate of false-negative cytology in patients who underwent thyroidectomy for presumably benign thyroid diseases. Predictive risk factors for false results and malignancy were evaluated along with cytology–histology discrepant cases.

Materials and methods: Females who underwent thyroidectomy between May 2014 and December 2022 were included. Demographics, ultrasound (US) features, fine-needle aspiration (FNA) diagnosis, surgical indications and outcomes, final histology reports, risk factors, and malignancy rate were recorded. Cytology–histology discrepant cases were further evaluated for interpretation errors and risk factors. Statistical analyses were performed using Fisher’s exact and Mann–Whitney U tests.

Results: Of 581 women with a benign thyroid disease who underwent thyroidectomy, 91 was diagnosed as incidental carcinoma (15.6%) and most was T1a (4.9 ± 2.7 mm, 95.6%). Final histology reports revealed mostly papillary carcinoma (93.4%). Predictors of malignancy such as age, family history, previous radiation exposure, and iodine-deficient diet did not help in risk stratification (p > 0.05, for each). However, FNA taken during pregnancy was determined as a risk factor (n = 7, 7.6%, p < 0.05) since it may cause a delay in diagnosis. Cytology–histology discrepant cases were seen to be mostly due to sampling errors (45%, p < 0.05), followed by misinterpretations (37.3%, p < 0.05). There was no reason for discrepancy in 17.5%, and this was linked to inherent nature of thyroid nodule with overlapping cytologic features. Best identifiable risk factor for misinterpretation was pregnancy as well (n = 5, 14.7%, p < 0.05).

Conclusions: Risk of malignancy in a presumably benign thyroid disease should not be ignored. Radiology–cytology correlation by an experienced dedicated team may help in decreasing sampling errors. Physiologic changes caused by pregnancy may shade malignant transformation in thyrocytes, and it would be appropriate to be cautious about benign FNA taken during this period.

KEYWORDS:

• Fine-needle aspiration (FNA)
• Bethesda cytology
• false negative
• cytology–histology discrepancy
• pregnancy

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Data from this study are available upon request since there are legal restrictions (by the Ministry of Health) on sharing data publicly. However, we anonymized the patients’ identities and protocol numbers on the system and saved whole data in Excel form; corresponding author will send them by email ([email protected]) on request.

Author contributions

Conceptualization: EU AF

Data curation: EU

Formal analysis: AF

Investigation: AF, EU

Methodology: EU

Project administration: EU

Supervision: EU

Validation: AF

Writing – original draft: EU

Writing – review & editing: EU

Additional information

Funding

The authors received no specific funding for this work.