A COMPARATIVE ANALYSIS OF THYROID CYTOLOGY CLASSIFICATION SYSTEMS: BETHESDA SYSTEM VERSUS FRCPATH, AUSTRALIAN, JAPANESE, AND ITALIAN APPROACHES IN THE INDIAN CONTEXT

Abstract

Objectives: There are many different popular coding systems in use across the world such as Bethesda, FRCPath (UK), the Australian reporting system, the Japanese Thyroid Reporting System, and the Italian classification system. By evaluating the strengths and weaknesses of each system concerning the Indian patient population and health-care infrastructure, this study aims to identify the most suitable approach for accurate thyroid cytology reporting and patient management in India. Methods: A retrospective cohort study was conducted at a tertiary care center in central India following due ethical clearance. A total of 208 cases met the inclusion criteria of this study. The clinical records and the cytological records of these cases were independently analyzed and reclassified by a group of pathologists into all the above-stated thyroid coding systems. Data were collected and analyzed using Microsoft Excel 2016. Results: Approximately 88.46% of the cases were women. Medial lobe was the most common site with prevalence of 80.29%. Colloid goiter is most common cytological diagnosis. Only for 11 cases, there was a difference in coding among these coding systems. Codes 1 and 2 are same in all the coding systems and the main difference identified for cases with Bethesda Codes 3 and 5. Conclusion: The Bethesda coding is simple and reliable for coding thyroid FNAC as it has been reported over the period. The other coding systems can also be used but they will have their long learning curve. Furthermore, Bethesda is being used universally making the report understandable.