The Bethesda System for Reporting Thyroid Cytopathology (BSRTC)

  • Idris Tolgay OcalEmail author
  • Mohiedean Ghofrani


Fine needle aspiration (FNA) has been widely accepted as the most accurate and cost-effective method for evaluating thyroid nodules. It is a safe and simple procedure and can be performed by palpation or under image guidance. It has also been established that the sensitivity and specificity of thyroid FNA is greatest for both benign and malignant diagnoses, while in the indeterminate categories, the surgical correlates lack accuracy. To further complicate this issue, there has been a wide range of terminology among cytopathologists for reporting this group of FNAs.

To standardize the terminology for the thyroid FNA reporting and provide better communication among physicians, the National Cancer Institute (NCI) hosted the multidisciplinary “Thyroid Fine Needle Aspiration State of the Science” conference in Bethesda, Maryland, on October 22–23, 2007, with 154 registrants including pathologists, surgeons, endocrinologists, and radiologists. The outcome of this conference was detailed in an atlas in 2010 as the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). A six-tiered reporting system was suggested that included three atypical/indeterminate categories as outlined below:
  • Nondiagnostic or unsatisfactory

  • Benign

  • Atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS)

  • Follicular neoplasm/suspicious for follicular neoplasm (including oncocytic lesions)

  • Suspicious for malignancy

  • Malignant

In this chapter, we summarize the cytopathologic findings and clinical significance of each category in detail, with specific emphasis on the indeterminate category.


The Bethesda system Thyroid FNA Indeterminate category 


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Pathology and Laboratory Medicine, Division of Anatomic Pathology, Department of Laboratory Medicine/PathologyMayo Clinic ArizonaScottsdaleUSA
  2. 2.Cytopathology, PeaceHealth LaboratoriesVancouverUSA

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