Comparison of Bethesda cytopathology classification to surgical pathology across racial-ethnic groups

Head Neck. 2019 Jul;41(7):2340-2345. doi: 10.1002/hed.25707. Epub 2019 Feb 21.


Background: The Bethesda System standardized the reporting of thyroid cytopathology and created categories to provide an estimation of a nodule's risk of malignancy. There are limited data describing their utility in different racial-ethnic groups.

Methods: A retrospective chart review of thyroid fine-needle aspirations (FNA) was performed within our health-care systems. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) were calculated for the total cohort, and racial-ethnic groups.

Results: The sensitivity, specificity, PPV, and NPV of the entire cohort was 93%, 77%, 57%, and 97%. Among patients who underwent surgery, African Americans contained a high number of Bethesda II FNAs (63%) compared to Hispanics (48%) and whites (45%). The sensitivity, specificity, and NPV were comparable among groups, the PPV was lowest for African Americans (43%), followed by Hispanics (60%) and whites (69%).

Conclusions: The Bethesda system's predictive value may differ among racial-ethnic groups.

Keywords: Bethesda system; fine-needle aspiration biopsy; prevalence; test characteristics; thyroid.