Evaluating Thyroid Lesions Using Fine-Needle Aspiration Cytology and the Bethesda System - Insights From a Tertiary Care Hospital

Sep 28, 2026

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Thyroid enlargement is commonly assessed with multiple modalities, yet fine-needle aspiration cytology (FNAC) remains central for accurate diagnosis and surgical decision-making. A combined prospective and retrospective study of 282 patients with thyroid lesions at AIIMS Deoghar (Aug 2023–Mar 2025) classified FNAC samples using the 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Results showed 85.1% benign cases (Bethesda II) and about 15% indeterminate or suspicious/malignant categories (III–VI). Gender correlated with cytological diagnosis, and the Bethesda System stratified malignancy risk to support evidence-based management.

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Abstract

Introduction

Materials and methods

Results

Conclusion

How to cite this article

Review began 11/07/2025 Review ended 11/24/2025 Published 12/01/2025 © Copyright 2025 Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98277 Open Access Original Article Evaluating Thyroid Lesions Using Fine-Needle Aspiration Cytology and the Bethesda System: Insights From a Tertiary Care Hospital Nikhil Kumar 1 , Nishi . 2, Nidhi Priya Barla 2, Ranwir Sinha 1, Rahul Kumar Bharti 1, Prima Lakra 3, Monalisa Katyare 2, Dheeraj Kumar 4 , Sanjeet Singh 1 1. Pathology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND 2. Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND 3. Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND 4. Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Deoghar, Deoghar, IND Corresponding author: Prima Lakra, [prima.lakra2006@gmail.com](prima.lakra2006@gmail.com) Abstract Introduction Thyroid enlargement is a common clinical condition often evaluated by various modalities, but fine-needle aspiration cytology (FNAC) remains the gold standard for accurate diagnosis and surgical decision-making. This study aimed to assess the cytological spectrum of thyroid lesions and evaluate the impact of FNAC in reducing unnecessary surgical interventions in a tertiary care center. Materials and methods A combined prospective and retrospective study was conducted on 282 patients with thyroid lesions at the All India Institute of Medical Sciences, Deoghar, Deoghar, Jharkhand, India, from August 2023 to March 2025. FNAC samples were classified according to the 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) . Clinical and cytomorphological data were analyzed to determine lesion distribution and malignancy risk. Results The majority of cases (85 . 1%) were benign (Bethesda category II), with colloid goiter (42 .55%) and lymphocytic thyroiditis (28 .01%) being most prevalent. Indeterminate (category III) and suspicious/malignant lesions (categories IV-VI) collectively accounted for approximately 15% of cases. Nonon-diagnostic samples were reported, attributed to on-site adequacy evaluation and ultrasound-guided aspirations. A significant association was observed between gender and cytological diagnosis (p=0 .010), with lymphocytic thyroiditis being more common in females and suspicious papillary carcinoma more frequent in males. Confirmed papillary carcinoma constituted 1.8% of cases, comparable to previous studies. The Bethesda System effectively stratified malignancy risk, guiding appropriate clinical management. Conclusion FNAC is a cost-effective, minimally invasive tool that reliably distinguishes benign from malignant thyroid lesions, thereby reducing unnecessary surgeries. The Bethesda System standardizes reporting and enhances communication between clinicians and pathologists, supporting evidence-based management. Ultrasound guidance and strict adherence to adequacy criteria optimizes diagnostic yield, making FNAC indispensable in thyroid lesion evaluation. Categories: Pathology Keywords: bethesda system of reporting thyroid cytopathology, colloid goiter, fine needle aspiration cytology (fnac), fna, thyroid cytology Introduction Thyroid enlargement is one of the most frequently encountered clinical conditions in routine medical practice [1] . Although various diagnostic modalities, such as physical examination, ultrasound (USG), and thyroid scintigraphy, are commonly employed to evaluate thyroid abnormalities, they often lack the specificity and sensitivity required for definitive diagnosis [2] . In contrast, fine-needle aspiration (FNA) has gained widespread acceptance as a first-line diagno

FAQs

What was the purpose of the study on thyroid lesions?

To assess the cytological spectrum of thyroid lesions and evaluate how FNAC helps reduce unnecessary surgical interventions in a tertiary care center.

How were FNAC samples classified in the study?

FNAC samples were classified according to the 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), using clinical and cytomorphological data.

What did the study find about benign versus suspicious/malignant cases?

Most cases were benign (Bethesda II, 85.1%), while indeterminate (III) and suspicious/malignant (IV–VI) categories together accounted for about 15%.

Sep 28, 2026

Uploaded by Kurz