Volume 35, Issue 6 pp. 715-723

ORIGINAL ARTICLE

The Bethesda System for Reporting Thyroid Cytopathology in the African American population: A tertiary centre experience

Carla Saoud,

Carla Saoud

orcid.org/0000-0002-4540-6990

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Gabrielle E. Bailey,

Gabrielle E. Bailey

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Ashleigh J. Graham,

Ashleigh J. Graham

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Zahra Maleki,

Corresponding Author

Zahra Maleki

[email protected]

orcid.org/0000-0003-3273-4802

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence

Zahra Maleki, Department of Pathology, Division of Cytopathology, Johns Hopkins Hospital, 600 N. Wolfe Street, Pathology 412C, Baltimore, MD 21287, USA.

Email: [email protected]

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Carla Saoud,

Carla Saoud

orcid.org/0000-0002-4540-6990

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Gabrielle E. Bailey,

Gabrielle E. Bailey

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Ashleigh J. Graham,

Ashleigh J. Graham

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Zahra Maleki,

Corresponding Author

Zahra Maleki

[email protected]

orcid.org/0000-0003-3273-4802

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence

Zahra Maleki, Department of Pathology, Division of Cytopathology, Johns Hopkins Hospital, 600 N. Wolfe Street, Pathology 412C, Baltimore, MD 21287, USA.

Email: [email protected]

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First published: 29 July 2024

https://doi.org/10.1111/cyt.13426

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Abstract

Background

The reported risk of malignancies (ROM) remains controversial for fine needle aspiration (FNA) of thyroid nodules in the African American (AA) population. Herein, the ROM along with frequency was assessed for each of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories.

Materials and Methods

The electronic pathology archive of a large academic hospital was retrospectively searched for cytopathology reports of thyroid nodules in AA patients (2010–2019) and Non-African American (NAA) control cases. The patients' demographic, thyroid nodule characteristics, FNA results using TBSRTC and surgical diagnoses were recorded, whenever available.

Results

Three hundred ninety-one cases were identified, 317 females (81.1%) and 74 males (18.9%) with median age 50.0 (SD = 14.4). The mean size of the nodules was 2.1 cm (SD = 1.4). The Bethesda categories were: 5.4% (I), 35.0% (II), 35.3% (III), 7.7% (IV), 3.3% (V) and 13.3% (VI). The overall ROM of thyroid nodules was 43.8% (89/203) on surgical follow-up (203/391). The ROM in each Bethesda categories were: 33.3% (I), 11.6% (II), 35.2% (III), 15.8% (IV), 83.3% (V) and 100% (VI) on surgical follow-up. The frequency of thyroid nodules was higher in AA females; however, the ROM was higher in AA males (48.3%) compared with AA females (41.2%).

Conclusion

The ROM in Categories I, II and III was higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in our AA patient population was higher than those in the literature. The overall ROM of thyroid nodules in AA males was higher than of AA females.

Graphical Abstract

The thyroid nodules are more frequently seen in African American females than males while the risk of malignancy is higher in thyroid nodules in males. The risk of malignancy in Categories I, II and III is higher than those reported in the TBSRTC while being similar in Categories IV, V and VI.

Thyroid nodules are more frequently seen in African American (AA) females than AA males while the risk of malignancy is higher in thyroid nodules in males. In African Americans, the risk of malignancy in Categories I, II and III is higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in this AA patient population is higher (43.8%) than the previously reported overall risk of malignancy (36%) in the literature.

CONFLICT OF INTEREST STATEMENT

The authors have no financial conflicts of interest to declare.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Volume35, Issue6

November 2024

Pages 715-723