J Pathol Transl Med.  2017 Nov;51(6):521-527. 10.4132/jptm.2017.09.26.

Thyroid Fine-Needle Aspiration Cytology Practice in Korea

• Cha YJ
• Pyo JY
• Hong S
• Seok JY
• Kim KJ
• Han JY
• Bae JM
• Kwon HJ
• Kim Y
• Min KW
• Oak S
• Chang S

• KMID: 2396533
• DOI: http://doi.org/10.4132/jptm.2017.09.26

Abstract

We reviewed the current status of thyroid fine-needle aspiration cytology (FNAC) in Korea. Thyroid aspiration biopsy was first introduced in Korea in 1977. Currently, radiologists aspirate the thyroid nodule under the guidance of ultrasonography, and cytologic interpretation is only legally approved when a cytopathologist makes the diagnosis. In 2008, eight thyroid-related societies came together to form the Korean Thyroid Association. The Korean Society for Cytopathology and the endocrine pathology study group of the Korean Society for Pathologists have been updating the cytologic diagnostic guidelines. The Bethesda System for Reporting Thyroid Cytopathology was first introduced in 2009, and has been used by up to 94% of institutions by 2016. The average diagnosis rates are as follows for each category: I (12.4%), II (57.9%), III (10.4%), IV (2.9%), V (3.7%), and VI (12.7%). The malignancy rates in surgical cases are as follows for each category: I (28.7%), II (27.8%), III (50.6%), IV (52.3%), V (90.7%), and VI (100.0%). Liquid-based cytology has been used since 2010, and it was utilized by 68% of institutions in 2016. The categorization of thyroid lesions into "atypia of undetermined significance" or "follicular lesion of undetermined significance" is necessary to draw consensus in our society. Immunocytochemistry for galectin-3 and BRAF is used. Additionally, a molecular test for BRAF in thyroid FNACs is actively used. Core biopsies were performed in only 44% of institutions. Even the institutions that perform core biopsies only perform them for less than 3% of all FNACs. However, only 5% of institutions performed core biopsies up to three times more than FNAC.

Keyword

Bethesda; Fine needle aspiration cytology; Thyroid neoplasms; Korea

MeSH Terms

Biopsy
Biopsy, Fine-Needle*
Biopsy, Needle
Consensus
Diagnosis
Galectin 3
Immunohistochemistry
Korea*
Pathology
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule
Ultrasonography
Galectin 3

Figure

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  Fig. 1. The diagnosis rate of each institution by the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category.

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  Fig. 2. (A) The malignancy rates for overall cytologic diagnoses are as follows for each category: I (1.8%), II (0.7%), III (6.3%), IV (19.1%), V (51.9%), and VI (63.5%). (B) The malignancy rates for surgical cases are as follows for each category: I (28.7%), II (27.8%), III (50.6%), IV (52.3%), V (90.7%), and VI (100.0%).

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