Thyroid FNA — Bethesda 2023 categories at a glance
Author: Faruk Skenderi, MD, PhDReviewed by: Semir Vranić, MD, PhDLast reviewed:
- Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2023;33(9):1039-1044. https://doi.org/10.1089/thy.2023.0141 (opens in new tab)
- Ali SZ, VanderLaan PA, eds. The Bethesda System for Reporting Thyroid Cytopathology. 3rd ed. Springer; 2023.
- Haugen BR, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133. https://doi.org/10.1089/thy.2015.0020 (opens in new tab)
Six diagnostic categories, malignancy risks, and recommended management. Useful pocket reference for cytology rotations and multidisciplinary meetings.
- I — Non-diagnostic: ROM 5–20% (mean 13%), repeat FNA with US guidance.
- II — Benign: ROM 2–7% (mean 4%), clinical follow-up.
- III — Atypia of undetermined significance (AUS): ROM 13–30% (mean 22%), repeat FNA or molecular testing.
- IV — Follicular neoplasm (FN): ROM 23–34% (mean 30%), lobectomy or molecular testing.
- V — Suspicious for malignancy: ROM 67–83% (mean 74%), lobectomy or near-total thyroidectomy.
- VI — Malignant: ROM 97–100% (mean 97%), surgical management based on tumour type.