Thyroid cytology reporting in the local setting based on the Bethesda system: Testing the water and looking beyond!

Thyroid diseases are common in our setting leading to significant morbidity [1]. According to National Cancer incidence data thyroid malignancies were the 3 commonest malignancy in women in 2010. In men, thyroid malignancies were placed 3 among the age group 15-34 years and 5th among 35-49 years [2]. Thyroid fine needle aspiration cytology test (FNAC) is a front line investigation to assess the possibility of a neoplasm in patients presenting with thyroid nodules. The original ‘Thy’ classification of the British thyroid association of the Royal College of pathologists of United Kingdom (RCP UK) formed the basis for thyroid FNAC reporting in Sri Lanka, since 2007[3]. In May 2014, the College of Pathologists of Sri Lanka initiated a dialog with the clinical stakeholders regarding issues related to the ‘Thy’ based FNAC reporting. Following discussions at a workshop attended by representatives from the Colleges of Pathologists, Radiologists, Surgeons and Endocrinologists, the Bethesda system (TBSRTC) was adopted for thyroid FNAC reporting in our setting [4]. Reporting the risk of subsequent malignancy (ROM) for each category was however not adopted till the availability of local data. The hand book titled ‘Thyroid Cytology Reporting. National Guidelines for Sri Lanka’ (NGSL) based on TBSRTC was published by the Ministry of Health in 2016 [5]. Currently NGSL forms the frame work for thyroid FNAC reporting in our setting. Some concerns have since been expressed regarding TBSRTC based NGSL guidelines.