Thyroid malignancy rates according to the Bethesda reporting system in Israel - A multicenter study

Ory Madgar*, Galit Avior, Isaac Shochat, Ben Zion Joshua, Lior Baraf, Yuval Avidor, khafif Avi khafif, Niddal Assadi, Eran E. Alon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: The Bethesda System for Reporting Thyroid Cytopathology was developed in 2007 to facilitate an accurate, reproducible communication of thyroid fine-needle aspiration (FNA) interpretations between clinicians and cytopathologists and to serve as a guide for treatment. Based on large patient series, the system details the risk of malignancy for each category as well as a suggested management for each FNA result. Though this system has been widely adopted, there are only few studies to determine whether results are applicable for Israel. Methods: A multicenter, retrospective analysis of medical charts of all patients who underwent thyroid surgery between January 1st, 2012 and December 31st, 2016 in four medical centers in Israel was performed. Data was analyzed for the overall risk of malignancy for the Bethesda system groups as well as comparison between the different laboratories performing the test. Results: Records of 810 thyroidectomies in which preoperative cytological reports and final pathology were available and reviewed. The malignancy rates according to the Bethesda groups’ I-VI for our cohort were: 27.8%, 17.6%, 41.4%, 41.4%, 86.9%, and 98.1% respectively. Similar results were seen when results were analyzed according to the different laboratories performing the tests. Conclusions: Post-surgical review of all Bethesda groups had higher malignancy rates than those reported in the original report. These results indicate a difference in the malignancy rates for the different Bethesda system groups in Israel compared to those reported. Physicians are encouraged to use data validated for their own country or patients’ community in addition to published values.

Original languageEnglish
Pages (from-to)1370-1375
Number of pages6
JournalEuropean Journal of Surgical Oncology
Issue number6
StatePublished - Jun 2021


  • Bethesda system
  • Malignancy rate
  • Nationwide
  • Risk of malignancy
  • Thyroid cancer


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