Thyroid cytology comes to Bethesda.

As outlined, the Bethesda system for reporting gyne-cologic cytopathology (TBS) has been taken as a model for consensus building and reporting in thyroid-fine needle aspiration (FNA) cytology. 1 The history of this process is reviewed in the article in this issue of the Journal by Cibas and Ali. 2 In parallel with the evolutionary path taken by the gynecologic materials, the current effort has been the subject of an international conference, comment periods, and multiple iterations of a summary statement, as well as the anticipation of future meetings and refinements. All who work in the field of thyroid cytology will welcome this effort at standardization. As with past TBS initiatives, it involves not only cyto-pathologists, but also specialists in medical imaging and interested clinicians. The result is a patient care–oriented effort relevant to all who work in this area. Since much of this effort is hosted by the National Cancer Institute (NCI)—in this case headed by Andrea Abati, MD—the term TBS seems to have become generalized as an important imprimatur for consensus efforts in clinically oriented cytopathology. I am confident that we will come to call the various versions of this evolving document TBS-Thyroid (TBST). Largely of historic interest in most of our practices is a similar consideration of breast FNA. 3 A key feature of this and other NCI summary statements in cytopathology is a clear effort to link reliable cytodi-agnostic criteria to diagnostic terminology that accurately reflects outcome expectations that are, in turn, facilitated by consensus-derived patient management guidelines. I am pleased to have been asked to comment on the current iteration of TBST in this issue of the Journal. This framework document mirrors that of the text/atlas that has or will soon appear in print, as well as online. It is stylistically telegraphic and does not address many details found in the much longer NCI document or in the text/atlas. Many interested practitioners will want to consult both or either of the latter. 1 My own perspective is that of an individual in a very busy private practice; I see a great many thyroid FNAs that have been collected in a variety of clinical settings by individuals who range from quite skilled to apparently somewhat unschooled in FNA technique and in specimen preparation. Before considering the current methods and nosology of thyroid cytopathology, it may be useful to observe a clinical trend noted in my own practice …