Not All Bethesda 1 Thyroid Nodules Were Created Equal: Different B1 Subgroups

Neta Raveh Gildin, Hector Cohen, Ohad Ronen

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The Bethesda System for Reporting Thyroid Cytopathology is a uniform method used worldwide to report thyroid fine-needle aspiration (FNA) outcomes. This study focuses on the Nondiagnostic/Unsatisfactory category, designated as Bethesda1 (B1). The documented risk of malignancy for B1 nodules can vary significantly, implying this category is not homogenous and might be composed of different subtypes. Our hypothesis was that B1 subgroups (blood only, insufficient thyrocytes, cyst content) will vary in their malignancy rate. Methods: The study design was observational and retrospective. The study population included 154 patients in the Galilee Medical Center who underwent FNA examination of the thyroid gland from 2013-2018 and had a B1 result. We looked at the final diagnosis of malignant or benign for patients who underwent surgery and calculated the malignancy rate for each subgroup. Results: Malignancy rates were higher in the Blood subgroup than in the other subgroups, and higher in the Thyrocytes subgroup than in the Cyst subgroup (P <.05). All malignancies were papillary thyroid carcinomas. There was no significant difference in the malignancy rate when we further divided the B1 samples into 2 groups based on the presence of epithelial cells. Many repeat FNA tests resulted in a different B1 subgroup. Conclusion: The different malignancy rates suggest that individual management approaches should be considered for each B1 subgroup.

Original languageEnglish
Pages (from-to)223-227
Number of pages5
JournalEndocrine Practice
Issue number3
StatePublished - Mar 2021

Bibliographical note

Publisher Copyright:
© 2020 AACE


We thank Mrs Orly Yakir and Mr Basem Hijazi for the statistical analysis and Mrs Tobie Kuritsky for editorial assistance. The article was written as part of the requirements of the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel, for an MD degree of N.R.G. The authors have no multiplicity of interest to disclose.

FundersFunder number
Azrieli Faculty of Medicine, Bar-Ilan University


    • Bethesda
    • cytopathology
    • nondiagnostic
    • thyroid
    • unsatisfactory


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