A 40-year-old woman presents with a 6 cm cold, firm, painless neck swelling in the anterior triangle that moves upward on swallowing. Fine needle aspiration cytology (FNAC) shows Hurthle cell features with nuclear enlargement. The FNAC Bethesda System category most appropriate for Hurthle cell lesion/neoplasm is:

• A Bethesda I — non-diagnostic
• B Bethesda II — benign
• C Bethesda VI — malignant
• D Bethesda IV — follicular neoplasm/Hurthle cell neoplasm (suspicious for neoplasm) ✓

Explanation

The Bethesda System for Reporting Thyroid Cytopathology: Category I — non-diagnostic/unsatisfactory; Category II — benign; Category III — AUS/FLUS (atypia of undetermined significance); Category IV — follicular neoplasm or Hurthle cell neoplasm (suspicious for neoplasm); Category V — suspicious for malignancy; Category VI — malignant. A Hurthle cell/oncocytic lesion with cellular features suggesting neoplasm falls in Bethesda IV, which carries a 25–40% malignancy risk and usually warrants a diagnostic lobectomy. Bethesda VI requires nuclear/architectural features of papillary carcinoma or malignant cells.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.