In the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), a FNA classified as Bethesda Category IV (Follicular Neoplasm) carries which estimated risk of malignancy and recommended management?
- A 5–15%; repeat FNA in 6 months
- B 15–30%; diagnostic hemithyroidectomy (lobectomy) ✓
- C 60–75%; total thyroidectomy
- D 30–50%; molecular marker testing then total thyroidectomy
Correct answer: B. 15–30%; diagnostic hemithyroidectomy (lobectomy)
Explanation
Bethesda Category IV (Follicular Neoplasm/Suspicious for Follicular Neoplasm) carries an estimated malignancy risk of 15–30% in the revised 2017 BSRTC (previously cited as up to 20–30%). The recommended management is diagnostic hemithyroidectomy (lobectomy), as FNA cytology cannot distinguish between follicular adenoma and follicular carcinoma — only histological demonstration of capsular or vascular invasion can. Molecular markers (e.g., ThyroSeq, Afirma) can refine risk stratification but do not replace surgical sampling for definitive diagnosis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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