Cytopathology — MCQs

Q: A patient with multinodular goiter underwent fine needle aspiration cytology which was suspicious for papillary thyroid carcinoma. What is the percentage of malignancy risk in this patient?

57%. This question tests your knowledge of the **Bethesda System for Reporting Thyroid Cytopathology (BSRTC)**, which is a standardized classification used to estimate the risk of malignancy (ROM) and guide clinical management. In the Bethesda System, the category **"Suspicious for Malignancy" (Category V)** carries a high risk of cancer. According to the updated Bethesda guidelines (2nd and 3rd editions), the risk of malignancy for a "Suspicious" nodule is approximately **50–75%**, with an average value often cited as **57%** (when NIFTP is considered a non-malignant outcome) or higher. Cytologically, this category is used when the aspirate shows some features of malignancy (like nuclear grooves or inclusions in Papillary Thyroid Carcinoma) that are strong but not sufficient for a definitive diagnosis of "Malignant" (Category VI) [1]. Why Other Options are Incorrect: * **A (20%) & C (30%):** These values are too low for Category V. A ROM of **10–30%** is typically associated with **Category III** (Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance - AUS/FLUS). * **D (41%):** This value is more closely associated with **Category IV** (Follicular Neoplasm/Suspicious for Follicular Neoplasm), which generally carries a ROM of **25–40%**. High-Yield Clinical Pearls for NEET-PG: * **Note:** The most common thyroid cancer is Papillary Carcinoma, characterized by Orphan Annie eye nuclei, Psammoma bodies, and nuclear grooves [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1099.

Practice by Chapter

Basic Principles of Cytopathology

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Specimen Collection and Processing

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Gynecologic Cytology

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Respiratory Tract Cytology

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Urinary Tract Cytology

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Effusion Cytology

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Fine Needle Aspiration Cytology

Practice Questions

Gastrointestinal Tract Cytology

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Ancillary Studies in Cytopathology

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Quality Assurance in Cytopathology

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