In this pattern benign follicular cells are detected, along with cells with nuclear enlargement, nuclear grooves, nuclear membrane irregularity, and/or nuclear molding, usually without any trace of intranuclear inclusions. Gupta A malignant thyroid FNA diagnosis accounts for 4%-8% of all thyroid FNAs, the majority of which are PTCs, and these patients will require thyroidectomy[53]. . ( a) In this sparsely cellular specimen, some of the cells had abundant cytoplasm and enlarged nuclei, some with prominent nucleoli. An inspiration for the thyroid proposal was the Bethesda System for reporting cervical cytology interpretations, first developed at an NCI workshop in 1988 and widely adopted in the United States for reporting Papanicolaou test results. When this panel was used for specimens with indeterminate cytology, sensitivity was 27%, specificity was 95%, positive predictive value was 66%, and negative predictive value was 78%[60]. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria and Explanatory Notes. BRAF mutation has become a specific marker for PTC and its variants[54]. This is used to immediately make slide preparations on one to 10 pre-prepared glass slides which will be stained, usually within the Giemsa family of stains, to assess cellular morphology (how the cells look), perform a lineage assessment (what cell line they belong to, both by morphology and phenotyping), and provide a complete differential count (500 cells are counted). The rate of malignancy in FNA-BRAF positive nodules has been shown to be 99.8%[55]. National Center for Biotechnology Information Amyloid can be observed in close association with tumor cells, and can be distinguished from the thick colloid of PTC by performing a Congo-red stain. The aspirates from anaplastic carcinoma do not pose any diagnostic difficulties. Renshaw Results: We evaluated 5030 thyroid FNAs. This category includes specimens with features characteristic of a malignant neoplasm, which are quantitatively or qualitatively insufficient to make a definitive diagnosis of malignancy (Figure (Figure4).4). The specimen is fixed in paraffin and cut for slide preparation. For a thyroid FNA specimen to be satisfactory for evaluation (and benign), 6 . et al. Like the marrow aspirate smear, touch imprint preparations provide a quick turnaround time (i.e., do not need decalcification) and great morphologic detail (if the aspirate smears are paucispicular or hemodiluted). For that reason the aspirate is then classified as AUS/FLUS to indicate the uncertainty of the findings. Cytologic preparations typically have high cellularity, and colloid is scant or absent. However; less than 10% of them represent malignant tumors. The 2017 Bethesda System for Reporting Thyroid Cytopathology These specimens are differentially used to study morphology, assess lineage, perform cell counts and differentials, triage and send for appropriate immunohistochemical stains, perform flow cytometry, and send ancillary cytogenetic and molecular genetic studies. For a thyroid FNA specimen to be satisfactory for evaluation (and benign), at least 6 groups of benign follicular cells are required, each group composed of at least 10 cells.6,7 The minimum size requirement for the groups allows one to determine (by the evenness of the nuclear spacing) whether they represent fragments of macrofollicles. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Planar cell polarity (PCP) proteins and spermatogenesis Presence of cell group with nuclear crowding, increased nuclear-cytoplasmic ratio, irregularities in nuclear membrane and micro-nuclei ( 40 pap stain on ThinPrep slide) (diagnostic categories V). An AUS result is obtained in 3% to 6% of thyroid FNAs.2,10 Higher rates likely represent overuse of this category when other interpretations are more appropriate. Cochand-Priollet Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Correspondence to: Evangelos P Misiakos, MD, FACS, Associate Professor of Surgery, Attikon University Hospital, University of Athens School of Medicine, 76 Aigeou Pelagous Street, Agia Paraskevi, 15 341, Attica, 12462 Athens, Greece. Baloch The nuclei are hyperchromatic, uniform in size and shape, and with indinstinct nucleoli. Due to the fact that the nuclei of this variant are darker than those of the regular PTC, the neoplastic cells of this variant may be mistaken for benign respiratory epithelial cells, or a colorectal neoplasm. Approximately 3% to 7% of thyroid FNAs have conclusive features of malignancy, and most are papillary carcinomas.1013 Malignant nodules are usually removed by thyroidectomy, with some exceptions (eg, metastatic tumors, non-Hodgkin lymphomas, and undifferentiated carcinomas). The cellular sample is typically monomorphic, although some specimens may appear pleomorphic; the cells are usually small or medium-sized, noncohesive, and contain an eccentrically located nuclei[35]. Figure 5. . PU The https:// ensures that you are connecting to the Grant Auger M, Stelow EB, Yang GCH. Thyroid, Cytopathology, Nodule, Papillary cancer, Fine needle, Biopsy. At low magnification, aspirates of PTC are typically cellular, epithelium-rich structures. FNAs contain oncocytic cells with abundant granular cytoplasm, conventional nuclei, a papillary architecture, and a lymphoplasmacytic background. Of those that prove to be malignant, many are FCs, but a significant proportion are follicular variants of papillary carcinoma.2,8,11,19. et al. Since this is a liquid sample, it does not need to undergo decalcification, can be smeared onto a slide and stained relatively quickly, used for flow cytometry (which needs unfixed, liquid cells), and sent fresh for molecular analysis. Modified Bethesda system informing cytopathologic adequacy - Nature Therefore, it is not prudent to remove every thyroid nodule we encounter in our medical practice. Aldinger KA, Samaan NA, Ibanez M, Hill CS. 119 0 obj <>/Filter/FlateDecode/ID[<80B644DBD03A284F83277CD8A09960C6><94D1BF37A2B04B428378CFB47946E293>]/Index[92 53]/Info 91 0 R/Length 121/Prev 842357/Root 93 0 R/Size 145/Type/XRef/W[1 2 1]>>stream It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. The diagnosis of a MALT lymphoma of the thyroid requires the use of immunophenotyping by flow cytometry or immunocytochemistry[9,37]. Incidence of malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. In part, each component is analyzed and interpreted in correlation together for a final report. The 2017 Bethesda System for Reporting Thyroid Cytopathology B Logani MTC was first described by Horn et al[45] in 1951, and it was first recognized as a unique clinicopathological entity by Hazard et al[46], in 1959. The documents underwent revision after each comment period before reposting on the Web. The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. Surgical intervention consisted of a 15 7 7-cm segmental mastectomy specimen that contained a large, ill-defined, irregular pink-tan . Any specimen that contains abundant colloid is adequate (and benign), even if six groups of follicular cells are not identified: a sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and therefore almost certainly benign. A: No. Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study. Cross PA, Poller D. The Bethesda thyroid terminology and progress towards international agreement on thyroid FNA cytology reporting. There was also a great difference regarding the percentage of the cases classified into the TIR 2/ DC II (benign) category (83.9%) compared with approximately half (55.4%) of the cases in the 6-tiered system. et al. Historically, terminology for thyroid FNA has varied significantly from one laboratory to another, creating confusion in some cases and hindering the sharing of clinically meaningful data among multiple institutions. Processing A collection method should harvest well-preserved cells that reliably represent any urinary tract lesion that might be present. Baloch The Bethesda System for Reporting Thyroid Cytopathology is the most preferred system for the diagnosis of FNA specimens, which also contains guidelines for the diagnosis and treatment of indeterminate cases. Cystic degeneration also is often found. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. . Moses et al[60] also examined the clinical utility of the above panel in thyroid FNA biopsies. Report of the Thyroid Cancer Guidelines Update Group. The many faces and mimics of papillary thyroid carcinoma. Rathan A: Probably, yes. Herein lies everything you were afraid to ask. et al. This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. The standard management of PTCs greater than 1 cm is total, or near-total thyroidectomy followed by radioactive iodine (131I) therapy to ablate residual thyroid tissue. American Society of Hematology. Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. CS Preoperative diagnostic categories of fine needle aspiration - PLOS Pedro Patricio de Agustin, MD, PhD, Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain, Erik K. Alexander, MD, Department of Medicine, Brigham and Womens Hospital, Boston, MA, Sylvia L. Asa, MD, PhD, Department of Pathology and Laboratory Medicine, University of Toronto; University Health Network and Toronto Medical Laboratories; Ontario Cancer Institute, Toronto, Canada, Kristen A. Atkins, MD, Department of Pathology, University of Virginia Health System, Charlottesville, Manon Auger, MD, Department of Pathology, McGill University Health Center and McGill University, Montreal, Canada, Zubair W. Baloch, MD, PhD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Katherine Berezowski, MD, Department of Pathology, Virginia Hospital Center, Arlington, Massimo Bongiovanni, MD, Department of Pathology, Geneva University Hospital, Geneva, Switzerland, Douglas P. Clark, MD, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, Batrix Cochand-Priollet, MD, PhD, Department of Pathology, Lariboisire Hospital, University of Paris 7, Paris, France, Barbara A. Crothers, DO, Department of Pathology, Walter Reed Army Medical Center, Springfield, VA, Richard M. DeMay, MD, Department of Pathology, University of Chicago, Chicago, IL, Tarik M. Elsheikh, MD, Ball Memorial Hospital/PA Labs, Muncie, IN, William C. Faquin, MD, PhD, Department of Pathology, Massachusetts General Hospital, Boston, Armando C. Filie, MD, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, Pinar Firat, MD, Department of Pathology, Hacettepe University, Ankara, Turkey, William J. Frable, MD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Kim R. Geisinger, MD, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, Hossein Gharib, MD, Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, Ulrike M. Hamper, MD, Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD, Michael R. Henry, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN, Jeffrey F. Krane, MD, PhD, Department of Pathology, Brigham and Womens Hospital, Boston, MA, Lester J. Layfield, MD, Department of Pathology, University of Utah Hospital and Clinics, Salt Lake City, Virginia A. LiVolsi, MD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Britt-Marie E. Ljung, MD, Department of Pathology, University of California San Francisco, Claire W. Michael, MD, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Ritu Nayar, MD, Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, Yolanda C. Oertel, MD, Department of Pathology, Washington Hospital Center, Washington, DC, Martha B. Pitman, MD, Department of Pathology, Massachusetts General Hospital, Boston, Celeste N. Powers, MD, PhD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Stephen S. Raab, MD, Department of Pathology, University of Colorado at Denver, UCDHSC Anschutz Medical Campus, Aurora, Andrew A. Renshaw, MD, Department of Pathology, Baptist Hospital of Miami, Miami, FL, Juan Rosai, MD, Dipartimento di Patologia, Instituto Nazionale Tumori, Milano, Italy, Miguel A. Sanchez, MD, Department of Pathology, Englewood Hospital and Medical Center, Englewood, NJ, Vinod Shidham, MD, Department of Pathology, Medical College of Wisconsin, Milwaukee, Mary K. Sidawy, MD, Department of Pathology, Georgetown University Medical Center, Washington, DC, Gregg A. Staerkel, MD, Department of Pathology, the University of Texas M.D.
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