A review of the English literature was conducted, and data were analyzed and summarized and integrated from the authors perspective. Gross specimen was measuring about 2x2x1.5 cm in size, soft in consistency, brownish black in color and roughly oval in shape [Table/Fig-4]. hbbd``b`$Ks ^ When evaluating an undifferentiated carcinoma using immunocytochemistry a basic immunopanel should include cytokeratins, calcitonin, leucocyte common antigen, carcinoembryonic antigen, thyroglobulin, chromogranin, and TTF-1. Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. You can now find us in many convenient retail stores, including select Walmart and Target locations. Hazard JB, Hawk WA, Crile G. Medullary (solid) carcinoma of the thyroid; a clinicopathologic entity. This PTC variant is a circumscribed thyroid tumor with papillary architecture and lymphoid follicles that mimics a Warthin tumor of the parotid gland. DP Fine-needle aspiration in the work-up of thyroid nodules. Since the PTC-FV variant represents one of the most common causes of a false negative diagnosis of PTC, it is important to distinguish this PTC variant from other benign conditions, such as a follicular neoplasm or adenomatous nodule. 8600 Rockville Pike Bone core biopsy. Such patients were followed clinically with periodic physical and sonographic examinations. ZW The NCI conference participants acknowledged the importance of developing a uniform terminology for reporting thyroid FNA results. A: No. . The general category FN/SFN is a self-sufficient interpretation; narrative comments that follow are optional. Preoperative diagnostic categories of fine needle aspiration - PLOS Figure 4. Unlike the core biopsy, decalcification is not required for the clot section. Dottorini Tumor cells with distinct granules with eccentric nuclei. A significant proportion of these cases (16%25%) prove not to be neoplasms but rather hyperplastic proliferations of Hrthle cells in nodular goiter or lymphocytic thyroiditis.26,27 About 15% to 45% of nodules are malignant, and the remainder of the neoplasms prove to be Hrthle cell adenomas.22,26,27, Many thyroid cancers, most especially papillary thyroid carcinoma (PTC), can be diagnosed with certainty by FNA. PG Cibas The Impact of Rapid On-Site Evaluation on the Quality and - PubMed Fine-needle aspiration (FNA) cytology is an important diagnostic tool in patients with thyroid lesions. FCs have cytomorphologic features that distinguish them from benign follicular nodules. endstream endobj startxref The Bethesda System For Reporting Thyroid Cytopathology. Pan-keratin is the most reliable positive immunostain in UTCs, acquiring an expression ranging from 50% to 100%. Maybe a routine peripheral smear caught some circulating blasts. Goellner Cerutti JM. Sparsely cellular specimens: Sample w/ not many cells in suspension can be made more conc'd by Cytospin or centrifugation preparation: 1mL properly prepared cell suspension in funnel of cytospin, centrifuge, cells will be deposited on slide & fluid absorbed by filter paper: Problem: bloody specimens: One subcategory includes cases with a microfollicular pattern and minimal colloid, that is, follicular lesion of undetermined significance (FLUS). The presence of true psammoma bodies with concentric laminations is highly suggestive of PTC; however the presence of psammoma bodies in cystic thyroid lesions is not diagnostic. Deveci 2023 ,https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer. Post Anesthesia Care Unit. LiVolsi Whatever the cause, you have reason to request a hematopathology workup and investigative studies. RA BRAF is not usually found in the follicular variant of papillary thyroid carcinoma, but is increasingly detectable in each step of dedifferentiation, including tall cell tumors and anaplastic cancer. This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. The separation of these four components allows for multiple sources of data collection and offers insurance against otherwise compromised specimens. The FNA aspirates of an MTC are usually composed of numerous cells, either presenting in cell aggregates or as a mixture of non-cohesive cells. This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. Touch preps can be imprinted, rolled, or crushed between glass to provide similar information. Once obtained, the core biopsy is used to make touch preps (discussed below) and then is transferred into a container with appropriate fixative (usually formalin) and sent to the laboratory for processing. However, nuclear grooves can be seen also in several thyroid diseases such, as Hashimotos thyroiditis, multinodular goiter, Hurthle cell tumors and medullary carcinoma[42,43]. Therefore, in the majority of patients in the AUS/FLUS category (72%-80%) the diagnosis will be resolved by repeat FNA, although 20%-28% of them will have AUS/FLUS on the repeat aspirate and thus require surgery. 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. Seventeen . Hematoxylin-eosinstained section of the bone core biopsy (100). Figure 3. Most (60%75%) prove to be papillary carcinomas, and the rest are usually FAs.2,10,12,30. The most common malignant diagnosis made after surgery in cases initially classified as AUS/FLUS is PTC, usually of the follicular variant (PTC-FV)[24,25]. The majority of the thyroid FNA specimens, in the range of 60% to 70%, are classified as benign, whereas approximately 20% to 30% fall into the 3 categories of suspicious for follicular neoplasm, suspicious for malignancy, and malignant[19]. Impact of proto-oncogene mutation detection in cytological specimens from thyroid nodules improves the diagnostic accuracy of cytology. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. 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 2017 Bethesda System for Reporting Thyroid Cytopathology A et al. This is particularly true of the follicular variant of PTC, which can be difficult to distinguish from a benign follicular nodule.28 Other PTCs may be incompletely sampled and yield only a small number of abnormal cells.29 If only 1 or 2 characteristic features of PTC are present, if they are only focal and not widespread throughout the follicular cell population, or if the sample is sparsely cellular, a malignant diagnosis cannot be made with certainty. ME Fadda G, Basolo F, Bondi A, Bussolati G, Crescenzi A, Nappi O, Nardi F, Papotti M, Taddei G, Palombini L. Cytological classification of thyroid nodules. Occasionally FNAC results can be inconsistent and can be a source of dispute among clinicians. Baloch LiVolsi As with the Bethesda System for cervical cytology, it is expected that subsequent workshops will lead to further refinements to this framework. ES B Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. The 2-day live conference in October 2007, attended by 154 registrants including pathologists, endocrinologists, surgeons, and radiologists, gave the committees an in-depth opportunity to present their conclusions and debate controversial areas. The adequacy of a thyroid FNA is defined by both the quantity and quality of the cellular and colloid components. Papillary thyroid carcinoma and variants. Cantara S, Capezzone M, Marchisotta S, Capuano S, Busonero G, Toti P, Di Santo A, Caruso G, Carli AF, Brilli L, et al. Yang J, Schnadig V, Logrono R, Wasserman PG. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. The discussions and conclusions regarding terminology and morphologic criteria from the NCI meeting, summarized in the publications by Baloch et al,4,5 form the framework for the terminology presented here and in atlas form.3 It is intended as a flexible framework that can be modified to suit the needs of the particular laboratory and the patients it serves. Moreover, a lower percentage of cases in the European system was placed into the TIR 4 and TIR 5 categories as well, compared with the American system. Different cell types of neurons form complicated circuits in the brain. We subcategorized Bethesda I into insufficient cellularity or artifacts, and Bethesda categories III and V into cellular without artifacts, sparsely cellular, or artifacts. The malignancy rate of the AUS/FLUS category is estimated to be between 5% and 15%[10], which is intermediate between that of the benign category (0%-3%) and that of the SFN category (15%-30%). LiVolsi The FNA specimens should be immediately processed for cytomorphologic analysis. Go to: . Bethesda System for Reporting Thyroid Fine-Needle Aspiration Specimens In order to establish a standardized diagnostic terminology/classification system for reporting thyroid FNAC results, the National Cancer Institute (NCI) in the United States sponsored the NCI Thyroid FNA State of the Science Conference with a group of experts at Bethesda, MD, in October 2007[7]. Based on the findings (MRI, gross and histopathology) cysticercosis was confirmed. Cibas Chemotherapy or radiotherapy usually cannot change the dismal prognosis of this cancer. Unlike complete blood counts (CBCs), which produce fast results, a bone marrow analysis requires a more in-depth analysis and, as a more invasive procedure, necessitates built-in redundancies to ensure the highest-quality results. Or the predominantly benign-appearing specimen that contains 1 or 2 groups with a few of the nuclear features of papillary carcinoma? Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. J Lee TI, Yang HJ, Lin SY, Lee MT, Lin HD, Braverman LE, Tang KT. Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009. Oxford University Press is a department of the University of Oxford. PG Atypia of Undetermined Significance/Follicular Lesion of - Springer Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules. Figure 5. In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. Medullary carcinoma is highly metastatic, as tumor cells can be disseminated through hematogenous and metastatic routes to numerous sites, including cervical lymph nodes, liver, lung, bone, and adrenal glands. The specimen is usually cellular with polygonal cells in loose papillary clusters with abundant eosinophilic cytoplasm. The four components of a routine bone marrow analysis. 92 0 obj <> endobj Neither of these patterns fits comfortably into the benign category, but the changes are insufficient for any of the more . Quick tip: A cellular aspirate smear is crucial to an adequate differential count and assessment of morphologic dysplasia. Such atypia may result from a variety of benign cellular changes, but in some cases may reflect an underline malignancy which has been suboptimally sampled or has intermediate diagnostic features[20-22]. Abati A. In this pattern many features of PTC are found, but it is sparsely cellular. The differential diagnosis includes hyperplastic adenomatous nodules, follicular adenoma, follicular carcinoma, and follicular variant of PTC, where the nuclear features remain ill defined. 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]. In general, patients diagnosed with FNA test as having PTC, are usually managed operatively, but the final decision of the type of resection (lobectomy vs total thyroidectomy) depends on numerous coexisting factors. Specimen Adequacy and Non-diagnostic Thyroid Nodules Frontiers | A Whole-Brain Cell-Type-Specific Sparse Neuron Labeling The 2017 Bethesda System for Reporting Thyroid Cytopathology Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. PK It was apparent from the discussions at the conference and the Web postings that the primary purpose of terminology is clarity of communication. Clark DP, Faquin WC. Until recently there were no uniform criteria for the various diagnostic categories in thyroid cytopathology. LiVolsi Unless specified as ND/UNS, the FNA specimen is considered adequate for evaluation. We thank Diane Solomon, MD, for review of the manuscript and helpful comments. . Therefore, it is not prudent to remove every thyroid nodule we encounter in our medical practice. Fine-needle aspiration biopsy (FNAB) showed sparsely cellular smears with a finely granular background and groups of cells arranged in 3-dimensional clusters and papillary formation (Figure 2, arrow). Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions.