Lloyd Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. On the other hand a definitive diagnosis of a low-grade lymphoma (usually a MALT lymphoma) is even more difficult. Hrthle cell carcinoma is a better gold standard than Hrthle cell neoplasm for fine-needle aspiration of the thyroid: defining more consistent and specific cytologic criteria. LiVolsi Of those that prove to be malignant, many are FCs, but a significant proportion are follicular variants of papillary carcinoma.2,8,11,19. 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. PG Deshpande AH, Munshi MM, Bobhate SK. Melton VA The nuclei are hyperchromatic, uniform in size and shape, and with indinstinct nucleoli. Without individual cells to analyze through flow cytometric methods, the clot section is limited to only tissue-type immunostaining. These alterations were made in order for the British system to be analogous to the BSRTC[11,16], although in other countries these modifications have not be totally embraced. Psammoma bodies are occasionally seen in some aspirates, most possibly arising from calcification of epithelial tips. Enlarged follicular cells arranged in monolayer sheets and follicular groups with nuclear elongation and chromatin clearing in a follicular variant of PTC case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). Oxford University Press is a department of the University of Oxford. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. Chemotherapy or radiotherapy usually cannot change the dismal prognosis of this cancer. Anaplastic carcinoma of the thyroid. The four components of a routine bone marrow analysis. Histologic trends in thyroid cancer 1969-1993: a clinico-pathologic analysis of the relative proportion of anaplastic carcinoma of the thyroid. After patient preparation, sedation, and the procedure itself, a bone marrow investigation provides four specimen types for pathologist review (Figure 1): the bone marrow core biopsy, the bone marrow touch imprint, the bone marrow aspirate smear, and the bone marrow clot particle. endstream endobj startxref Mazzaferri EL. For example, increased serum calcitonin levels and/or strong immunoresponce of chromogranin which is disclosed after multiple FNA tests can indicate the diagnosis of a medullary carcinoma. A full molecular panel of BRAF, RAS, RET/PTC and PAX8PPAR offer additional diagnostic value[58]. Descriptive comments that follow are used to subclassify the malignancy and summarize the results of special studies, if any. 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. JR On the other hand, it might be clinically equivalent to an ND result if the sonographic features are worrisome and the endocrinologist is not convinced that the sample is representative. Grant Fine-needle aspiration (FNA) cytology is an important diagnostic tool in patients with thyroid lesions. Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. ( a) In this sparsely cellular specimen, some of the cells had abundant cytoplasm and enlarged nuclei, some with prominent nucleoli. JR Ravetto Fadda Tumor cells with distinct granules with eccentric nuclei. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Lerma E, Arguelles R, Rigla M, Otal C, Cubero JM, Bagu S, Carreras AM, Eulalia E, Gonzalez-Campora R, Galera H, et al. VA Papillary thyroid carcinoma and variants. The diagnosis of a MALT lymphoma of the thyroid requires the use of immunophenotyping by flow cytometry or immunocytochemistry[9,37]. Benign cyst-lining cells are typically polygonal or fusiform with abundant cytoplasm, well-defined cellular borders, sometimes enlarged, grooved nuclei, and small distinct nucleoli. Aspirate slides are also used for cytochemical and iron stains. MS If resected, virtually all benign follicular nodules turn out to be nodules of a multinodular goiter or follicular adenomas. Cytopreparatory Techniques Questions Flashcards | Quizlet Cytopreparatory Techniques | SpringerLink Baloch The Bethesda System for Reporting Thyroid Cytopathology - OUP Academic The cystic lining showed outer cellular and inner sparsely cellular areas [Table/Fig-8]. Core tip: Fine-needle aspiration (FNA) cytology is widely used for the diagnosis of thyroid nodules, although cases with indeterminate results are not rare. ND/UNS results occur in 2% to 20% of cases but ideally should be limited to no more than 10% of thyroid FNAs, excluding samples composed exclusively of macrophages.810, Specimens that consist only of cyst contents (macrophages) are problematic. EK Jing X, Michael CW, Pu RT. Adequacy issues usually arise in sparsely cellular specimens, since low cellularity or inadequate representation may pose potential for missing a significant pathological process including malignancy. Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid: today and tomorrow. Giorgadze This system allows patients with FNAs showing focal atypia to undergo repeat aspiration prior to surgery. Marchevsky AM, Walts AE, Bose S, Gupta R, Fan X, Frishberg D, Scharre K, Zhai J. Evidence-based evaluation of the risks of malignancy predicted by thyroid fine-needle aspiration biopsies. [2] First documented in HeLa cells, where there are generally 10-30 per nucleus, [3] Paraspeckles are now known to also exist in all human primary cells, transformed cell lines and . There may be small fragments of amorphous material-colloid vs amyloid. Thus, the maximal number of spermatids can be packed and supported by a fixed population . The false-negative rate of a benign interpretation is low (0%3%),2,12 but patients are nevertheless followed up with repeated assessment by palpation or ultrasound at 6- to 18-month intervals.15 If the nodule shows significant growth or suspicious sonographic changes, a repeated FNA is considered. You can now find us in many convenient retail stores, including select Walmart and Target locations. Since it is a two-dimensional specimen and reveals cells in cut section, it is not ideal for assessment of dysplasia (a marrow aspirate is preferred), but it is extremely useful in identifying possible reasons for a dry tap (a term for when liquid marrow cannot be aspirated during the bone marrow procedure), since the architecture can show fibrosis, sheets of cohesive plasma cells, or metastatic tumor which could result in a dry tap. ZW Hematopathologists can assess morphology, histologic architecture, and immunologic and phenotype profiles (Figure 2) across all four components to create a comprehensive report for your patient. ZW Cantara S, Capezzone M, Marchisotta S, Capuano S, Busonero G, Toti P, Di Santo A, Caruso G, Carli AF, Brilli L, et al. Note: Please review ASHs disclaimerregarding the use of the information contained in these articles. This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. Cibas ES. Before the specimen is transferred to a container with anticoagulant, some of the already clotted specimen may be submitted for permanent histology in formalin. LiVolsi Until recently there were no uniform criteria for the various diagnostic categories in thyroid cytopathology. Piana S, Frasoldati A, Ferrari M, Valcavi R, Froio E, Barbieri V, Pedroni C, Gardini G. Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? specimens with obscuring blood, poor cell preservation, and an insufficient sample of follicular cells. This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. Preparations for the conference began 18 months earlier with the designation of a steering committee, coordination with cosponsoring organizations, and the establishment of a dedicated, permanent Web site. V DP LiVolsi Royal College of Physicians. A review of the English literature was conducted, and data were analyzed and summarized and integrated from the authors perspective. The phenotypic composition of the various marrow components is key to understanding their utility for further investigative diagnostic studies. In adult mammalian testes, spermatids, most notably step 17-19 spermatids in stage IV-VIII tubules, are aligned with their heads pointing toward the basement membrane and their tails toward the tubule lumen. There are focal features suggestive of papillary carcinoma, including nuclear grooves, enlarged nuclei with pale chromatin, and alterations in nuclear contour and shape in an otherwise predominantly benign-appearing sample (especially in patients with Hashimoto thyroiditis or with abundant colloid and other benign-appearing follicular cells). SL How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? A: No. M 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%). 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. Taken together, the study results confirmed several tenets of TBSRTC approach to adequacy: 1) A sample should be considered ND/UNS if it is sparsely cellular, even if there are a few groups of. Click, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). The risk of malignancy in the HCLUS category was significantly lower than in the other subtypes of AUS. Search for other works by this author on: Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care, Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation, The Bethesda System for Reporting Thyroid Cytopathology, Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference, The: National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference: a summation, Fine-needle aspiration cytology of the thyroid, 1980 to 1986, Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses, Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients, Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves, Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations, Accuracy of fine-needle aspiration of thyroid: a review of 6226 cases and correlation with surgical or clinical outcome, Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11,000 biopsies, Non-diagnostic fine-needle aspiration biopsy: a dilemma in management of nodular thyroid disease, Value of repeat fine needle aspiration (FNA) of the thyroid [abstract], Post thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference, Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts, NCCN thyroid carcinoma practice guidelines, Fine-needle aspiration of follicular lesions of the thyroid: diagnosis and follow-up, Diagnosis of follicular neoplasm: a gray zone in thyroid fine-needle aspiration cytology, Factors that predict malignant thyroid lesions when fine-needle aspiration is suspicious for follicular neoplasm., Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens, Fine-needle aspiration biopsy of the thyroid: an appraisal. A: Ideally, blasts should be calculated on the aspirate smear differential count; however, in cases where blasts express CD34, then a CD34 count on the core biopsy might be possible. 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. Logrono Bethesda System for Reporting Thyroid Fine-Needle Aspiration Specimens This category refers to cellular specimens with abundant follicular cells arranged in a microfollicular pattern with minimal colloid. The Bethesda System For Reporting Thyroid Cytopathology. National Center for Biotechnology Information We subcategorized Bethesda I into insufficient cellularity or artifacts, and Bethesda categories III and V into cellular without artifacts, sparsely cellular, or artifacts. Based on the findings (MRI, gross and histopathology) cysticercosis was confirmed. For patients with large tumors (> 4 cm), the best approach could be a total thyroidectomy, considering the fact that large tumors have an elevated risk of malignancy[40]. Sparsely cellular specimen means exact what it says - cells are sparse. Heitz Such patients were followed clinically with periodic physical and sonographic examinations. Map ; Apps; Tools . Enter your ZIP Code, or City and State below to find the stores nearest you and a listing of the device models available within each. They can be readily classified as malignant due to nuclear pleomorphism, chromatin clumping, necrosis, atypical mitoses and other malignant features[40]. Perceptions of diagnostic terminology and cytopathologic reporting of fine-needle aspiration biopsies of thyroid nodules: a survey of clinicians and pathologists. (2021).Demystifying the Bone Marrow Biopsy: A Hematopathology Primer. The rate of malignancy in FNA-BRAF positive nodules has been shown to be 99.8%[55]. In a study that segregated CFO cases and analyzed them separately, the risk of malignancy for a CFO sample was 4%.9 The risk of malignancy for ND/UNS (not including CFO) is 1% to 4%.810, The Bethesda System for Reporting Thyroid Cytopathology: Recommended Diagnostic Categories*, The Bethesda System for Reporting Thyroid Cytopathology: Implied Risk of Malignancy and Recommended Clinical Management, A repeated aspiration with ultrasound guidance is recommended for ND/UNS and clinically or sonographically worrisome CFO cases and is diagnostic in 50% to 88% of cases,2,6,9,11,13,14 but some nodules remain persistently ND/UNS. Note granulocytic precursors (arrows) and erythroid cells (arrow heads). The aspirates from anaplastic carcinoma do not pose any diagnostic difficulties. A: Probably, yes. In 1966 Williams demonstrated that this tumor derives from the parafollicular cells, known also as calcitonin-producing C cells, which have an ectodermal neural crest origin[47]. IR It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. Some laboratories, for example, may want to state the risk of malignancy associated with the general category, based on their own data or that found in the literature (Table 2). Sparsely definition, in a thinly distributed way; not thickly or densely: Michigan's Upper Peninsula is very sparsely populated, as more than 90% of it is forested. Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009. The 2017 Bethesda System for Reporting Thyroid Cytopathology The conclusions regarding terminology and morphologic criteria from the NCI meeting led to the Bethesda Thyroid Atlas Project and form the framework for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The first draft of the committees summary documents was posted on the Web site and open for online discussion from May 1 to June 30, 2007. Aldinger KA, Samaan NA, Ibanez M, Hill CS. Should atypical follicular cells in thyroid fine-needle aspirates be subclassified? In this review we analyze current literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable and practical methodology to use in everyday clinical practice. Thyroid FNA is a well established procedure used in the preoperative diagnosis of thyroid nodules. Redman R, Yoder BJ, Massoll NA. Undifferentiated (anaplastic) thyroid carcinoma (UTC) is an extremely aggressive thyroid malignancy with a very poor prognosis. ( a) In this sparsely cellular specimen, some cells have abundant cytoplasm, enlarged nuclei, and prominent nucleoli. 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. The cells have abundant pink cytoplasm, basally located nuclei and nuclear features of conventional PTC. The inherited forms are characterized by an autosomal dominant mode of inheritance and are associated with point mutations in the RET proto-oncogene on chromosome 10. The spindle-shaped morphology of these cells is helpful in distinguishing these cells from PTC[24,34]. The nuclei are enlarged, with usually an oval or irregular shape, and include intense nuclear grooves and inclusions. Architectural atypia may present in smears with paucity of cells, which contain a few microfollicles, trabeculae, or crowded groups. This category is reserved for aspirates with borderline cellularity and is subdivided into two subcategories. Regardless the staining method used, all slides with diagnostic material are used for the evaluation and clarification of each case. Therefore, the DC III (AUS/FLUS) cases are managed conservatively with repeat FNAs, whereas the DC IV, DC V, and DC VI cases, and TIR 3, TIR 4 and TIR 5 cases respectively, are managed operatively, with thyroid lobectomy or total thyroidectomy. The individual tumor cells are enlarged, oval in shape with eosinophilic cytoplasm; the nuclei show elongation, oval shape, membrane thickening, chromatin clearing, grooves, and inclusions. HHS Vulnerability Disclosure, Help The molecular testing proved to have a high specificity, although the sensitivity was quite low (60%). This resulted in diagnostic inconsistencies among different laboratories and difficulty in communicating the implications of thyroid fine-needle aspiration (FNA) results both to clinicians (endocrinologists and endocrine surgeons) and laboratory doctors (pathologists and radiologists)[6]. Some thyroid FNAs are not easily classified into the benign, suspicious, or malignant categories. The general category malignant is used whenever the cytomorphologic features are conclusive for malignancy. Thus, our aim was to standardize a manual, simple, cost-effective innovative technique, namely, ACS to process clear/sparsely cellular specimens and also to compare ACS smears along with cytocentrifuged specimens which were used as control smears. The site is secure. Low and high power of clot particle. Every thyroid FNA must be evaluated for adequacy. Some categories have 2 alternative names; a consensus was not reached at the NCI conference on a single name for these categories. H These can be highly useful when a core biopsy is suboptimal, demonstrates marked myelofibrosis, is a dry tap, or otherwise fails to provide adequate visual data for morphology, architecture, cellularity, and hematopoietic lineage assessments. Help . A serum protein electrophoresis might have even shown a monotypic expansion. WC et al. Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated fna be the preferred initial approach? Fine-needle aspiration cytology (FNAC) has been widely adopted as a meticulous, secure and cost-effective method for the diagnosis of non-toxic thyroid nodules[1,2]. 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. A moderately or markedly cellular sample is composed of a virtually exclusive population of Hrthle cells, yet the clinical setting suggests a benign Hrthle cell nodule, eg. The risk of malignancy for an AUS nodule is difficult to ascertain because only a minority of cases in this category have surgical follow-up. A specimen is considered as suspicious for malignancy (SFM), when some features of malignancy (usually PTC features) exist, but the findings are not sufficient for a definitive diagnosis[9]. Unlike the core biopsy, decalcification is not required for the clot section. Atypical cells in fine-needle aspiration biopsy specimens of benign thyroid cysts. Furthermore, the clot section, like the core biopsy, can be used for immunohistochemical stains. It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. Different cell types of neurons form complicated circuits in the brain. AA PU The nuclei have conventional PTC nuclear features that distinguish it from Hurthle cell neoplasms[35]. This category includes the diagnoses of nodular goiter, nodular goiter with hyperplastic nodules, colloid nodules, cyst contents with/without benign follicular cells, and lymphocytic thyroiditis; (3) DC III Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (Figure (Figure2).2).