Agrawal S, Rao RS, Parikh DM, Parikh HK, Borges AM, Sampat MB. a. crush method b. cytocentrifuge c. fine needle aspiration d. liquid-based b. cytocentrifuge cytocentrifugation is the most common method of handling sparsely cellular specimens such as urine or spinal fluid The high sensitivity rate, as well as the high negative prognostic value of BRAF testing in AUS/FLUS and SFN/SFN categories have been also demonstrated by Alexander et al[57]. PG Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. Dottorini 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]. J Its clinical utilization is significant, as it can define whether a recently emerged thyroid nodule should be managed expectantly or surgically, and can assist in selecting the appropriate surgical procedure when necessary[3]. Patients with the sporadic forms of MTC or the familial MTC are most often middle-aged (mean age 50 years old), except in familial cases, in which they are relatively younger. Copyright 2023 American Society for Clinical Pathology. The nucleoli are usually small and eccentric; however, rare oncocytic variants of PTC can show prominent nucleoli. Some thyroid FNAs are not easily classified into the benign, suspicious, or malignant categories. Melton Maybe a routine peripheral smear caught some circulating blasts. hbbd``b`$Ks ^ View an interactive bone marrow clot specimen online. Such cases represent a minority of thyroid FNAs and in the Bethesda System are reported as atypia of undetermined significance (AUS) or follicular lesion of undetermined significance. The necessity for this category was debated at the NCI conference, after which a vote (limited to the clinicians in attendance) was taken, and the majority voted in favor of this category. The four components of a routine bone marrow analysis. In short, bone marrow analyses yield dynamic results, informing clinical diagnostics and treatment plans. Cellular crowding and overlapping are conspicuous, and the follicular cells are usually larger than normal. Additional benign findings (eg, black thyroid, reactive changes, radiation changes, cyst lining cells) can be mentioned as descriptive diagnoses at the discretion of the cytopathologist. ES Renshaw noted that a Hurthle cell neoplasm demonstrating one of the following features: Small cell dysplasia, large cell dysplasia, severe nuclear crowding, and dishesive cellular pattern is usually associated with a high risk of malignancy[33]. It is important to note that only nodules with atypia of undetermined significance should be placed in the AUS category. VanderLaan PA, Marqusee E, Krane JF. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. PTC accounts for 80% of all thyroid malignancies and occurs more often in women with a 3:1 female-to-male ratio, with a mean age at presentation 30-40 years. It also predicted cancer in the majority of indeterminate samples, as well as of the suspicious for cancer samples. RV Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Modified Bethesda system informing cytopathologic adequacy - Nature Review of the literature suggests a malignancy rate of 55%-75% for the suspicious category[8]. Or the predominantly benign-appearing specimen that contains 1 or 2 groups with a few of the nuclear features of papillary carcinoma? VA 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. This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. Free Histology Flashcards about Cytology - StudyStack Help . Federal government websites often end in .gov or .mil. The precious cell block | Journal of Clinical Pathology 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. Bongiovanni M, Crippa S, Baloch Z, Piana S, Spitale A, Pagni F, Mazzucchelli L, Di Bella C, Faquin W. Comparison of 5-tiered and 6-tiered diagnostic systems for the reporting of thyroid cytopathology: a multi-institutional study. BRAF mutation has become a specific marker for PTC and its variants[54]. et al. AS VA The Bethesda System for Reporting Thyroid Cytopathology is the most widely used system for the diagnosis of thyroid FNA specimens. Various diagnostic terminologies, including indeterminate, atypical, and suspicious for malignancy, were used to describe these challenging cases[5]. A suspicious interpretation is rendered only when the majority of the follicular cells are arranged in abnormal architectural groupings (microfollicles, crowded trabeculae). The rate of malignancy in FNA-BRAF positive nodules has been shown to be 99.8%[55]. The National Cancer Institute Thyroid FNA State of the Science Conference: Wrapped up. A: Ideally, no. DP 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. Highly cellular specimens are ideal for smeared preparations, whereas sparsely cellular specimens will require multiple centrifugation steps and special cell consolidation processing. Mazzaferri EL. One nucleus has an apparent intranuclear pseudoinclusion ( arrow ). Intussusception in an adult revealing a Vanek's tumor: A case report. Deshpande AH, Munshi MM, Bobhate SK. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. Proposal of the SIAPEC-IAP Italian Consensus Working Group. A complete bone marrow biopsy examination usually involves the review of these four specimens noted here in a slide tray: A) marrow aspirate smear, B) marrow core biopsy, C) clot section, and D) touch imprint preparation. "Demystifying the Bone Marrow Biopsy: A Hematopathology Primer." Psammoma bodies are occasionally seen in some aspirates, most possibly arising from calcification of epithelial tips. Bethesda, MD 20894, Web Policies Schlinkert Cantara et al[59] evaluated this panel of tumor-associated mutations in thyroid FNA samples. R Planar cell polarity (PCP) proteins and spermatogenesis Employing genetic markers to improve diagnosis of thyroid tumor fine needle biopsy. Some categories have 2 alternative names; a consensus was not reached at the NCI conference on a single name for these categories. b=D`.+u{tZ>aSW}\b_ ^/:'!!TQf1H7y` fY0Xa8 Kelman Gough The 6 general diagnostic categories are shown in bold type in Table 1. The differential diagnosis for the latter includes hyperplastic adenomatoid nodule with Hurthle cell change, Hurthle cell adenoma, and Hurthle cell carcinoma; (5) DC V Suspicious for malignancy. It usually affects the elderly population, and often presents as a large and bulky tumor with extrathyroidal extension and metastases. ( a) In this sparsely cellular specimen, some of the cells had abundant cytoplasm and enlarged nuclei, some with prominent nucleoli. That said, this specimen (if involved by a disease process) can be sent for genetic testing such as polymerase chain reaction and does not present the issue of being postdecalcification (which may hinder some genetic tests). 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. After these initial assessments, immunostains often aim to assess architecture, fibrosis, lymphoid aggregates, myeloid lineage maturity, and other related potential pathologies. Figure 1. Papillary structures are not as common as it was believed, because intact papillae are often too large to enter the fine needle or are disrupted during the preparation of the smears. BRAF testing has been coupled successfully with the Bethesda Thyroid FNA classification system to offer molecular quality assurance on positive samples, as well as a diagnostic upgrade on samples of indeterminate diagnostic categories, such as AUS/FLUS and SFN/SHN[54]. 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]. Among thyroid malignancies, PTC has the highest propensity to appear cystic, as 10% of the PTC specimens are entirely cystic. Moreover, large, atypical, histiocytoid cells with enlarged nuclei and abundant vacuolated cytoplasm usually coexist. Careers, Unable to load your collection due to an error. Amanda L. - Multi-Skilled Technician - LinkedIn Every thyroid FNA must be evaluated for adequacy. Unlike the core biopsy, decalcification is not required for the clot section. Urine Cytology | SpringerLink ME Cytologic preparations typically have high cellularity, and colloid is scant or absent. 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). van Heerden It is expected that the many benefits, clinical and investigational, of the Bethesda cervical terminology will also apply to the Bethesda thyroid terminology. 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. Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. Asa Faquin WC, Cibas ES, Renshaw AA. Herein lies everything you were afraid to ask. 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]. How to Interpret Thyroid Fine-Needle Aspiration Biopsy Reports: A Guide B) 1,000 view. JA CB The following breakdown shines some light inside the black box of hematologic diagnostics and may provide insight into what the hematopathology report tells you. Of those that prove to be malignant, many are FCs, but a significant proportion are follicular variants of papillary carcinoma.2,8,11,19. endstream endobj startxref Listing the acceptable fixatives for use in cytology 5. A: No. The term benign follicular nodule applies to the most common benign pattern: an adequately cellular specimen composed of varying proportions of colloid and benign follicular cells arranged as macrofollicles and macrofollicle fragments. CellMapper is a crowd-sourced cellular tower and coverage mapping service. National Center for Biotechnology Information Retrieved from https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer. Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. Despite the fact that not all PTC were detected by this panel, a positive molecular test helped to refine the FLUS cases into high-risk and low-risk categories[61]. Surgical intervention consisted of a 15 7 7-cm segmental mastectomy specimen that contained a large, ill-defined, irregular pink-tan . Q: Can flow cytometry be performed on the core biopsy? Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. Cibas ES, Ali SZ. et al. Author contributions: Misiakos EP, Margari N, Meristoudis C, Petropoulos K, and Spathis A contributed significantly in preparation, collection of data, writing and critically revising the manuscript; Machairas N, Schizas D, Karakitsos P and Machairas A contributed in data analysis, and writing the manuscript. The AUS/FLUS category in the Bethesda system, represents aspirates that contain follicular, lymphoid, or other cell types with architectural and/or nuclear atypia that is more pronounced than that observed in benign lesions yet not sufficient to be characterized as suspicious for follicular neoplasm (SFN), or suspicious for malignancy[10]. They can be sparsely cellular, because of the marked fibrosis and hyalinization encountered in some cases[19,51]. 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]. Almost simultaneously, in Europe, the British Thyroid Association-Royal College of Physicians and the Italian Society for Anatomic Pathology and Cytopathology-International Academy of Pathology (SIAPEC-IAP) thyroid reporting systems, each comprised of 5 diagnostic classes, have been introduced[10,11]. ZW Therefore, it is not prudent to remove every thyroid nodule we encounter in our medical practice. HHS Vulnerability Disclosure, Help et al. RT Half of patients present with significant compression of the upper respiratory and the digestive tract in the neck, resulting in dyspnea, hoarseness, dysphagia, and pain. Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results? Cibas ES. Layfield LJ, Cibas ES, Gharib H, Mandel SJ. Ultrasound guidance is preferable than palpation-guided FNA for small nodules (< 1 cm), cystic lesions and when a prior FNA is nondiagnostic[13]. Architectural atypia may present in smears with paucity of cells, which contain a few microfollicles, trabeculae, or crowded groups. On the other hand, these polarized spermatids also align across the plane of seminiferous epithelium, mimicking planar cell polarity (PCP . ZW 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. Sparsely cellular and contains atypical lymphoid cells Suspicious for malignancy, not otherwise specified Other primary thyroid malignancies like anaplastic carcinoma and poorly differentiated carcinoma Suboptimal cellularity or preservation can lead to uncertainty and result in a suspicious for malignancy interpretation Cytology images In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. Abati A. Alexander Immunohistochemistry test for specific biomarkers (i.e., calcitonin, thyroglobulin) will easily distinguish MTC from other thyroid malignancies. The molecular diagnosis and management of thyroid neoplasms. A review of the English literature was conducted, and data were analyzed and summarized and integrated from the authors perspective. As a result, 3 to 15 glass slides from each patient are taken and examined, which can be either Giemsa- or Papanikolaou-stained slides[14]. Krane JF, Vanderlaan PA, Faquin WC, Renshaw AA. 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. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. and transmitted securely. Note granulocytic precursors (arrows) and erythroid cells (arrow heads). This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. Since recurrent PTC typically secretes thyroglobulin, serum monitoring of thyroglobulin serves as a useful tumor marker for recurrent PTC[35]. Preparation Methods Vimentin immunoexpression is also a common finding[52]. These specimens demonstrate inadequate cellularity, poor fixation and preservation, obscuring blood or ultrasound gel, or a combination of the above factors. L B Evangelos P Misiakos, Dimitrios Schizas, Konstantinos Petropoulos, Anastasios Machairas, 3, Niki Margari, Christos Meristoudis, Aris Spathis, Petros Karakitsos, Department of Cytopathology, Attikon University Hospital, University of Athens School of Medicine, Attica, 12462 Athens, Greece. The many faces and mimics of papillary thyroid carcinoma. Thyroid nodules is a very usual clinical problem, as it is diagnosed in approximately 60% of the general population in Western countries[1]. In this study the AUS category was further subdivided into HCLUS (atypical cells rule out Hurthle cell neoplasm) and FLUS. Without individual cells to analyze through flow cytometric methods, the clot section is limited to only tissue-type immunostaining. The general category FN/SFN is a self-sufficient interpretation; narrative comments that follow are optional. 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. To address terminology and other issues related to thyroid FNA, the National Cancer Institute (NCI) hosted the NCI Thyroid Fine Needle Aspiration State of the Science Conference. The meeting was organized by Andrea Abati, MD, and took place on October 22 and 23, 2007, in Bethesda, MD. However, there are cases with diagnostic uncertainty due to suboptimal sampling or preservation, and overlapping cytomorphologic features with other thyroid conditions. Such changes may represent atypical but benign cyst lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). endstream endobj 93 0 obj <>>> endobj 94 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Thumb 35 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 95 0 obj <>stream According to the Bethesda system for reporting thyroid cytopathology, a specimen . Yang J, Schnadig V, Logrono R, Wasserman PG. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. (2021).Demystifying the Bone Marrow Biopsy: A Hematopathology Primer. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Carcinoma of the thyroid. The clot sections, core biopsy, marrow aspirate, and touch preps all contribute to the overall assessment of patients collected marrow. This interpretation applies to cellular samples that are composed exclusively (or almost exclusively) of Hrthle cells. The accuracy of fine-needle aspiration biopsy and frozen section in patients with thyroid cancer. Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, Abati A. Pathology Outlines - Suspicious for malignancy 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. S LiVolsi They are then stained and processed much like the original core biopsy. Before the routine use of thyroid FNA, the percentage of surgically resected thyroid nodules that were malignant was 14%.1 With current thyroid FNA practice, the percentage of resected nodules that are malignant surpasses 50%.2. While there are advantages and disadvantages to each component regarding turnaround time, comprehensiveness, and diagnostic utility (Table), their synergism provides ample information for your consultant hematopathologists. Cyst lining cells are usually elongated, containing pale chromatin, with sparsely found intranuclear grooves, large nucleoli, and always associated with hemosiderin-laden macrophages and benign-appearing macrofollicle fragments. As a result they may be not diagnosed through the FNA test, resulting in a false-negative test[44]. Thyroid aspiration cytology: current status. Additionally, since the cells are smeared, they are technically three-dimensional, and morphology can be assessed. Williams ED. Before the specimen is transferred to a container with anticoagulant, some of the already clotted specimen may be submitted for permanent histology in formalin. PDF Goal of Ideal Specimen Preparation S A cellular specimen composed of Hrthle cells arranged in loosely cohesive sheets or isolated in a case diagnosed as Hrthle cell adenoma ( 40 pap stain on ThinPrep slide) (diagnostic categories IV). Aspirate slides are also used for cytochemical and iron stains. A benign result is obtained in 60% to 70% of thyroid FNAs. An online atlas of illustrations of the Bethesda diagnostic categories is currently being assembled on the Papanicolaou Society Website under the direction of Syed Ali, MD, chair of the Online Atlas Committee. 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. Yassa Johnson As a library, NLM provides access to scientific literature. Grant McHenry The second subcategory includes cases with nuclear atypia, such as the presence of occasional nuclear grooves, nuclear crowding, and abnormal chromatin pattern, which are characteristics of papillary carcinoma (PTC). IR Within these sections, there are often small areas of hematopoietic material preserved from their original marrow environment. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. Q: Can flow cytometry be used for assessment of morphologic dysplasia? Different cell types of neurons form complicated circuits in the brain.
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