See more. The precious cell block | Journal of Clinical Pathology Baloch ZW, LiVolsi VA. Fine-needle aspiration of the thyroid: today and tomorrow. 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. Use freshly squeaky-cleaned slides. 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]. Ancillary testing (eg, immunohistochemical analysis, flow cytometry) in borderline cases is usually more helpful with medullary carcinoma and lymphoma than with PTC. Dottorini Chronic sialadenitis: sparsely cellular specimen with fewer lymphocytes and germinal center fragments; no characteristic lymphoepithelial islands. The nucleoli are usually small and eccentric; however, rare oncocytic variants of PTC can show prominent nucleoli. Charge Nurse Job Denver Colorado USA,Research/Development Neither of these patterns fits comfortably into the benign category, but the changes are insufficient for any of the more . DeLellis Faquin A: Ideally, no. qA;`Yb]@b,@ "~Xbqs8J In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. Distant metastases seldom occur, but may develop in 20% of cases in late stage. B) 600 view of trilineage hematopoiesis. Both the European and the American systems are considered as a significant accomplishment and hold the promise for better classification of thyroid FNA results[6,10,11,17,18]. Rubenfeld As a result they may be not diagnosed through the FNA test, resulting in a false-negative test[44]. Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. Jing X, Michael CW, Pu RT. Cytological diagnosis of paucicellular variant of anaplastic carcinoma of thyroid: report of two cases. French 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. 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. At low magnification, aspirates of PTC are typically cellular, epithelium-rich structures. L Clark It is the hope of all contributors to this project that this terminology proposal will be a valuable first step toward uniformity and consensus in the reporting of thyroid FNA interpretations. Specimen Adequacy and Non-diagnostic Thyroid Nodules For that reason these findings are best interpreted as SFM. 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. Asa We also evaluated aspects of specimen quality that differed according to the use of ROSE. One nucleus has an apparent intranuclear pseudoinclusion (arrow). Since the marrow is abundantly deep red and more viscous than blood, the red cell and platelet components will eventually form clots if no anticoagulant is present. Cases that demonstrate the nuclear features of papillary carcinoma are excluded from this category. 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). Such changes may represent atypical but benign cyst lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). Note granulocytic precursors (arrows) and erythroid cells (arrow heads). Hematoxylin-eosinstained sections of the clot particle. They found that apart from the TIR III category, for the TIR 1/DCI(unsatisfactory/nondiagnostic) category the percentage of cases in the 5-tiered system was greater than twice the percentage of cases in the 6-tiered system (7.5% vs 3%). Cytopreparatory Techniques | SpringerLink Fine-needle aspiration (FNA) has an essential role in the evaluation of euthyroid patients with a thyroid nodule. Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. The contribution of intraoperative frozen section after a suspicious FNA diagnosis is questionable, as Lee et al[38] have demonstrated that preoperative FNA has a higher sensitivity than frozen section in detecting PTC. In the World Health Organization classification, Hrthle cell adenoma and Hrthle cell carcinoma are considered oncocytic variants of FA and FC, respectively.24 Studies suggest, however, that follicular and Hrthle cell tumors have different underlying genetics.4,25 For this reason, and because they have such distinctive morphologic features, it is helpful to specify that a sample raises the possibility of a Hrthle cell rather than a follicular neoplasm. 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. But the nuclear and architectural changes of some PTCs are subtle and focal. The double needle from the same aspirate procedure is used to cut a core biopsy of optimal length (longer is better; i.e., more data). The Bethesda System for Reporting Thyroid cytopathology. PDF The Bethesda System for Reporting Thyroid Cytopathology Recognizably benign cellular changes (eg, typical cyst lining cells, focal Hrthle cell change, changes ascribed to radioiodine therapy, black thyroid) should not be interpreted as AUS. VanderLaan PA, Marqusee E, Krane JF. LiVolsi 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]. What is one to do with the sparsely cellular specimen consisting mostly of microfollicles? Wright-Giemsa staining of the marrow aspirate smear. 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. Touch preps can be imprinted, rolled, or crushed between glass to provide similar information. A minor population of follicular cells show nuclear enlargement, often accompanied by prominent nucleoli, eg, Specimens from patients with a history of radioactive iodine, carbimazole, or other pharmaceutical agents, Repair due to involutional changes such as cystic degeneration and/or hemorrhage, There is an atypical lymphoid infiltrate (in which a repeated aspirate for flow cytometry is desirable), but the degree of atypia is insufficient for the general category suspicious for malignancy.. 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. Wu HH, Rose C, Elsheikh TM. Figure 6. moc.oohay@sokaisime. 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). The phenotypic composition of the various marrow components is key to understanding their utility for further investigative diagnostic studies. Does the fine-needle aspiration diagnosis of Hrthle-cell neoplasm/follicular neoplasm with oncocytic features denote increased risk of malignancy? Hay WC Yang B lobectomy). Sparsely cellular specimen means exact what it says - cells are sparse. This system allows patients with FNAs showing focal atypia to undergo repeat aspiration prior to surgery. 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. 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). Other benign subcategories include consistent with lymphocytic (Hashimoto) thyroiditis in the proper clinical context and consistent with granulomatous (subacute) thyroiditis. This is a partial list and does not include a variety of other benign conditions like infections and amyloid goiter that are occasionally sampled by FNA. The method could also be applicable to other sparsely cellular samples such as cerebrospinal fluid (CSF) samples, or eye vitreous fluid samples. Before Copyright 2023 American Society for Clinical Pathology. Post Anesthesia Care Unit. In several countries the Cytological Communities have adopted the first system or the other, as there is still an ongoing dispute on whether the 5-tiered system or the 6-tiered system is more efficient[12]. Jan 2018 - Present5 years 4 months. How to Interpret Thyroid Fine-Needle Aspiration Biopsy Reports: A Guide Prognosis is dismal with a mean survival of 2.5 to 6 mo and an overall 5-year survival of 0% to 14%. MS The thyroid FNAs can be performed either by direct puncture after palpating the thyroid nodule, or more commonly under ultrasound guidance by dedicated thyroid specialists (endocrinologists, radiologists, or pathologists). An official website of the United States government. Due to the decalcification and need for fixation, bone core biopsy slides are usually not available to review until the following day. Ramzy Inadequate samples are reported as nondiagnostic (ND) or unsatisfactory (UNS). 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 A serum protein electrophoresis might have even shown a monotypic expansion. The main purpose of thyroid FNA is to identify patients with higher risk for malignancy, and to prevent unnecessary surgeries for benign conditions. Highly cellular specimens are ideal for smeared preparations, whereas sparsely cellular specimens will require multiple centrifugation steps and special cell consolidation processing. However, we cannot answer medical or research questions or give advice. The National Cancer Institute Thyroid FNA State of the Science Conference: Wrapped up. There were several subsequent drafts and online discussion periods (August 15 to September 30, 2007, and November 30 to December 15, 2007). CR Lymphoepithelial cyst. Some thyroid FNAs are not easily classified into the benign, suspicious, or malignant categories. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. View an interactive bone marrow aspirate online. Handle sparsely cellular specimens ii. 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]. Quick tip: A cellular aspirate smear is crucial to an adequate differential count and assessment of morphologic dysplasia. The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. Utilization of ancillary studies in thyroid fine needle aspirates: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference.
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