Why do some investigations yield more, or less, information than others? 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. et al. KH
gynecologic cytology specimens 3. lobectomy). Such changes may represent atypical but benign cyst lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). Unlike the core biopsy, decalcification is not required for the clot section. A review of the English literature was conducted, and data were analyzed and summarized and integrated from the authors perspective. 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]. Therefore, detailed neuronal morphology is required to understand normal neuronal function . Preparation Methods RA
Bethesda, MD 20894, Web Policies 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? 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. Dottorini
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.
Intranuclear inclusions and multinucleated cells have been reported. Agrawal S, Rao RS, Parikh DM, Parikh HK, Borges AM, Sampat MB. Vimentin immunoexpression is also a common finding[52]. For most cases surgical resection is not an effective treatment and only palliative therapies are used. H
Palpation-guided FNA can be performed when a thyroid nodule is easily palpable (> 1.0 cm in diameter) and rather solid.
Cantara S, Capezzone M, Marchisotta S, Capuano S, Busonero G, Toti P, Di Santo A, Caruso G, Carli AF, Brilli L, et al. The .gov means its official.
Each of these four specimens have their strengths and limitations; therefore, they should be assessed separately.
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. Since there is a considerable proportion of patients with a thyroid nodule who remain undiagnosed with FNA, molecular biology could be very helpful at that point. (iii) Cytologic and architectural atypia: 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). 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. Picture of four bone marrow specimens in a slide tray. The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. 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). Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. The many faces and mimics of papillary thyroid carcinoma. They are then stained and processed much like the original core biopsy. Almost all patients with MTC have a significantly elevated serum calcitonin level, and in some cases these tumors can produce substances that can lead to paraneoplastic syndromes[35,44].
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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. 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]. Figure 3. This technique is conclusive for the majority of cases suspicious for PTC, lymphoma, or follicular neoplasm after previous incomplete FNA results. Cystic degeneration also is often found. Ultrasound guidance is preferable than palpation-guided FNA for small nodules (< 1 cm), cystic lesions and when a prior FNA is nondiagnostic[13].
Renshaw AA. The specimen is fixed in paraffin and cut for slide preparation. Determination of cellular phenotype (what the cell expresses on its surface, or in its cytoplasm) on an aspirate is carried out by flow cytometry. 2021 L Street NW, Suite 900,Washington, DC 20036, Phone 202-776-0544Toll Free 866-828-1231Fax 202-776-0545, Copyright 2023 by American Society of Hematology, Support Opportunities|Privacy Policy|Terms of Service|Contact Us, Helping hematologists conquer blood diseases worldwide, Demystifying the Bone Marrow Biopsy: A Hematopathology Primer, https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer, Relative quantity of different cell types, Provides material for flow and molecular studies.
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. Inclusion in an NLM database does not imply endorsement of, or agreement with, In this pattern many features of PTC are found, but it is sparsely cellular. . For that reason these findings are best interpreted as SFM. CS
Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Lloyd
Goellner
The prognosis of this tumor is good; death due to PTC is rare. 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. .
They can be sparsely cellular, because of the marked fibrosis and hyalinization encountered in some cases[19,51]. The diagnosis of this variant as a PTC is relatively easy, due to the numerous papillae and the coexisting intranuclear inclusions. Help . See: http://creativecommons.org/licenses/by-nc/4.0/, P- Reviewer: Eilers SG, Li XL S- Editor: Qiu S L- Editor: A E- Editor: Liu SQ, National Library of Medicine In a large study with 1382 cases in a community practice setting, in the United States, Wu et al[32] diagnosed AUS in 27% of cases, ranging from 10% to 47% among pathologists participating in the study. Two-dimensional fixed tissue specimens from the biopsy and clot are easily stained with immunohistochemical methods while three-dimensional, liquid cellular content can be assessed with flow cytometry. (B) A case diagnosed as DC IV (suspicious for a follicular neoplasm) shows moderately cellular specimen with abundant microfollicles (x15; scale bar, 200 m) (C-F) Architectural alterations such as microfollicles (C and D), 3-dimensional branching (E), and architectural crowding (F) are frequently observed in cases categorized as DC IV Statistics . 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. 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. While the V600E and K601E mutations were almost equally observed in the AUS/FLUS category, there was a slight predominance of K601E mutation in SFN/SHN category.
Broome JT, Solorzano CC. Chung
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Macrofollicular variant of papillary carcinoma: a potential thyroid FNA pitfall, Focal features of papillary carcinoma of the thyroid in fine-needle aspiration material are strongly associated with papillary carcinoma at resection, Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: follow-up and management, American Society for Clinical Pathology, The Clinical Laboratory Is an Integral Component to Health Care Delivery : An Expanded Representation of the Total Testing Process, Transformations of marginal zone lymphomas and lymphoplasmacytic lymphomas: Report from the 2021 SH/EAHP Workshop, Validation of a rapid HLA-DQA1*05 pharmacogenomics assay to identify at-risk resistance to antitumor necrosis factor therapy among patients with inflammatory bowel disease, Lessons learned from patient outcomes when lowering hemoglobin transfusion thresholds during COVID-19 blood shortages, Phenotypic and genotypic infidelity in B-lineage neoplasms, including transdifferentiation following targeted therapy: Report from the 2021 SH/EAHP Workshop, About American Journal of Clinical Pathology, About the American Society for Clinical Pathology, Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance, Follicular Neoplasm or Suspicious for a Follicular Neoplasm, Appendix 1 Bethesda Thyroid Atlas Contributors, Receive exclusive offers and updates from Oxford Academic, Assessment of The Bethesda System for Reporting Thyroid Cytopathology: Surgical and Long-Term Clinical Follow-up of 2,893 Thyroid Fine-Needle Aspirations, Impact of the Reclassification of Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma to Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on the Bethesda System for Reporting Thyroid Cytopathology: A Large Academic Institutions Experience, Neutrophil-Rich Ki-1Positive Anaplastic Large Cell Lymphoma: A Study by Fine-Needle Aspiration Biopsy, Kuttner Tumor of the Submandibular Gland: Fine-Needle Aspiration Cytologic Findings of Seven Cases. The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. The site is secure. One subcategory includes cases with a microfollicular pattern and minimal colloid, that is, follicular lesion of undetermined significance (FLUS). 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. 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. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Cochand-Priollet
Federal government websites often end in .gov or .mil. The benefit of thyroid FNA derives in large part from the ability to make a reliably benign interpretation that avoids unnecessary surgery. Papillary thyroid carcinoma and variants. Alexander
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 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. Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA. Highly cellular specimens are ideal for smeared preparations, whereas sparsely cellular specimens will require multiple centrifugation steps and special cell concentration methods.
They can be readily classified as malignant due to nuclear pleomorphism, chromatin clumping, necrosis, atypical mitoses and other malignant features[40]. A benign follicular nodule is the most common benign pattern that is, an adequately cellular specimen composed of varying proportions of colloid and benign follicular cells arranged as macrofollicle and macrofollicle fragments. 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. The FNA specimens show enlarged follicular cells arranged in monolayer sheets and follicular groups in a background of thin and thick colloid (Figure (Figure6).6). .
View an interactive bone marrow core biopsy online. We reviewed the English literature regarding Thyroid Cytopathology systems in order to identify the most suitable methodology, taking into account our prospective as well.
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Excision is considered for persistently ND/UNS nodules because about 10% prove to be malignant.13. As such, the redundancies in place discussed here and the compound output of the four major components have synergistic effects on diagnostic evaluation. A: No. Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. 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. The documents underwent revision after each comment period before reposting on the Web. et al. endstream
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Because of its aggressive, infiltrative nature, patients with an undifferentiated carcinoma often require a tracheostomy as an emergency procedure.
B) 1,000 view. the contents by NLM or the National Institutes of Health. However, some three dimensional structures that resemble the epithelial tips of papillae without the fibrovascular cores can be seen[35]. The above panel correctly identified cancer in 78.2%, whereas cytology identified 58.9% of the thyroid cancers. We thank Diane Solomon, MD, for review of the manuscript and helpful comments. This category also includes cases with a predominant population of Hurthle cells; these cases are labelled Hurthle cell neoplasm (Figure (Figure3).3). Oncocytic cells with nuclear features of papillary carcinoma are excluded from this interpretation. 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. 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]. Last but not least, repeated FNAs will lead to a diagnosis in 72%-80% of indeterminate cases where repeated FNAs were needed. 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. . 119 0 obj
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If resected, virtually all benign follicular nodules turn out to be nodules of a multinodular goiter or follicular adenomas. For a thyroid FNA specimen to be satisfactory for evaluation (and benign), 6 . 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. As such, if a dry tap is encountered during a bone marrow procedure, it may be beneficial to obtain two bone core biopsies to send to the laboratory. G
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Note: Please review ASHs disclaimerregarding the use of the information contained in these articles. The preparation of a "cell block" (a formalin-fixed, paraffin-embedded sediment of the urine sample) can be particularly useful because small pieces of tumor are often easier to evaluate with this preparation method. Oxford University Press is a department of the University of Oxford.
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sharing sensitive information, make sure youre on a federal Although these nuclear alterations are usually disseminated, they are mild and incomplete. If these constitute the minority of the follicular cells, they have little significance and the FNA can be interpreted as benign. The most common scenarios can be described as follows: There is a prominent population of microfollicles in an aspirate that does not otherwise fulfill the criteria for follicular neoplasm/suspicious for follicular neoplasm. This situation may arise when a predominance of microfollicles is seen in a sparsely cellular aspirate with scant colloid. Notes and recommendations are not required but can be useful in certain circumstances. 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. Tumor cells with distinct granules with eccentric nuclei. et al. ES
Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. 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. After the aspirate, the most expected informative component of a bone marrow workup is likely the core needle biopsy. The method could also be applicable to other sparsely cellular samples such as cerebrospinal fluid (CSF) samples, or eye vitreous fluid samples. This variant of PTC is not common, but it is important to be recognized as it may be confused with a Hurthle cell neoplasm[44]. This website is intended for pathologists and laboratory personnel but not for patients. Baloch
In such laboratories, macrophages only often constituted the great majority of ND/UNS cases, with rates that ranged from 15% to 30%.2,9,11,12 Other laboratories considered the risk of a false-negative result negligible and reported macrophages only as benign.10,11 At the 2007 NCI Conference, it was decided that cyst-fluid-only (CFO) cases should be considered a clearly identified subset of ND/UNS. ES
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. Quick tip: A cellular aspirate smear is crucial to an adequate differential count and assessment of morphologic dysplasia. Royal College of Physicians. . IB
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). 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]. Nuclear atypia or pleomorphism and mitoses are uncommon. 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.
van Heerden
You order a bone marrow analysis for your patient. B
The rate of malignancy in FNA-BRAF positive nodules has been shown to be 99.8%[55]. In part, each component is analyzed and interpreted in correlation together for a final report.
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. This variant is sometimes difficult to diagnose, because in some cases the characteristic neoplastic cells are sparsely evident in the mass. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Examine microscopically and determine the number of drops that will produce satisfactory cellularity on the slide.
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