BRAF mutation has become a specific marker for PTC and its variants[54]. 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. The cancer cells are also elongated, with a height-to-weight ratio of at least 3:1.
Undifferentiated (anaplastic) thyroid carcinoma (UTC) is an extremely aggressive thyroid malignancy with a very poor prognosis. Gharib
Prepares and stains all specimen types (gyn, medical cytology, fna) for cytologic examination. 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. Benign cyst-lining cells are typically polygonal or fusiform with abundant cytoplasm, well-defined cellular borders, sometimes enlarged, grooved nuclei, and small distinct nucleoli. Pan-keratin is the most reliable positive immunostain in UTCs, acquiring an expression ranging from 50% to 100%. Lymphoepithelial cyst. 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.
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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]. Additionally an immunohistochemical panel, including thyroglobulin, TTF1, and CDX2 may help in the differential diagnosis of such difficult cases.
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Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions.
There were several subsequent drafts and online discussion periods (August 15 to September 30, 2007, and November 30 to December 15, 2007). et al. 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. This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. Bone 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]. These include hypocellular smears with extensive cystic degeneration with rare follicular cells with nuclear atypia indicative of PTC.
If the nodule is almost entirely cystic, with no worrisome sonographic features, an endocrinologist might proceed as if the CFO were a benign result. McHenry
This document summarizes several years of work, begun as a Web-based discussion, followed by a live conference, and culminating in the production of a print and online atlas. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. of value in acquiring a cellular sample, possibly due to increasing hemodilution. Cytologic features of histologically proven follicular adenoma and An AUS result is obtained in 3% to 6% of thyroid FNAs.2,10 Higher rates likely represent overuse of this category when other interpretations are more appropriate. The discs are 2 mm thick in the unprocessed state, but less thick when processed, and sometimes slightly . Whatever the cause, you have reason to request a hematopathology workup and investigative studies. Sparsely cellular specimen means exact what it says - cells are sparse. G
Clark DP, Faquin WC. 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. However cases with indeterminate cytological findings still remain a matter of debate. Agrawal S, Rao RS, Parikh DM, Parikh HK, Borges AM, Sampat MB. This category is reserved for aspirates with borderline cellularity and is subdivided into two subcategories. ZW
specimen from ileal conduits Urine samples from these conduits contain a large number of degenerated intestinal epithelial cells, and
Any specimen that contains abundant colloid is adequate (and benign), even if 6 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 risk of malignancy for an AUS nodule is difficult to ascertain because only a minority of cases in this category have surgical follow-up. van Heerden
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Albores-Saavedra J, Wu J. Q: Can flow cytometry be used for assessment of morphologic dysplasia? Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA. Interestingly all predicted cancer proved to be papillary thyroid carcinoma in the final histology[59]. Thyroid aspiration cytology: current status. The morphology is similar to that seen on the core biopsy. et al. Seventeen . VA
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According to the Bethesda system for reporting thyroid cytopathology, a specimen . Cerutti JM.
Summarizing 3 slide smear methods 6. Figure 6. PDF Quality Assurance in Cytopathology and Histopathology of the Thyroid This is the most common variant of PTC and is characterized by a predominantly follicular architecture. In this review we analyze all literature regarding Thyroid Cytopathology Reporting systems trying to identify the most suitable methodology to use in clinical practice for the preoperative diagnosis of thyroid nodules. These specimens typically show sheets of bland thyroid follicular cells, which represent flattened macrofollicles.
Whenever a specific diagnosis (eg, lymphocytic thyroiditis) can be rendered and whenever there is any atypia, the specimen is, by definition, adequate for evaluation. View an interactive bone marrow clot specimen online. The molecular diagnosis and management of thyroid neoplasms. The purpose of this diagnostic category is to identify a nodule that might be a follicular carcinoma (FC) and triage it for surgical lobectomy. The bone marrow aspirate is arguably the most straightforward aspect of the bone marrow workup. government site. 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. Baloch
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The isolated cyst-lining cells in thyroid aspirates are often difficult to distinguish from PTC. In short, bone marrow analyses yield dynamic results, informing clinical diagnostics and treatment plans. A syringe with applied negative pressure gently removes approximately 5 mL of deep red, semi-liquid marrow content. This technique is conclusive for the majority of cases suspicious for PTC, lymphoma, or follicular neoplasm after previous incomplete FNA results. Gupta
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(General, Ortho . Surgical intervention consisted of a 15 7 7-cm segmental mastectomy specimen that contained a large, ill-defined, irregular pink-tan . Anderson Cancer Center, Houston, Edward B. Stelow, MD, Department of Pathology, University of Virginia Health System, Charlottesville, Jerry Waisman, MD, Department of Pathology, New York University of Medicine, New York, Helen H. Wang, MD, DrPH, Department of Pathology, Beth Israel-Deaconess Medical Center, Boston, MA, Philippe Vielh, MD, PhD, Department of Pathology, Institut de Cancerologie Gustave Roussy, Villejuif, France, Grace C. H. Yang, MD, Department of Pathology, Weill Medical College of Cornell University, New York, NY, Matthew A. Zarka, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale. When this panel was used for specimens with indeterminate cytology, sensitivity was 27%, specificity was 95%, positive predictive value was 66%, and negative predictive value was 78%[60]. 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]. You order a bone marrow analysis for your patient. 119 0 obj
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Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated fna be the preferred initial approach? Figure 1. 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]. WC
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Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. MTC was first described by Horn et al[45] in 1951, and it was first recognized as a unique clinicopathological entity by Hazard et al[46], in 1959. ID
Notes and recommendations are not required but can be useful in certain circumstances. By using redundancies across components, your consultant hematopathologists may offer insights into the architecture, morphology, immunostaining, and flow cytometry profiles of any identified hematologic entity. The rate of malignancy in FNA-BRAF positive nodules has been shown to be 99.8%[55]. et al. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Amanda L. - Multi-Skilled Technician - LinkedIn These indeterminate results imply surgeons to consider alternative therapies (e.g., thyroid lobectomy with intraoperative frozen section). The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. 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. Benson
Furthermore, various other thyroid FNA reporting systems have been created, in which the experiences of the pathologists and/or associated risks of malignancy have been taken into account. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. An effort should be made to use this category as a last resort and limit its use to approximately 7% or fewer of all thyroid FNAs. Faquin WC, Cibas ES, Renshaw AA.
Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. The clinical and diagnostic impact of using standard criteria of adequacy assessment and diagnostic terminology on thyroid nodule fine needle aspiration. The .gov means its official. LiVolsi
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]. For some of the general categories, some degree of sub-categorization can be informative and is often appropriate; recommended terminology is shown in Table 1. Guidelines for management of thyroid cancer. 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]. The significance and clinical value of a CFO result depend in large part on sonographic correlation. Frequency Calculator eNB ID Calculator . 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. Due to the decalcification and need for fixation, bone core biopsy slides are usually not available to review until the following day.
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B) 600 view of trilineage hematopoiesis. The diagnosis of MTC can be confirmed by simply measuring serum calcitonin levels, which are markedly elevated in the majority of cases (> 10 pg/mL)[48]. 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. RA
Sarasota Memorial Health Care System. 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. VA
There was also a great difference regarding the percentage of the cases classified into the TIR 2/ DC II (benign) category (83.9%) compared with approximately half (55.4%) of the cases in the 6-tiered system. C
Megakaryocytes (yellow circles) can be seen at low power. Conspicuous cellularity alone does not qualify the nodule for a suspicious interpretation.23 If the sample is cellular but mostly macrofollicular (intact spheres and flat fragments of evenly spaced follicular cells), a benign interpretation is appropriate.
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).
For most cases surgical resection is not an effective treatment and only palliative therapies are used. 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. Salivary Glands and Other Head and Neck Structures
There are three main methods of sample preparation; smears, liquid-based preparations, and cell block--these preparation methods may be used singly or in . 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. PDF Goal of Ideal Specimen Preparation Hematology.org.https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer(label-accessed May 01, 2023). 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]. However, there are cases with diagnostic uncertainty due to suboptimal sampling or preservation, and overlapping cytomorphologic features with other thyroid conditions. A full molecular panel of BRAF, RAS, RET/PTC and PAX8PPAR offer additional diagnostic value[58]. 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.
Amrikachi
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. 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]. Intussusception in an adult revealing a Vanek's tumor: A case report.
Cystic degeneration also is often found. The same general principle applies to other thyroid malignancies like medullary carcinoma and lymphoma, but these are encountered less frequently than PTC.
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]. For that reason these findings are best interpreted as SFM. 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. Redman R, Yoder BJ, Massoll NA. View an interactive bone marrow core biopsy online. hWkO+t{9!
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Herein lies everything you were afraid to ask. What is the hematopathologist looking for when assembling all the parts to report back in consultation with you? It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. The management of cases with papillary microcarcinomas, i.e., tumors less than 1.0 cm in diameter, is still controversial. Figure 4. The interpretation should provide clinically relevant information that will assist referring physicians in the management of patients. It is not widely agreed whether this neoplasm is a variant of PTC or not, although it seems to have the same RET gene rearrangements as PTC.
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