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Renshaw AA. Figure 6. For a thyroid FNA specimen to be satisfactory for evaluation (and benign), 6 . 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. 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. Cytopreparatory Techniques Questions Flashcards | Quizlet This subset of patients could benefit form a repeat FNA; (4) DC IV Follicular Neoplasm or Suspicious for a Follicular Neoplasm. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Preparation Methods A print atlas, with more than 40 contributing authors Appendix 1, is in press.3. Explaining the use and composition of pre-fixatives and their effect on cellular morphology 4. To address terminology and other issues related to thyroid fine-needle aspiration (FNA), the National Cancer Institute (NCI) hosted the NCI Thyroid FNA State of the Science Conference. Many laboratories have traditionally considered a macrophages-only sample unsatisfactory and included them in the ND/UNS category, with the understanding that, because the parenchyma of the nodule has not been sampled, one cannot exclude a cystic papillary carcinoma. Figure 5. Such cases occur with some regularity, and they are best classified as suspicious for malignancy, qualified as suspicious for papillary carcinoma. Nodules called suspicious for papillary carcinoma are resected by lobectomy or thyroidectomy. H Picture of four bone marrow specimens in a slide tray. Note extensive red blood cells in the background. The main purpose of thyroid FNA is to stratify higher risk patients for surgery, and to prevent unnecessary surgeries for benign conditions. Alternatively, a more prominent than usual population of microfollicles may occur (and may be disproportionately apparent on a minority of smears) in a moderately or markedly cellular sample, but the overall proportion of microfollicles is not sufficient for a diagnosis of follicular neoplasm/suspicious for follicular neoplasm. Due to the decalcification and need for fixation, bone core biopsy slides are usually not available to review until the following day. Pu Because of the densely cellular composition of bone marrow, the imprints impart many cells directly on the slides. 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. G Jo VY, Stelow EB, Dustin SM, Hanley KZ. The Bethesda System for Reporting Thyroid cytopathology. Cross PA, Poller D. The Bethesda thyroid terminology and progress towards international agreement on thyroid FNA cytology reporting. 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? Use freshly squeaky-cleaned slides. Cibas How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? Cerutti JM. VA Does Hrthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? If resected, virtually all benign follicular nodules turn out to be nodules of a multinodular goiter or follicular adenomas. We reviewed the English literature regarding Thyroid Cytopathology systems in order to identify the most suitable methodology, taking into account our prospective as well. The aspirates from anaplastic carcinoma do not pose any diagnostic difficulties. Specimen Adequacy and Non-diagnostic Thyroid Nodules For that reason the aspirate is then classified as AUS/FLUS to indicate the uncertainty of the findings. Post Anesthesia Care Unit. 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. BRAF mutation has become a specific marker for PTC and its variants[54]. In: Ali SZ, Cibas ES, editors. The specimen is usually cellular with polygonal cells in loose papillary clusters with abundant eosinophilic cytoplasm. 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. In this pattern cystic degeneration with hemosiderin-laden macrophages is present. CA RT Ohori NP, Singhal R, Nikiforova MN, Yip L, Schoedel KE, Coyne C, McCoy KL, LeBeau SO, Hodak SP, Carty SE, et al. We also evaluated aspects of specimen quality that differed according to the use of ROSE. 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. Cytologic preparations typically have high cellularity, and colloid is scant or absent. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Horn RC. B Describing methods to: i. One subcategory includes cases with a microfollicular pattern and minimal colloid, that is, follicular lesion of undetermined significance (FLUS). Atypia of Undetermined Significance/Follicular Lesion of - Springer Last but not least, repeated FNAs will lead to a diagnosis in 72%-80% of indeterminate cases where repeated FNAs were needed. Gharib Each of these four specimens have their strengths and limitations; therefore, they should be assessed separately. Such patients were followed clinically with periodic physical and sonographic examinations. Cytologic features of histologically proven follicular adenoma and et al. PU 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. Aldinger KA, Samaan NA, Ibanez M, Hill CS. The following breakdown shines some light inside the black box of hematologic diagnostics and may provide insight into what the hematopathology report tells you. (General, Ortho . hb```f``jg`e`bf@ a=TbO>9\!@)s\2q F)}w38|)0KQD[Vi>Rc@8[@5ii` .Q@q!d - `' }i@&QAz@%,700g& pL`r, l|Bj2"BTg]((@G@{2L2xVWA0Kk3\2 Ii 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]. Approximately 3% to 7% of thyroid FNAs have conclusive features of malignancy, and most are papillary carcinomas.1013 Malignant nodules are usually removed by thyroidectomy, with some exceptions (eg, metastatic tumors, non-Hodgkin lymphomas, and undifferentiated carcinomas). Agrawal S, Rao RS, Parikh DM, Parikh HK, Borges AM, Sampat MB. 0 In: Clark DP, Faquin WC, editors. A: No. et al. Wright-Giemsa staining of the marrow aspirate smear. However cases with indeterminate cytological findings still remain a matter of debate. 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. Moses W, Weng J, Sansano I, Peng M, Khanafshar E, Ljung BM, Duh QY, Clark OH, Kebebew E. Molecular testing for somatic mutations improves the accuracy of thyroid fine-needle aspiration biopsy. 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. Figure 4. In 2007 the Royal College of Pathologists introduced a new thyroid FNA reporting system, which was based on the existing United Kingdom terminology, but with some alterations, like new subcategories (i.e., c for cystic lesions, a for atypia, f for follicular neoplasm). WC 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]. There are cyst-lining cells that may appear atypical owing to the presence of nuclear grooves, prominent nucleoli, elongated nuclei and cytoplasm, and/or intranuclear cytoplasmic inclusions in an otherwise predominantly benign-appearing sample.16. Such changes may represent atypical but benign cyst-lining cells, but a papillary carcinoma cannot be entirely excluded (ThinPrep, Papanicolaou stain). Rathan The sample is composed of numerous monomorphic lymphoid cells. Papaparaskeva K, Nagel H, Droese M. Cytologic diagnosis of medullary carcinoma of the thyroid gland. AA 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]. 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. As a result they may be not diagnosed through the FNA test, resulting in a false-negative test[44]. Quick tip: A cellular aspirate smear is crucial to an adequate differential count and assessment of morphologic dysplasia. 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. ( a) In this sparsely cellular specimen, some cells have abundant cytoplasm, enlarged nuclei, and prominent nucleoli. Baloch 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. Pathologic Quiz Case: A Large, Ill-Defined Cystic Breast Mass - Allen Press The neoplastic cells resemble Hurthle cells but have diagnostic nuclear features of PTC. Various diagnostic terminologies, including indeterminate, atypical, and suspicious for malignancy, were used to describe these challenging cases[5]. B) 1,000 view. The hyalinizing trabecular tumor is an uncommon malignancy originating from follicular cells, with certain unique features, such as trabecular growth, marked intracellular hyalinization along with nuclear grooves and pseudoinclusions. Cibas Williams ED. Additionally, since the cells are smeared, they are technically three-dimensional, and morphology can be assessed. Loose cellular material can be held together to make into a cell block in all of the following EXCEPT a. agar b. albumin c. blood clot d. resin resin A slide of breast fluid has the cells washing off during staining. Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions. Deveci et al. The clinical and diagnostic impact of using standard criteria of adequacy assessment and diagnostic terminology on thyroid nodule fine needle aspiration. lobectomy). et al. We subcategorized Bethesda I into insufficient cellularity or artifacts, and Bethesda categories III and V into cellular without artifacts, sparsely cellular, or artifacts. The bone marrow aspirate is arguably the most straightforward aspect of the bone marrow workup. The general category FN/SFN is a self-sufficient interpretation; narrative comments that follow are optional. Processing A collection method should harvest well-preserved cells that reliably represent any urinary tract lesion that might be present. The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. Oncocytic cells with nuclear features of papillary carcinoma are excluded from this interpretation. Bongiovanni M, Krane JF, Cibas ES, Faquin WC. H212 Week 7: Cytology questions and answers 100% correct