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Thyroid

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Practical Cytopathology

Part of the book series: Practical Anatomic Pathology ((PAP))

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Abstract

This chapter provides cytopathologists and trainees with brief and clearly formatted reference materials for navigating through various thyroid lesions obtained by thyroid fine needle aspiration (FNA).

These reference materials include current clinical practice guidelines and indications for ultrasound (US)-guided FNA of thyroid nodules, the accuracy rate of thyroid FNA, sample collection and preparation methods, a description of normal and abnormal thyroid elements in the cytologic interpretation, differential diagnosis by using the recommended terminology (the Bethesda System for Reporting Thyroid Cytopathology), and the value of currently established ancillary studies that aid in the interpretation of indeterminate thyroid nodules.

By including a variety of case studies with high-quality images, condensed (table format) diagnostic-related information, and frequently asked questions, we emphasize the strength and challenge of thyroid FNA cytopathology interpretation and its possible implication in management and cancer staging with the recent 8th edition AJCC cancer staging guidelines.

The Bethesda System for Reporting Thyroid Cytopathology is linked to an associated risk for malignancy to each Bethesda category. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and its relation to risk of malignancy and recommended clinical management, also poses a challenge with regard to diagnostic criteria and differentiation from papillary thyroid carcinoma (PTC) and its follicular variant.

Our goal is for readers to find this chapter a useful and practical resource when practicing thyroid FNA cytology.

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References

  1. Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab. 1955;15(10):1270–80.

    Article  CAS  PubMed  Google Scholar 

  2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cibas ES, Alexander EK, Benson CB, de Agustín PP, Doherty GM, Faquin WC, et al. Indications for thyroid FNA and pre-FNA requirements: a synopsis of the National Cancer Institute Thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol. 2008;36(6):390–9.

    Article  PubMed  Google Scholar 

  4. Pitman MB, Abele J, Ali SZ, Duick D, Elsheikh TM, Jeffrey RB, et al. Techniques for thyroid FNA: a synopsis of the National Cancer Institute Thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol. 2008;36(6):407–24.

    Article  PubMed  Google Scholar 

  5. Zhang M, Lin O. Molecular testing of thyroid nodules: a review of current available tests for fine-needle aspiration specimens. Arch Pathol Lab Med. 2016;140(12):1338–44.

    Article  CAS  PubMed  Google Scholar 

  6. Gordon DL, Gattuso P, Castelli M, Bayer W, Emanuele MA, Brooks MH. Effect of fine needle aspiration biopsy on the histology of thyroid neoplasms. Acta Cytol. 1993;37(5):651–4.

    CAS  PubMed  Google Scholar 

  7. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19(11):1159–65.

    Article  PubMed  Google Scholar 

  8. Faquin WC, Wong LQ, Afrogheh AH, Ali SZ, Bishop JA, Bongiovanni M, et al. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology. Cancer Cytopathol. 2016;124(3):181–7.

    Article  PubMed  Google Scholar 

  9. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–6.

    Article  PubMed  Google Scholar 

  10. Asa SL. The evolution of differentiated thyroid cancer. Pathology. 2017;49(3):229–37.

    Article  PubMed  Google Scholar 

  11. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.

    Article  PubMed  Google Scholar 

  12. Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on Cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid. 2017;27(6):751–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LD, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2(8):1023–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Paulson VA, Shivdasani P, Angell TE, Alexander EK, Cibas E, Krane JF, et al. NIFTP accounts for over half of “carcinomas” harboring RAS mutations. Thyroid. 2017;27:506–11.

    Article  CAS  PubMed  Google Scholar 

  15. Strickland KC, Howitt BE, Marqusee E, Alexander EK, Cibas ES, Krane JF, et al. The impact of noninvasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid. 2015;25(9):987–92.

    Article  PubMed  Google Scholar 

  16. Strickland KC, Vivero M, Jo VY, Lowe AC, Hollowell M, Qian X, et al. Preoperative cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a prospective analysis. Thyroid. 2016;26(10):1466–71.

    Article  PubMed  Google Scholar 

  17. Krane JF, Alexander EK, Cibas ES, Barletta JA. Coming to terms with NIFTP: a provisional approach for cytologists. Cancer. 2016;124(11):767–72.

    Google Scholar 

  18. Baloch ZW, Seethala RR, Faquin WC, Papotti MG, Basolo F, Fadda G, et al. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a changing paradigm in thyroid surgical pathology and implications for thyroid cytopathology. Cancer Cytopathol. 2016;124(9):616–20.

    Article  PubMed  Google Scholar 

  19. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules--2016 update. Endocr Pract. 2016;22(5):622–39.

    PubMed  Google Scholar 

  20. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508–16.

    Article  PubMed  Google Scholar 

  21. Pusztaszeri MP, Krane JF, Cibas ES, Daniels G, Faquin WC. FNAB of benign thyroid nodules with papillary hyperplasia: a cytological and histological evaluation. Cancer Cytopathol. 2014;122(9):666–77.

    Article  PubMed  Google Scholar 

  22. Layfield LJ, Abrams J, Cochand-Priollet B, Evans D, Gharib H, Greenspan F, et al. Post-thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid fine needle aspiration state of the science conference. Diagn Cytopathol. 2008;36(6):442–8.

    Article  PubMed  Google Scholar 

  23. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306–15.

    Article  PubMed  Google Scholar 

  24. Deveci MS, Deveci G, LiVolsi VA, Baloch ZW. Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-up. Cytojournal. 2006;3:9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Giorgadze T, Rossi ED, Fadda G, Gupta PK, Livolsi VA, Baloch Z. Does the fine-needle aspiration diagnosis of “Hürthle-cell neoplasm/follicular neoplasm with oncocytic features” denote increased risk of malignancy? Diagn Cytopathol. 2004;31(5):307–12.

    Article  PubMed  Google Scholar 

  26. French CA, Alexander EK, Cibas ES, Nose V, Laguette J, Faquin W, et al. Genetic and biological subgroups of low-stage follicular thyroid cancer. Am J Pathol. 2003;162(4):1053–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Mendelsohn G, Baylin SB, Bigner SH, Wells SA, Eggleston JC. Anaplastic variants of medullary thyroid carcinoma: a light-microscopic and immunohistochemical study. Am J Surg Pathol. 1980;4(4):333–41.

    Article  CAS  PubMed  Google Scholar 

  28. Kaserer K, Scheuba C, Neuhold N, Weinhäusel A, Vierhapper H, Haas OA, et al. C-cell hyperplasia and medullary thyroid carcinoma in patients routinely screened for serum calcitonin. Am J Surg Pathol. 1998;22(6):722–8.

    Article  CAS  PubMed  Google Scholar 

  29. Sheikh HA, Tometsko M, Niehouse L, Aldeeb D, Swalsky P, Finkelstein S, et al. Molecular genotyping of medullary thyroid carcinoma can predict tumor recurrence. Am J Surg Pathol. 2004;28(1):101–6.

    Article  PubMed  Google Scholar 

  30. Krampitz GW, Norton JA. RET gene mutations (genotype and phenotype) of multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma. Cancer. 2014;120(13):1920–31.

    Article  CAS  PubMed  Google Scholar 

  31. Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer. 2000;88(5):1139–48.

    Article  CAS  PubMed  Google Scholar 

  32. Akslen LA, LiVolsi VA. Poorly differentiated thyroid carcinoma--it is important. Am J Surg Pathol. 2000;24(2):310–3.

    Article  CAS  PubMed  Google Scholar 

  33. Nishida T, Katayama S, Tsujimoto M, Nakamura J, Matsuda H. Clinicopathological significance of poorly differentiated thyroid carcinoma. Am J Surg Pathol. 1999;23(2):205–11.

    Article  CAS  PubMed  Google Scholar 

  34. Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, et al. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol. 2007;31(8):1256–64.

    Article  PubMed  Google Scholar 

  35. Kane SV, Sharma TP. Cytologic diagnostic approach to poorly differentiated thyroid carcinoma: a single-institution study. Cancer Cytopathol. 2015;123(2):82–91.

    Article  PubMed  Google Scholar 

  36. Zhao L, Gong Y, Wang J, Dawlett M, Huo L, Caraway NP, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid bed lesions from patients with thyroidectomy for thyroid carcinomas. Cancer Cytopathol. 2013;121(2):101–7.

    Article  PubMed  Google Scholar 

  37. Suh YJ, Son EJ, Moon HJ, Kim EK, Han KH, Kwak JY. Utility of thyroglobulin measurements in fine-needle aspirates of space occupying lesions in the thyroid bed after thyroid cancer operations. Thyroid. 2013;23(3):280–8.

    Article  CAS  PubMed  Google Scholar 

  38. Webster N, Fox C, Fan F. Thyroid bed fine needle aspiration in patients after thyroidectomy--a useful follow-up tool with proposed diagnostic categories. Ann Diagn Pathol. 2014;18(3):177–80.

    Article  PubMed  Google Scholar 

  39. Cho M, Oweity T, Brandler TC, Fried K, Levine P. Distinguishing parathyroid and thyroid lesions on ultrasound-guided fine-needle aspiration: a correlation of clinical data, ancillary studies, and molecular analysis. Cancer Cytopathol. 2017;125(9):674–82.

    Article  CAS  PubMed  Google Scholar 

  40. Domingo RP, Ogden LL, Been LC, Kennedy GC, Traweek ST. Identification of parathyroid tissue in thyroid fine-needle aspiration: a combined approach using cytology, immunohistochemical, and molecular methods. Diagn Cytopathol. 2017;45(6):526–32.

    Article  PubMed  Google Scholar 

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Correspondence to Huihong Xu .

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Xu, H., Cerda, S. (2020). Thyroid. In: Xu, H., Qian, X., Wang, H. (eds) Practical Cytopathology . Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-24059-2_13

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  • DOI: https://doi.org/10.1007/978-3-030-24059-2_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24058-5

  • Online ISBN: 978-3-030-24059-2

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