Thyroid FNA: Challenges and Opportunities

Abstract

nificance or Follicular Lesion of Undetermined Significance (AUS/FLUS). The authors succinctly summarize the areas of diagnostic overlap between AUS/FLUS and other categories and suggest ways to avoid overusing AUS/FLUS. Lobo et al. [2] present data from the UK on the histologic outcomes of the diagnostic categories for thyroid FNA that are used in the UK. Of note, the Royal College of Pathologists revised their thyroid FNA terminology in 2009 to allow for concordance between the UK system and TBSRTC. They found that the categories of the revised UK classification have clear and predictable risks of malignancy which permit management decisions based on the FNA interpretation. Cochand-Priollet et al. [3] discuss the merits and challenges inherent in implementing TBSRTC in the European community at large. As part of this large endeavor, they share with the reader their reproducibility study, which included 4 participants representing several different European nations. The following three papers dig deeper into the AUS/ FLUS category. VanderLaan et al. [4] examine variables that affect the AUS/FLUS rates of individuals, with an eye towards reducing overuse by providing confidential periodic feedback to pathologists on their AUS/FLUS rate. The authors report, among other things, that the AUS/ There was a shared sense of excitement and accomplishment among the participants at the conclusion of the 2-day National Cancer Institute (NCI) Thyroid FineNeedle Aspiration (FNA) State of the Science Conference in Bethesda, Md., USA, in 2007. Over 150 cytopathologists, surgical pathologists, endocrinologists, radiologists, and surgeons with an interest in thyroid disease had met for 2 days to talk about thyroid FNA, most notably about developing an evidence-based, common terminology for reporting thyroid FNA results. Since then, recommendations have been published, print and online atlases with definitions and criteria have appeared, and the resulting Bethesda terminology has been widely adopted in the USA and elsewhere. We are starting to speak the same language, at long last, and we look forward to reaping the benefits for patients and the healthcare system. Where do we go from here? This issue of Acta Cytologica, with its focus on thyroid FNA, attempts to point the way. Although the terminology obstacle has been overcome, notable challenges remain, not the least of which is the application of the new terminology in practice. Ohori and Schoedel [1] lead off this issue with a review of the 6 categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), with special attention to the category Atypia of Undetermined SigPublished online: December 9, 2011