Thyroid Fine Needle Aspiration Cytology Research Articles

Follicular neoplasm of thyroid in a young female: a case report from central India

Thyroid FNAC is very common but its interpretation is difficult. A 16‑year‑old female patient presented with a single thyroid nodule. A cytologic diagnosis of follicular neoplasm was made on fine needle aspiration cytology (FNAC). Papanicolaou and May–Grunwald–Giemsa staining showed high cellularity, abundant micro-follicles, cell crowding and uniform nuclear morphology. Reporting was done according to Bethesda system. The distinction between Follicular neoplasm and Nodular goiter is the most common differential diagnostic problem in solitary nodules as cytological appearances overlap. Findings were suggestive of follicular neoplasm which is rare in this age group.

Management of benign paediatric thyroid nodules: experience from paediatric ENT services of a tertiary care hospital

<p class="abstract">Thyroid nodules are a common occurrence in adults but are rarely seen in children. We present here four cases of paediatric thyroid nodules. Patients were subjected to a thorough clinical evaluation, blood thyroid level testing, ultrasonography (USG) and fine needle aspiration cytology (FNAC). The size of the nodules ranged from 2 cm to 7.5 cm. All four nodules were reported as “benign” on FNAC, of which three under-went total thyroidectomy owing to the bi-laterality and large size of the nodules. None of the cases had post-operative complications of hypocalcemia or recurrent laryngeal nerve paralysis. Of the 3 patients taken up for surgery one patient was found to have papillary thyroid carcinoma. Subsequent radiological investigation showed no residual disease. All three operated cases were followed-up in the ENT outpatient department for at least 2 years and showed no signs of recurrence. One patient with a small thyroid nodule (2 cm) was managed non – surgically and has been kept on follow up since 12 months. In our experience, total thyroidectomy, even in a benign disease, in expert hands, is a safe procedure and the best management option in children with large goiter, to avoid recurrence and thereby a redo surgery. </p>

Clinical study of thyroid swellings

<p><strong>Background:</strong> Thyroid swellings are very frequently encountered in ENT practice, ranging from a simple cyst to a malignant tumour. Disorder of structure of thyroid gland, due to various etiological factors, will give rise to swelling in the neck region. Clinical signs and symptoms are inadequate to diagnose thyroid disorders as similar presentations are seen in various thyroid disorders. So, this study of thyroid swellings was done to know different clinical presentations, age and sex distribution, correlation between thyroid swellings and thyroid function tests, analyse various thyroid swellings and etiological factors based on pathological reports.</p><p class="abstract"><strong>Methods:</strong> A prospective study with 50 patients of thyroid swellings was conducted over 2 years, after taking consent from each patient. Patients were clinically examined by inspection, palpation, percussion, auscultation and underwent thyroid function tests. Ultrasonography (USG) and fine needle aspiration cytology (FNAC) was done in all patients. </p><p class="abstract"><strong>Results:</strong> Total 50 patients of thyroid swellings were studied. Mean age of the patients was 38.92 years with female preponderance (74%). Thyroid swellings were commonly present bilaterally (54%). 82% cases showed euthyroid state. USG revealed that most of the patients had colloid nodule (46%), followed by MNG (26%). Majority of lesions were benign on both USG and FNAC reports. MNG (44%) was reported frequently in the provisional diagnosis, followed by colloid nodule (24%).</p><p class="abstract"><strong>Conclusions:</strong> In all cases of thyroid swellings, detailed clinical history, thorough clinical examination is required. Thyroid function test, USG and FNAC reports help to reach the definitive diagnosis. Histopathological report confirms and gives final diagnosis.</p><p> </p>

English

BACKGROUND Papillary thyroid carcinoma is the most common malignancy of the thyroid gland. Fine Needle Aspiration Cytology (FNAC) is a rapid, safe and economic procedure, and has a sensitivity approaching of 93.5 % and specificity close to 90 % for diagnosing papillary thyroid carcinomas. This study aims at correlating the cytological and histological diagnosis to arrive at the rate of concordance and discordance, identify variants of papillary thyroid carcinoma (PTC) on cytology and discuss the cytological mimics of PTC. METHODS Data from cases was collected over a period of three years (2015 - 2018). A descriptive study was done. Cases from Osmania General Hospital representing histologically proven cases of papillary carcinoma thyroid along with their corresponding cytological findings were analysed. Cytosmears were obtained from fine needle aspiration of thyroid lesions using a 26-gauge needle, stained with haematoxylin and eosin (H&E). Thyroidectomy specimens were fixed in 10 % buffered formalin, grossed and paraffin embedded. After processing, sections obtained by microtomy were stained with H & E for histopathologic evaluation. RESULTS The institute received a total of 258 thyroid specimens for histopathology and 686 cases for thyroid FNAC over a period of three years. This study includes 70 cases which had both cytology and histopathology correlation at our institution. 65 cases were diagnosed as PTC on histopathology and correct diagnosis was made on cytology with 73.8 % concordance (48 / 65 cases) and discordance was seen in 26.1 % (17 / 65 cases). 5 cases were misdiagnosed on cytology as PTC, and on histopathological examination were diagnosed as non-PTC. CONCLUSIONS Fine needle aspiration shows variable accuracy for PTC, ranging from 65 % to 90 %. The architectural arrangement of cells in papillary fragments and presence of nuclear features in majority of cells is diagnostic of the conventional variant of PTC. The other variants however, pose a diagnostic dilemma on account of their architectural variation, altered cytomorphology and the scant presence of nuclear features. An increase in the awareness of cytomorphology of variants and also of the mimics of PTC helps improve the diagnostic accuracy on FNAC. KEYWORDS Papillary Thyroid Carcinoma, Variants of PTC, Cytohistopathological Correlation

Implementation of Precaptured Videos of Thyroid Fine-Needle Aspiration Cytology Specimens for External Quality Control Purposes

Objective: The objective of this study was examine the feasibility of developing a proficiency testing scheme for cytology labs wishing to be accredited according to ISO 15189:2012, by using videos captured by static telecytological applications. Methods: The current study was carried out on 252 adequate specimens of 157 patients, retrospectively selected from the department’s registry. In all cases, surgical excision followed the initial cytological diagnosis. Three diagnostic categories of cytological reports were used. All cases were confirmed by histological diagnosis of surgical specimens. One representative video from each case was transferred via file transfer protocol to password-protected accounts for remote review by 3 independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor’s and reviewer’s diagnoses were collected, recorded and statistically evaluated. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of precaptured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect. Conclusions: Videos production by static telecytology applications can be used as an alternative method for cytological diagnosis validation. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. Pre-captured videos can improve significantly small cytology departments’ quality indices. Precaptured videos can also be used for teleconsultation and second opinion purposes and improve the performance of the already existing static telecytology stations.

Usefulness of The Bethesda System of Reporting Thyroid Cytopathology in Surgical Planning.

The Bethesda system for reporting thyroid cytopathology (TBSRTC) has attempted to standardize thyroid fine needle aspiration cytology (FNAC) reporting internationally into six diagnostic categories and help in clinical decision making. But there exists a significant variation in the reporting percentage and rates of malignancies in each category across the centres which complicates clinical decision making. To study the usefulness of TBSRTC in surgical planning of thyroid nodules and to correlate TBSRTC with final histopathology. 85 patients with thyroid nodules who underwent surgery were evaluated prospectively. Preoperatively FNAC and TBSRTC reporting was done and following surgery histopathology was correlated with cytology. Distribution of 85 patients amongst the six categories of TBSRTC was as follows: 2.35% in Category I, 68.23% II, 7.05% III, 16.47% IV, 2.35% V and 3.52% VI. In 93% (79) of patients TBSRTC correlated with histopathology whereas in 7% (6) it did not. Risk of malignancy calculated was 0% in II, 33.33% in III, 7.14% in IV and 100% in V and VI categories. Sensitivity, specificity, Positive Predictive Value and Negative Predictive Value of TBSRTC was 100% for V, VI categories, whereas it was 100%, 78%, 15% and 100% respectively for III, IV. The diagnostic accuracy in our study is 100% for Category V and VI whereas it is 79% for Category III and IV. TBSRTC proved to be a very good screening platform for triaging patients with thyroid nodules into benign and malignant groups, as it is directly related to risk of malignancy in each category. It has helped in appropriate surgical planning in 96.4% of our patients.

Delicate needle with the finest gauge for a butterfly gland, the thyroid: Is it worth mentioning?

Thyroidology has yet to declare the optimal needle size for thyroid fine-needle aspiration (FNA) cytology. In this respect, the researches on this issue remain restricted in English-language literature. Currently, Saraph and colleagues (1) evaluated dissimilarity between 23- and 25-gauge needles in terms of nondiagnostic/unsatisfactory rates of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) after FNA applications. The authors had worked with a sum of 141 23- and 157 25-gauge needles and reported their nondiagnostic/unsatisfactory rates as 31.09% and 35.07%, respectively, with no statistical difference. However, Dong et al. (2) reported working with 240 consecutive nodules, had undergone US-guided FNA (US-FNA), and obtained the highest scores of sample quality with 25-gauge needles in thyroid FNA cytology, comparing with 22- and 23-gauge needles, very recently. The authors declared the nondiagnostic scores of 15.42%, 19.58%, and 14.17% for US-FNA with 22-, 23-, and 25-gauge needles, respectively (2). In addition, recently, Shumrick et al. (3) reported 148 thyroid nodules in 107 cases, had undergone US-FNA, revealing significantly less non-diagnostic cytology with 27-gauged needles, 11.3%, comparing 25-gauge needles, 24.7%. We recently have studied the possible impact of size cutoff of 10- and 15-mm for the thyroid nodules on three diagnostic tools; i) strain elastography (SE), ii) sonography-guided FNA cytology, and iii) histopathology. A sum of 425 cases with 500 thyroid nodules had undergone US-guided FNA (USFNA) with 27-gauge finest-needle by a single surgeon (I.S.), surgeon-performed US (SUS), with a local anesthetic agent (1-3 mL of 1% lidocaine with 1:100,000 epinephrine) based on American Thyroid Association (ATA) management guidelines for patients with thyroid nodules and differentiated thyroid cancer [i.e. low, intermediate, and high suspicion nodules]; 2015 ATA management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer] for three years and two months. TBSRTC 1st ed. had been used for this period, for the mentioned considerable and novel ‘SUS based’ US-FNA terminology with the specific and also ‘ well-accepted and crucial’ size cut offs of 10- and 15- mm in Thyroidology revealing the FNA cytology outcomes with27-gauge fine needles, for Category I, per se, TBSRTC, 1st ed. were revealed as 9.0% (4). Moss et al.(5) notified that regular and coordinated thyroid FNA should be performed with smaller needle gauges, 24-27-gauges, without aspiration, routinely, in a systematic review and meta-analysis. Saraph et al. (1) specified the utilization of a 25-gauge needle did not produce a lower nondiagnostic rate, comparing the 23-gauge one. In addition, they pointed out that larger nodules might increase diagnostic rates, while the older and cystic nodules are prone to inadequate samples. We agree with Saraph and colleagues’(1) opinion about the limitations of nodule location, such as a posterior, more difficult to reach nodules, and sonography of composition (mixed and solid) and echogenicity which may be crucial parameters for this issue. Nonetheless, we postulate that the so-called needle gauge concept selectively enriches with finer needles. Additionally, we currently introduced the proposal of a novel terminology, “minimally invasive FNA (MIFNA)” and “minimally invasive thyroid FNA; Thyroid MIFNA (Thy MIFNA)”, including 27-gauge fine-needle with pre-procedural topical and local anesthetic agents administration, hope to contribute in Thyroidology (6). Of note, we might recommend opting for a 27-gauge finest needle in terms of US-FNA for a butterfly gland, the thyroid, with reasonable low rates of non-diagnostic/unsatisfactory cytology, TBSRTC, 1st and 2nd ed. and low severity of pain, as a matter of course. To this end, we also recommend: “think twice with larger needles for thyroid US-FNA”. This issue merits further investigation.

Should Liquid Based Cytology (LBC) be Applied to Thyroid Fine Needle Aspiration Cytology Samples?: Comparative Analysis of Conventional and LBC Smears.

Context:Liquid-based cytology (LBC) is a cyto-preparatory technique that may be applied to fine-needle aspiration (FNA) samples. However, its efficacy over conventional smears (CS) in thyroid is controversial.Aims:The aim of this study was to compare CS versus LBC (SurePath, BD) preparations in thyroid FNA samples for diagnostic efficacy.Settings and Design:Prospective case-control study using split sample analysis in 200 non-consecutive cases of thyroid FNA reported as per the Bethesda system.Methods and Material:Detailed cytomorphological features were evaluated in CS and LBC preparations. Cellularity was scored as 0–3. Based on diagnostic efficacy, they were categorized into three groups:(i) CS and LBC equivalent for diagnosis, (ii) CS better than LBC, and (iii) LBC better than CS for providing the diagnosis.Statistical Analysis Used:Paired t test for cellularity scores and descriptive for diagnostic efficacy.Results:There were 7 unsatisfactory, 118 benign, 10 atypia or follicular lesion of undetermined significance, 25 follicular neoplasms, 6 suspicious for malignancy, and 34 malignant thyroid FNA cases based on routine conventional smears. Cellularity of conventional smears was significantly higher than paired LBC smears (paired t test, P < 0.005). Comparison of overall diagnostic efficacy showed that LBC and CS were equivalent in 59% of cases; CS was superior to LBC in 37% cases and LBC was better than CS in 4% cases only. LBC smears showed higher unsatisfactory rate as compared to CS (18% vs. 3.5%). In category 2, the two techniques were equivalent in 87% of cases. In categories 4 and 6, CS were superior to LBC.Conclusions:In thyroid FNA cases, conventional smears are superior to LBC preparation in terms of cellularity and diagnostic efficacy and hence, LBC preparations should not replace conventional smears for making a routine cytomorphological diagnosis.

Thyroid fine needle aspiration cytology

Thyroid fine needle aspiration cytology

Correlation of sonographic and cytologic patterns of thyroid nodules.

Introductionthyroid nodules are palpable in about 8% of adults. It is necessary to differentiate benign nodules from malignant ones by the non-invasive ultrasonography thereby reducing the frequency of the invasive fine needle aspiration cytology (FNAC). The study assessed the sonographic and FNAC patterns of thyroid nodules for benign and malignant features in a black African population.Methodsthis was a hospital-based, cross-sectional study design over a 1-year period in which one hundred and seven (107) consenting patients between 15 to 80 years of age with palpable thyroid masses by convenience sampling, were consecutively recruited to have both thyroid ultrasound scan and FNAC of their thyroid mass sequentially. Frequency, percentages and two-by-two contingency table were employed for data analysis.Resultsthe sonographic features of the thyroid nodules varied from round 80 (74.8%) to oval 25 (23.4%) masses, the presence of thin peripheral halo 83 (77.6%), heterogeneous echo-pattern 104 (97.2%) with cystic component and peripheral vascularity 75 (70.1%). One hundred and five (98.1%) study participants showed benign features on sonography while two had features suspicious of malignancy; however FNAC result in the same group of patients was suggestive of benign masses in all 107 (100%) patients. Histology however confirmed malignancy in the 2 participants with ultrasound features suggestive of malignant thyroid nodules.Conclusionultrasonography is very sensitive in the characterization of thyroid nodules into benign or suspicious for malignancy in black African population.

Malignancy Rates of Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) Cases: A Tertiary Center Study.

To evaluate the malignancy rates of Atypia of undetermined significance /follicular lesion of undetermined significance (AUS/FLUS) cases in the light of clinical and sonographic features. The percentage of AUS/FLUS cases, second fine needle aspiration cytology (FNAC) results, cyto-histopathological correlations and risk of malignancy were analyzed. 113 out of 1461 thyroid FNAC samples (7.7%) were diagnosed as AUS/FLUS and included in the study. Seventy three out of 113 cases (64.6 %) underwent repeat biopsies or surgery. From 45 cases repeat biopsies were taken and 28 had thyroidectomy or lobectomy. There was a significant relation between nodule size and underwent surgery or repeat FNAC (p=0.036). Malignancy rate was 24.6% for cases which had any managements. The malignancy rates were higher in AUS/FLUS cases with cytological atypia (28.8%). After surgery the most common malignancy was papillary thyroid carcinoma, followed by follicular carcinoma. The risk of malignancy of AUS/FLUS cases is quite high because of the heterogeneity of the group. The sub-classification of this category according to cytological or/and architecture atypia may be more useful in predicting malignancy risk. Further larger studies with ancillary techniques including molecular analysis may be more useful in determining the malignancy risk and appropriate management of this heterogeneous category.

Evaluation of the Italian Cytological Reporting System and Comparison with Histopathology with Respect to Indeterminate Thyroid Lesions

Introduction: The British system (RCPath-Thy1-5), The Bethesda System for Reporting Thyroid Cyto-Pathology (BSRTC) and The Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification are the most practised thyroid reporting systems with high discriminative factor in classifying thyroid lesions on Fine Needle Aspiration Cytology (FNAC). Surprisingly, none of these classification systems are reliable, when the question is about ‘indeterminate for malignancy’ category. Aim: To find out a better cytological reporting system between Bethesda and Italian classification with respect to indeterminate lesions of thyroid. Materials and Methods: A cross-sectional retrospective study was undertaken in department of Cyto pathology at SDM College of medical sciences and hospital, Dharwad from year January 2015 to January 2018. Thyroid FNAC cases were collected from departmental archives. Among these cases, all FNAC slides for which thyroid surgery were done were reviewed by two cytopathologists and reporting was done using SIAPEC reporting system and BSRTC system. Among those cases (N=33), only indeterminate lesions were selected for the study. Fourteen cases were reported under TIR-3A and 19 cases were reported under TIR-3B. Histological outcomes and cyto-histopathological comparision was done using Chi-Square test. Risk Of Malignancy (ROM), sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) were determined. Results: ROM for TIR-3A lesions is 35.7% and for TIR-3B lesions is 58.89%. ROM for Atypia of Undetermined Significance/ Follicular Lesion of Undetermined Significance (AUS/FLUS) lesions is 71.4% and Follicular Neoplasm (FN)/Suspicious for FN category (FN/SFN) lesions are 42.3%. The study revealed very high sensitivity and specificity under Italian system when compared to Bethesda system in identifying malignant outcomes. ROM in Italian sub-classification was more than the anticipated levels. Conclusion: Current study concludes that SIAPEC reporting system is more satisfactory than BSRTC system while evaluating the indeterminate nodules for malignant outcomes. Our results indicate that cases classified solely on architectural atypia have almost 50% lower ROM when compared with cases with cytological atypia.

Potential role of mobile rapid on-site evaluation® in thyroid fine-needle aspiration cytology to reduce delayed repeated aspiration.

Rapid on-site evaluation of fine-needle aspiration cytology is time-consuming and requires specialized cytopathology staff. Mobile Rose® is a newly developed device for rapid on-site evaluation of fine-needle aspiration cytology. This study aimed to investigate the potential role of Mobile Rose® in reducing delayed repeated aspiration of the thyroid. A total of 120 cytological samples were collected and observed using Mobile Rose® after fine-needle aspiration cytology between September and October 2020, with immediate assessment of minimal or no cell clusters after conventional smear preparation. After qualifying and scoring, needle washout materials were prepared using the BD CytoRichTM method and correlated with cytology results. The average turn-around time of Mobile Rose® was found to be 1.5 minutes. Sensitivity, specificity, positive predictive value, and negative predictive value were 94.4%, 100%, 100%, and 57.1%, respectively. False-negative results were attributed to small aggregates of cells that were difficult to distinguish from the background and artifacts. Mobile Rose® may represent an important innovation for rapid on-site evaluation that is fast, has high diagnostic performance, does not require the presence of specialized cytology staff, and can reduce delayed repeated aspiration of the thyroid gland. However, further minor improvements and confirmation are required.

English

BACKGROUND The Bethesda system of reporting thyroid cytopathology is an outstanding and systematic approach of reporting thyroid cytology samples, thereby reducing the communication gap between cytopathologist and clinician, leading to a better patient care approach. We aim to study the thyroid fine needle aspiration (FNA) using the Bethesda system and evaluate its accuracy taking histopathology as gold standard. METHODS This was a descriptive study including 200 consecutive cases which came to our cytology department between January 2014 and December 2014. All thyroid fine needle aspiration cytology (FNAC) were categorised as per the Bethesda system and followed up with corresponding histopathology. RESULTS Out of the 200 cases, adequacy criteria was met in 196 (98 %) cases. 176 (88 %) cases fell in the benign category, 4 (2 %) cases were inadequate samples, 8 (4 %) showed features of follicular neoplasm / suspicious of follicular neoplasm and 12 (6 %) were malignant lesions. Histopathology follow up was available for all cases. Statistical analysis showed a specificity of 100 % (high), sensitivity of 40 % (low). Positive predictive value was 100 %, negative predictive value was 90.4 %. Accuracy rate was 91 %. CONCLUSIONS Interpreting the thyroid FNAC results using Bethesda system allowed a superior interlaboratory agreement leading to improved clinical management. KEYWORDS Thyroid, Cytology, Bethesda

Implementation of Bethesda system for reporting thyroid cytology in an academic institution: A 2 year retrospective study

Thyroid diseases are the most common endocrine diseases in India. Both benign and malignant diseases present as thyroid nodules. Fine needle aspiration cytology (FNAC) has proven to be one of the most effective tools for evaluation of thyroid nodules. Interpretation of FNAC has been standardized by the Bethesda system for reporting thyroid cytopathology (TBSRTC). Aim: To categorize all the thyroid lesions utilizing TBSRTC, in an academic institution for a duration of 2 years and find its histopathological correlation. Materials and Methods: A 2 year retrospective study included all 229 patients who underwent thyroid FNAC in the institution. All the clinical and relevant radiological investigations were retrieved from hospital information system. All Papanicolaou and May Grunwald Giemsa stained smears were categorized under TBSRTC in to 6 categories. Results: Maximum number of cases were between the age group of 31-45yr. Male: Female ratio in our study was 1:13. There were 12 cases (5.2%) under Unsatisfactory/non diagnostic category, 196(85.5%) cases belonged to benign category, 1 case (0.04%) of Atypia of undetermined significance/follicular lesion of undetermined significance,10 cases (4.3%) belonged to follicular/ suspicious for follicular neoplasm,4 cases (1.7%) belonged to suspicious for malignancy & 6 (2.6%) belonged to Malignant category. Cyto histopathology discrepancy rate was 7.14%. Conclusions: TBSRTC brings about uniformity in reporting of thyroid cytology, thereby helping in better patient management and avoiding unwanted surgeries. Keywords: Bethesda system, Fine needle aspiration cytology, Follicular neoplasm, Malignant, Reporting, Thyroid.

Thyroid cytology in Pakistan: An institutional audit of the atypia of undetermined significance/follicular lesion of undetermined significance category.

Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow-up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases. The integrated laboratory management system retrieved the thyroid FNACs from 2010 to 2018 and subsequent surgical pathology specimens. For the AUS/FLUS cases, data regarding patient demographics, cytology and histological diagnoses were recorded. The results were tabulated as the overall frequency of AUS/FLUS in thyroid FNACs, cytohistological correlation (benign and malignant) and ROM. Over a period of 9 years, 256 (10.9%) cases out of 2342 thyroid FNACs were reported as AUS/FLUS at our institution. Mean age was 43.5years. The majority (70.3%) of patients were female. Seventy-two of 104 resection specimens (69.2%) were reported as benign and 32 cases (30.7%) had malignant diagnosis. Upper-bound ROM was 30.7% (32 cases with malignant diagnosis out of 104 resection specimens). Lower-bound ROM was calculated as 12.5% (32 cases with malignant diagnosis out of 256 total AUS diagnosis). The AUS/FLUS category of thyroid cytology and associated ROM remain an evolving area. Individual institutions should monitor the frequency and include ROM in the dashboard indicators to remain within the recommended range.

Malignancy Analyses of Thyroid Nodules in Patients Subjected to Surgery with Cytological- and Ultrasound-Based Risk Stratification Systems

The fine needle aspiration (FNA) cytology is the gold standard for the preoperative diagnosis of thyroid cancer. However, up to 30% of FNA examinations yield nondiagnostic or indeterminate results and this complicates patient management. Clinical features and ultrasound (US) patterns, including US risk stratification systems, could be useful in the preoperative diagnostic workup and prediction of malignancy, but the evidences are not univocal. Methods: 400 consecutive patients subjected to thyroid surgery were retrospectively enrolled at our institution in Calabria, Southern Italy. Preoperative US and FNA cytological descriptions, formulated according to the “Italian consensus for reporting thyroid fine-needle aspiration cytology” (ICCRTC) classification and three US risk stratification systems (those developed by the American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi (AACE/ACE/AME), American Thyroid Association (ATA), and American College of Radiology (ACR-TIRADS)), were collected, along with histological results. Results: 147 thyroid cancer cases, in large majority papillary carcinomas, were detected on final histological examination. Almost two-thirds of patients subjected to thyroid surgery for either benign or malignant lesions were female. Patient’s age ≤20 years and between 21–30 years were clinical features associated with increased risk of thyroid cancer in logistic regression analyses. US features associated with thyroid cancer included irregular margins, solid composition, microcalcifications, and marked hypoechogenicity. The AACE/ACE/AME, ATA, and ACR-TIRADS risk categories, corresponding to specific US patterns, were strong predictors of malignancy in both genders, but not in nodules with indeterminate cytology. A measured difference between the longitudinal (L) and the anteroposterior (AP) diameter &gt;5 mm, a proxy for a parallel-oriented oval shape of a nodule, emerged as a robust protective factor against thyroid cancer (OR 0.288 (95%CI 0.817–0.443); p &lt; 0.001), regardless of cytological risk. Conclusions: Some, but not all, well-established predictors of TC have been confirmed in this study. Controversy surrounds the diagnostic performance of US risk stratification systems for the detection of thyroid cancer in the subgroup of nodules with indeterminate cytology, suggesting their use only to set the thresholds for FNA. A measured difference between L and AP diameters &gt;5 mm may represent an additional and practical tool for ruling out malignancy in thyroid nodules, with the potential to reduce unnecessary surgical procedures.

An overview of thyroid fine-needle aspiration practice in Myanmar.

Fine-needle aspiration cytology (FNAC) of the thyroid is a widely accepted method for aiding the diagnosis of thyroid nodules. In Myanmar, it has been done since the early 1990s, and mainly performed by surgeons and otorhinolaryngologists. The interpretation of cytology is solely made by pathologists. Although some of the experts particularly those from specialist hospitals use the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), many still prefer the British five-tier cytopathology report. Available local publications addressing the accuracy of FNAC and cytologic-histologic correlations were queried. Ten studies performed in 1991-2018 on 540 thyroid nodules were included. Cytologic-histologic correlations showed a range of sensitivity from 64.29% to 100%, specificity from 93% to 100%, and diagnostic accuracy from 94% to 100%. The adoption of TBSRTC by pathologists is still slow and should be encouraged via seminars and training programs. Further multihospital-based large cohort studies with uniform design and adequate follow-up are needed to better promote and assess utility of thyroid FNAC in Myanmar.

Effects of bedside adequacy assessment in thyroid cytology on cytological sufficiency and the final histopathological diagnosis

Purpose: The thyroid fine needle aspiration cytology (FNAC) is a fast, reliable, and economical method for the interpretation of thyroid nodules. This method contributes to the later management of patients and reduces unnecessary surgical interventions. This study aimed to demonstrate the contribution of bedside adequacy assessment during FNAC to the accuracy rates of cytological competence and final histological diagnosis.Materials and Methods: The study included 443 patients who underwent FNAC in a university hospital between 2012 and 2015. Correlations between the histological diagnosis categories of patients who had and who did not have bedside adequacy assessment were compared per sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.Results: As a result of comparison of cytological and histopathological diagnoses, 30.7% sensitivity, ‎75% specificity, 50% positive predictive value, 57.1% negative predictive value and 55.1% diagnostic accuracy were found in the group with bedside adequacy assesment. Whereas in the group without bedside adequacy assessment, 50% sensitivity, 69.2% specificity, 42.8% positive predictive value, 75% negative predictive value, and 63.1% diagnostic accuracy were foundConclusion: Bedside adequacy assessment increases the cytological adequacy proportion, but does not contribute to the diagnostic accuracy rate.

Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update.

In Taiwan, thyroid fine-needle aspiration cytology is easily accessible and reliable for evaluating thyroid nodules. The sonographic pattern plays a major role and is the deciding factor for aspiration. We conducted a nationwide survey in 2017 and it revealed that 31% of laboratories had adopted The Bethesda System for Reporting Thyroid Cytopathology. There was a relatively high unsatisfactory rate (24.04%) and low rates of indeterminate diagnoses, including atypia of undetermined significance/follicular lesions of undetermined significance: 4.87%, and follicular neoplasm/suspicious for a follicular neoplasm: 0.35%. Moreover, the risks of malignancy in benign, atypia of undetermined significance, and suspicious for a follicular neoplasm were relatively high. These may reflect strict diagnostic criteria for indeterminate categories and better patient selection for surgery. Improvements in specimen sampling and continuing education programs are crucial. Newly-developed thyroid cytology technologies, such as immunocytochemistry, molecular testing, and computerized cytomorphometry, may further facilitate cytology diagnoses.