RV et al. specimen from ileal conduits Urine samples from these conduits contain a large number of degenerated intestinal epithelial cells, and JA 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]. 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. Zubair W. Baloch, MD, PhD, served as chair of the Terminology and Morphologic Criteria committee. A minor population of follicular cells show nuclear enlargement, often accompanied by prominent nucleoli, eg, Specimens from patients with a history of radioactive iodine, carbimazole, or other pharmaceutical agents, Repair due to involutional changes such as cystic degeneration and/or hemorrhage, There is an atypical lymphoid infiltrate (in which a repeated aspirate for flow cytometry is desirable), but the degree of atypia is insufficient for the general category suspicious for malignancy.. gynecologic cytology specimens 3. These alterations were made in order for the British system to be analogous to the BSRTC[11,16], although in other countries these modifications have not be totally embraced. Characteristically, distinct granules (calcitonin granules) are spotted in the cytoplasm of the cancer cells, as well as eccentric nuclei, indicating a plasmacytoid appearance to the tumor cells. Herein lies everything you were afraid to ask. The atypical thyroid fine-needle aspiration: past, present, and future. Regardless the staining method used, all slides with diagnostic material are used for the evaluation and clarification of each case. Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. Flat sheets showing enlarged, pale nuclei with finely granular chromatin of a papillary Ca case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. The hallmark of this diagnostic category is a disturbed cytoarchitecture: follicular cells are arranged predominantly in microfollicular or trabecular arrangements. ES et al. 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. 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. See: http://creativecommons.org/licenses/by-nc/4.0/, P- Reviewer: Eilers SG, Li XL S- Editor: Qiu S L- Editor: A E- Editor: Liu SQ, National Library of Medicine In this pattern many features of PTC are found, but it is sparsely cellular. Figure 6. 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. Accessibility We welcome suggestions or questions about using the website. After these initial assessments, immunostains often aim to assess architecture, fibrosis, lymphoid aggregates, myeloid lineage maturity, and other related potential pathologies. Any specimen that contains abundant colloid is considered 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. Weber D, Brainard J, Chen L. Atypical epithelial cells, cannot exclude papillary carcinoma, in fine needle aspiration of the thyroid. What is one to do with the sparsely cellular specimen consisting mostly of microfollicles? The cytological diagnosis of PTC is based mainly on the characteristic nuclear morphology. These specimens typically show sheets of bland thyroid follicular cells, which represent flattened macrofollicles. Layfield LJ, Cibas ES, Gharib H, Mandel SJ. Vimentin immunoexpression is also a common finding[52]. 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. Core tip: Fine-needle aspiration (FNA) cytology is widely used for the diagnosis of thyroid nodules, although cases with indeterminate results are not rare. While their individual turnaround times vary, these specimens are usually reported together to make sure all aspects are accounted for, which can take approximately three days on average. Renshaw AA. After the aspirate, the most expected informative component of a bone marrow workup is likely the core needle biopsy. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. Undifferentiated (anaplastic) thyroid carcinoma (UTC) is an extremely aggressive thyroid malignancy with a very poor prognosis. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM. BRAF testing has been coupled successfully with the Bethesda Thyroid FNA classification system to offer molecular quality assurance on positive samples, as well as a diagnostic upgrade on samples of indeterminate diagnostic categories, such as AUS/FLUS and SFN/SHN[54]. If the tumor is small and confined to the thyroid, thyroidectomy may be feasible; however, in most cases the tumor extends outside the thyroid gland preventing adequate resection[35]. 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. Cytologic preparations typically have high cellularity, and colloid is scant or absent. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. Bethesda, MD 20894, Web Policies ZW 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]. 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. As with the Bethesda System for cervical cytology, it is expected that subsequent workshops will lead to further refinements to this framework. We also evaluated aspects of specimen quality that differed according to the use of ROSE. Some laboratories, for example, may want to state the risk of malignancy associated with the general category, based on their own data or that found in the literature (Table 2). The most common malignant diagnosis made after surgery in cases initially classified as AUS/FLUS is PTC, usually of the follicular variant (PTC-FV)[24,25]. Benign follicular nodules often have a small population of microfollicles and crowded groups. Lee TI, Yang HJ, Lin SY, Lee MT, Lin HD, Braverman LE, Tang KT. How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? Chronic sialadenitis: sparsely cellular specimen with fewer lymphocytes and germinal center fragments; no characteristic lymphoepithelial islands. qA;`Yb]@b,@ "~Xbqs8J Why do some investigations yield more, or less, information than others? That said, this specimen (if involved by a disease process) can be sent for genetic testing such as polymerase chain reaction and does not present the issue of being postdecalcification (which may hinder some genetic tests). At low magnification, aspirates of PTC are typically cellular, epithelium-rich structures. The prognosis of this tumor is good; death due to PTC is rare. PG The FNA aspirates of an MTC are usually composed of numerous cells, either presenting in cell aggregates or as a mixture of non-cohesive cells. Q: Can flow cytometry be performed on the core biopsy? However, we cannot answer medical or research questions or give advice. B Hamberger In part, each component is analyzed and interpreted in correlation together for a final report. Patients with sporadic MTC present with a solitary, circumscribed thyroid nodule, usually in the middle to upper-outer half of the thyroid gland. Thyroid, Cytopathology, Nodule, Papillary cancer, Fine needle, Biopsy. In this study the AUS category was further subdivided into HCLUS (atypical cells rule out Hurthle cell neoplasm) and FLUS. 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. Ramzy It allows classification of nodules as benign or malignant, and patients with malignant nodules are scheduled for surgery. These changes are not pathognomonic, as they are frequently detected in some PTCs, especially in the follicular variant, and in benign lesions as well, such as follicular adenomas. The benefit of thyroid FNA derives in large part from the ability to make a reliably benign interpretation that avoids unnecessary surgery. The clot sections, core biopsy, marrow aspirate, and touch preps all contribute to the overall assessment of patients collected marrow. Last but not least, repeated FNAs will lead to a diagnosis in 72%-80% of indeterminate cases where repeated FNAs were needed. The contribution of intraoperative frozen section after a suspicious FNA diagnosis is questionable, as Lee et al[38] have demonstrated that preoperative FNA has a higher sensitivity than frozen section in detecting PTC. 2023 ,https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer. The core biopsy is useful for assessing overall marrow cellularity, trilineage hematopoiesis, and marrow architecture. Ohori NP, Singhal R, Nikiforova MN, Yip L, Schoedel KE, Coyne C, McCoy KL, LeBeau SO, Hodak SP, Carty SE, et al. Tyrosine-derived polymeric surfactant nanospheres insert cholesterol in cell membranes. BRAF mutation has become a specific marker for PTC and its variants[54]. Pu Faquin 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. As a result they may be not diagnosed through the FNA test, resulting in a false-negative test[44]. According to the Bethesda system for reporting thyroid cytopathology, a specimen . Summarizing 3 slide smear methods 6. Hypocellular or paucispicular smears preclude these assessments, which are not easily (or accurately) performed on the core biopsy (Table). 2. Several systems have been proposed for the cyropathologic diagnosis of the thyroid nodules. 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]. 0 Gharib McHenry Describing methods to: i. Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. A print atlas, with more than 40 contributing authors Appendix 1, is in press.3. The site is secure. Map ; Apps; Tools . Papillary thyroid carcinoma. Cyst lining cells are usually elongated, containing pale chromatin, with sparsely found intranuclear grooves, large nucleoli, and always associated with hemosiderin-laden macrophages and benign-appearing macrofollicle fragments. government site. Notes and recommendations are not required but can be useful in certain circumstances. Distant metastases seldom occur, but may develop in 20% of cases in late stage. The 6 general diagnostic categories are shown in bold type in Table 1. For that reason the aspirate is then classified as AUS/FLUS to indicate the uncertainty of the findings. ES In order to establish a standardized diagnostic terminology/classification system for reporting thyroid FNAC results, the National Cancer Institute (NCI) in the United States sponsored the NCI Thyroid FNA State of the Science Conference with a group of experts at Bethesda, MD, in October 2007[7]. A: Ideally, blasts should be calculated on the aspirate smear differential count; however, in cases where blasts express CD34, then a CD34 count on the core biopsy might be possible. 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. The remaining 10% of cases represent a significant subset of thyroid specimens with some form of AUS/FLUS. The diagnosis of this variant as a PTC is relatively easy, due to the numerous papillae and the coexisting intranuclear inclusions. Utilization of ancillary studies in thyroid fine needle aspirates: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Additional descriptive comments (beyond such subcategorization) are optional and left to the discretion of the cytopathologist. 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. Several patterns of nuclear atypia may be also present without being quantitatively and/or qualitatively sufficient for the interpretation of suspicious for malignancy. C This variant of PTC is not common, but it is important to be recognized as it may be confused with a Hurthle cell neoplasm[44]. Click, Copyright PathologyOutlines.com, Inc. Click, 30150 Telegraph Road, Suite 119, Bingham Farms, Michigan 48025 (USA). Because of the densely cellular composition of bone marrow, the imprints impart many cells directly on the slides. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). 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). $AJ !b``3iK CA Theoharis C, Roman S, Sosa JA. et al. Cibas V Two-dimensional fixed tissue specimens from the biopsy and clot are easily stained with immunohistochemical methods while three-dimensional, liquid cellular content can be assessed with flow cytometry. A cellular specimen composed of Hrthle cells arranged in loosely cohesive sheets or isolated in a case diagnosed as Hrthle cell adenoma ( 40 pap stain on ThinPrep slide) (diagnostic categories IV). CellMapper is a crowd-sourced cellular tower and coverage mapping service. The spindle-shaped morphology of these cells is helpful in distinguishing these cells from PTC[24,34]. PG HHS Vulnerability Disclosure, Help Ghossein The significance and clinical value of a CFO result depend in large part on sonographic correlation. An explicit statement of adequacy is optional. Lloyd Aldinger KA, Samaan NA, Ibanez M, Hill CS. Note extensive red blood cells in the background. Sparsely cellular and contains atypical lymphoid cells Suspicious for malignancy, not otherwise specified Other primary thyroid malignancies like anaplastic carcinoma and poorly differentiated carcinoma Suboptimal cellularity or preservation can lead to uncertainty and result in a suspicious for malignancy interpretation Cytology images 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). The cells have abundant pink cytoplasm, basally located nuclei and nuclear features of conventional PTC. Mazzaferri EL. H Deveci Listing the acceptable fixatives for use in cytology 5. Chung Figure 2. 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. RT S Pedro Patricio de Agustin, MD, PhD, Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain, Erik K. Alexander, MD, Department of Medicine, Brigham and Womens Hospital, Boston, MA, Sylvia L. Asa, MD, PhD, Department of Pathology and Laboratory Medicine, University of Toronto; University Health Network and Toronto Medical Laboratories; Ontario Cancer Institute, Toronto, Canada, Kristen A. Atkins, MD, Department of Pathology, University of Virginia Health System, Charlottesville, Manon Auger, MD, Department of Pathology, McGill University Health Center and McGill University, Montreal, Canada, Zubair W. Baloch, MD, PhD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Katherine Berezowski, MD, Department of Pathology, Virginia Hospital Center, Arlington, Massimo Bongiovanni, MD, Department of Pathology, Geneva University Hospital, Geneva, Switzerland, Douglas P. Clark, MD, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, Batrix Cochand-Priollet, MD, PhD, Department of Pathology, Lariboisire Hospital, University of Paris 7, Paris, France, Barbara A. Crothers, DO, Department of Pathology, Walter Reed Army Medical Center, Springfield, VA, Richard M. DeMay, MD, Department of Pathology, University of Chicago, Chicago, IL, Tarik M. Elsheikh, MD, Ball Memorial Hospital/PA Labs, Muncie, IN, William C. Faquin, MD, PhD, Department of Pathology, Massachusetts General Hospital, Boston, Armando C. Filie, MD, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, Pinar Firat, MD, Department of Pathology, Hacettepe University, Ankara, Turkey, William J. Frable, MD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Kim R. Geisinger, MD, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, Hossein Gharib, MD, Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, Ulrike M. Hamper, MD, Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD, Michael R. Henry, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN, Jeffrey F. Krane, MD, PhD, Department of Pathology, Brigham and Womens Hospital, Boston, MA, Lester J. Layfield, MD, Department of Pathology, University of Utah Hospital and Clinics, Salt Lake City, Virginia A. LiVolsi, MD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Britt-Marie E. Ljung, MD, Department of Pathology, University of California San Francisco, Claire W. Michael, MD, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Ritu Nayar, MD, Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, Yolanda C. Oertel, MD, Department of Pathology, Washington Hospital Center, Washington, DC, Martha B. Pitman, MD, Department of Pathology, Massachusetts General Hospital, Boston, Celeste N. Powers, MD, PhD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Stephen S. Raab, MD, Department of Pathology, University of Colorado at Denver, UCDHSC Anschutz Medical Campus, Aurora, Andrew A. Renshaw, MD, Department of Pathology, Baptist Hospital of Miami, Miami, FL, Juan Rosai, MD, Dipartimento di Patologia, Instituto Nazionale Tumori, Milano, Italy, Miguel A. Sanchez, MD, Department of Pathology, Englewood Hospital and Medical Center, Englewood, NJ, Vinod Shidham, MD, Department of Pathology, Medical College of Wisconsin, Milwaukee, Mary K. Sidawy, MD, Department of Pathology, Georgetown University Medical Center, Washington, DC, Gregg A. Staerkel, MD, Department of Pathology, the University of Texas M.D.