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Published in: Endocrine Pathology 4/2011

01-12-2011

Update in Thyroid Fine Needle Aspiration

Authors: William C. Faquin, Massimo Bongiovanni, Peter M. Sadow

Published in: Endocrine Pathology | Issue 4/2011

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Abstract

Thyroid fine needle aspiration (FNA) is a safe, cost effective, and relatively accurate method for guiding the initial management of a thyroid nodule. The popularity of thyroid FNA is reflected in the fact that over 350,000 thyroid FNAs are performed each year in the USA. As we move into the next decade, several issues pertaining to thyroid FNA are being addressed including: how to better apply thyroid FNA as a differential test for follicular-patterned thyroid tumors, how to manage the atypical thyroid FNA, and how to use thyroid FNA in the evaluation of poorly differentiated thyroid carcinomas.
Literature
1.
go back to reference Werga P, Wallin G, Skoog L, Hamberger B. Expanding role of fine-needle aspiration cytology in thyroid diagnosis and management. World J Surg 2000; 24: 907–12.PubMedCrossRef Werga P, Wallin G, Skoog L, Hamberger B. Expanding role of fine-needle aspiration cytology in thyroid diagnosis and management. World J Surg 2000; 24: 907–12.PubMedCrossRef
2.
go back to reference Lundgren CI, Zedenius J, Skoog L. Fine-needle aspiration biopsy of benign thyroid nodules: an evidence-based review. World J Surg 2008; 32: 1247–52.PubMedCrossRef Lundgren CI, Zedenius J, Skoog L. Fine-needle aspiration biopsy of benign thyroid nodules: an evidence-based review. World J Surg 2008; 32: 1247–52.PubMedCrossRef
3.
go back to reference Bukhari MH, Niazi S, Hanif G, et al. An updated audit of fine needle aspiration cytology procedure of solitary thyroid nodule. Diagn Cytopathol 2008; 36: 104–12.PubMedCrossRef Bukhari MH, Niazi S, Hanif G, et al. An updated audit of fine needle aspiration cytology procedure of solitary thyroid nodule. Diagn Cytopathol 2008; 36: 104–12.PubMedCrossRef
4.
go back to reference Deveci MS, Deveci G, LiVolsi VA, Baloch ZW. Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-up. Cytojournal 2006;3:1–9.CrossRef Deveci MS, Deveci G, LiVolsi VA, Baloch ZW. Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-up. Cytojournal 2006;3:1–9.CrossRef
5.
6.
go back to reference Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118: 282–9.PubMed Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118: 282–9.PubMed
7.
go back to reference Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer 2000; 90: 357–63.PubMedCrossRef Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer 2000; 90: 357–63.PubMedCrossRef
8.
go back to reference Layfield LJ, Elsheikh TM, Fili A, Nayar R, Shidham V. Review of the state of the art and recommendations of the Papanicolaou Society of Cytopathology for urinary cytology procedures and reporting: the Papanicolaou Society of Cytopathology Practice Guidelines Task Force. Diagn Cytopathol 2004; 30: 24–30.PubMedCrossRef Layfield LJ, Elsheikh TM, Fili A, Nayar R, Shidham V. Review of the state of the art and recommendations of the Papanicolaou Society of Cytopathology for urinary cytology procedures and reporting: the Papanicolaou Society of Cytopathology Practice Guidelines Task Force. Diagn Cytopathol 2004; 30: 24–30.PubMedCrossRef
9.
go back to reference Guidelines of the Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Diagn Cytopathol 1996; 15: 84–9. Guidelines of the Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Diagn Cytopathol 1996; 15: 84–9.
10.
go back to reference Clark D, Faquin W. Thyroid Cytopathology. Essentials in Cytopathology Series. New York: Springer 2005. Clark D, Faquin W. Thyroid Cytopathology. Essentials in Cytopathology Series. New York: Springer 2005.
11.
go back to reference Oertel YC. Fine-needle aspiration of the thyroid: technique and terminology. Endocrinol Metab Clin North Am 2007; 36: 737–51, vi-vii. Oertel YC. Fine-needle aspiration of the thyroid: technique and terminology. Endocrinol Metab Clin North Am 2007; 36: 737–51, vi-vii.
12.
go back to reference Grant CS, Hay ID, Gough IR, McCarthy PM, Goellner JR. Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses. Surgery 1989; 106: 980–5; discussion 85–6. Grant CS, Hay ID, Gough IR, McCarthy PM, Goellner JR. Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses. Surgery 1989; 106: 980–5; discussion 85–6.
13.
go back to reference Renshaw AA. An estimate of risk of malignancy for a benign diagnosis in thyroid fine-needle aspirates. Cancer Cytopathol 2010;118:190–195.PubMedCrossRef Renshaw AA. An estimate of risk of malignancy for a benign diagnosis in thyroid fine-needle aspirates. Cancer Cytopathol 2010;118:190–195.PubMedCrossRef
14.
go back to reference Kato MA, Fahey TJ. Molecular markers in thyroid cancer diagnostics. Surg Clin N Am 2009;89:1139–1155.PubMedCrossRef Kato MA, Fahey TJ. Molecular markers in thyroid cancer diagnostics. Surg Clin N Am 2009;89:1139–1155.PubMedCrossRef
15.
go back to reference Nikiforov YE, et al. Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules. J Clin Endocrinol Metab 2009;94:2092–2098.PubMedCrossRef Nikiforov YE, et al. Molecular testing for mutations in improving the fine-needle aspiration diagnosis of thyroid nodules. J Clin Endocrinol Metab 2009;94:2092–2098.PubMedCrossRef
16.
go back to reference Nikiforov YE. Thyroid carcinoma: molecular pathways and therapeutic targets. Mod Pathol 2008;21:S37-S43.PubMedCrossRef Nikiforov YE. Thyroid carcinoma: molecular pathways and therapeutic targets. Mod Pathol 2008;21:S37-S43.PubMedCrossRef
17.
go back to reference Ohori NP et al. Contribution of molecular testing to thyroid fine-needle aspiration cytology of “follicular lesion of undetermined significance/atypia of undetermined significance.” Cancer Cytopathol 2010;118:17–23.PubMedCrossRef Ohori NP et al. Contribution of molecular testing to thyroid fine-needle aspiration cytology of “follicular lesion of undetermined significance/atypia of undetermined significance.” Cancer Cytopathol 2010;118:17–23.PubMedCrossRef
18.
go back to reference Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. New York, Springer, 2009. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. New York, Springer, 2009.
19.
go back to reference Baloch ZW, LiVolsi VA. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the national cancer institute thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol 2008;36:425–437.PubMedCrossRef Baloch ZW, LiVolsi VA. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the national cancer institute thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol 2008;36:425–437.PubMedCrossRef
20.
go back to reference Baloch ZW, Fleisher S, et al. Diagnosis of “follicular neoplasm”: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol 2002;26:41–44.PubMedCrossRef Baloch ZW, Fleisher S, et al. Diagnosis of “follicular neoplasm”: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol 2002;26:41–44.PubMedCrossRef
21.
go back to reference Faquin WC, Baloch ZW. Fine-needle aspiration of follicular patterned lesions of the thyroid: Diagnosis, management, and follow-up according toNational Cancer Institute Recommendations. Diagn Cytopathol 2010;10:731–739. Faquin WC, Baloch ZW. Fine-needle aspiration of follicular patterned lesions of the thyroid: Diagnosis, management, and follow-up according toNational Cancer Institute Recommendations. Diagn Cytopathol 2010;10:731–739.
22.
go back to reference 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 Cytopathol 2007;111:306–315. 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 Cytopathol 2007;111:306–315.
23.
go back to reference Krane JF, Nayar R, Renshaw AA. Atypical cells of undetermined significance. In: Ali SZ, Cibas ES, editors. The Bethesda system for reporting thyroid cytopathology. New York: Springer, 2010:37–49.CrossRef Krane JF, Nayar R, Renshaw AA. Atypical cells of undetermined significance. In: Ali SZ, Cibas ES, editors. The Bethesda system for reporting thyroid cytopathology. New York: Springer, 2010:37–49.CrossRef
24.
go back to reference Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer Cytopathol. 2009;117:195–202.CrossRef Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer Cytopathol. 2009;117:195–202.CrossRef
25.
go back to reference Renshaw AA. Subclassification of atypical cells of undetermined significance in direct smears of fine-needle aspirations of the thyroid: Distinct patterns and associated risk of malignancy. Cancer Cytopathol. 2011. doi:10.1002/cncy.20154. Renshaw AA. Subclassification of atypical cells of undetermined significance in direct smears of fine-needle aspirations of the thyroid: Distinct patterns and associated risk of malignancy. Cancer Cytopathol. 2011. doi:10.​1002/​cncy.​20154.
26.
go back to reference Muddegowda PH, Lingegowda J, Natesan R, Kurpad R. Divide and rule: Cytodiagnosis of thyroid lesions using pattern analysis: A study of 233 cases. Diagn Cytopathol. 2010. doi:10.1002/dc.21486. Muddegowda PH, Lingegowda J, Natesan R, Kurpad R. Divide and rule: Cytodiagnosis of thyroid lesions using pattern analysis: A study of 233 cases. Diagn Cytopathol. 2010. doi:10.​1002/​dc.​21486.
27.
go back to reference Shi Y, Ding X, Klein M, et al. Thyroid fine-needle aspiration with atypia of undetermined significance: a necessary or optional category? Cancer Cytopathol. 2009;117:298–304.CrossRef Shi Y, Ding X, Klein M, et al. Thyroid fine-needle aspiration with atypia of undetermined significance: a necessary or optional category? Cancer Cytopathol. 2009;117:298–304.CrossRef
28.
go back to reference Jing X, Roh MH, Knoepp SM, Zhao L, Michael CW. Minimizing the diagnosis of "follicular lesion of undetermined significance" and identifying predictive features for neoplasia. Diagn Cytopathol. 2011;39:737–742. Jing X, Roh MH, Knoepp SM, Zhao L, Michael CW. Minimizing the diagnosis of "follicular lesion of undetermined significance" and identifying predictive features for neoplasia. Diagn Cytopathol. 2011;39:737–742.
29.
go back to reference Mahajan A, Kasper K, Lin X, et al. Thyroid FNA atypia of undetermined significance (AUS): variability in pathologist reporting and clinical follow-up. Mod Pathol. 2011;24(1 s):98A. Mahajan A, Kasper K, Lin X, et al. Thyroid FNA atypia of undetermined significance (AUS): variability in pathologist reporting and clinical follow-up. Mod Pathol. 2011;24(1 s):98A.
30.
go back to reference Weber D, Brainard J, Chen L. Atypical epithelial cells, cannot exclude papillary carcinoma, in fine needle aspiration of the thyroid. Acta Cytol. 2008;52:320–324.PubMedCrossRef Weber D, Brainard J, Chen L. Atypical epithelial cells, cannot exclude papillary carcinoma, in fine needle aspiration of the thyroid. Acta Cytol. 2008;52:320–324.PubMedCrossRef
31.
go back to reference Volante M, Collini P, Nikiforov YE, 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;31:1256–64.PubMedCrossRef Volante M, Collini P, Nikiforov YE, 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;31:1256–64.PubMedCrossRef
32.
go back to reference Sakamoto A, Kasai N, Sugano H. Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a high-risk group of papillary and follicular carcinomas. Cancer. 1983;52:1849–55PubMedCrossRef Sakamoto A, Kasai N, Sugano H. Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a high-risk group of papillary and follicular carcinomas. Cancer. 1983;52:1849–55PubMedCrossRef
33.
go back to reference Volante M, Landolfi S, Chiusa L, et al. Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients. Cancer. 2004;100:950–7.PubMedCrossRef Volante M, Landolfi S, Chiusa L, et al. Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients. Cancer. 2004;100:950–7.PubMedCrossRef
34.
go back to reference Wreesmann VB, Ghossein RA, Patel SG, et al. Genome-wide appraisal of thyroid cancer progression. Am J Pathol 2002;161(5):1549–56.PubMedCrossRef Wreesmann VB, Ghossein RA, Patel SG, et al. Genome-wide appraisal of thyroid cancer progression. Am J Pathol 2002;161(5):1549–56.PubMedCrossRef
35.
go back to reference Luna-Ortiz K, Hurtado-Lopez LM, Dominguez-Malagon H, et al. Clinical course of insular thyroid carcinoma. Med Sci Monit. 2004;10:CR108-11. Luna-Ortiz K, Hurtado-Lopez LM, Dominguez-Malagon H, et al. Clinical course of insular thyroid carcinoma. Med Sci Monit. 2004;10:CR108-11.
36.
go back to reference Pulcrano M, Boukheris H, Talbot M, et al. Poorly differentiated follicular thyroid carcinoma: prognostic factors and relevance of histological classification. Thyroid. 2007;17:639–46.PubMedCrossRef Pulcrano M, Boukheris H, Talbot M, et al. Poorly differentiated follicular thyroid carcinoma: prognostic factors and relevance of histological classification. Thyroid. 2007;17:639–46.PubMedCrossRef
37.
go back to reference Bongiovanni M, Bloom L, Krane JF, et al. Cytomorphologic features of poorly differentiated thyroid carcinoma: a multi-institutional analysis of 40 cases. Cancer. Cytopathol 2009. Bongiovanni M, Bloom L, Krane JF, et al. Cytomorphologic features of poorly differentiated thyroid carcinoma: a multi-institutional analysis of 40 cases. Cancer. Cytopathol 2009.
38.
go back to reference Pietribiasi F, Sapino A, Papotti M, et al. Cytologic features of poorly differentiated 'insular' carcinoma of the thyroid, as revealed by fine-needle aspiration biopsy. Am J Clin Pathol. 1990;94:687–92.PubMed Pietribiasi F, Sapino A, Papotti M, et al. Cytologic features of poorly differentiated 'insular' carcinoma of the thyroid, as revealed by fine-needle aspiration biopsy. Am J Clin Pathol. 1990;94:687–92.PubMed
39.
go back to reference Sironi M, Collini P, Cantaboni A. Fine needle aspiration cytology of insular thyroid carcinoma. A report of four cases. Acta Cytol. 1992;36:435–9.PubMed Sironi M, Collini P, Cantaboni A. Fine needle aspiration cytology of insular thyroid carcinoma. A report of four cases. Acta Cytol. 1992;36:435–9.PubMed
40.
go back to reference Guiter GE, Auger M, Ali SZ, et al. Cytopathology of insular carcinoma of the thyroid. Cancer. 1999;87:196–202.PubMedCrossRef Guiter GE, Auger M, Ali SZ, et al. Cytopathology of insular carcinoma of the thyroid. Cancer. 1999;87:196–202.PubMedCrossRef
41.
go back to reference Nguyen GK, Akin MR. Cytopathology of insular carcinoma of the thyroid. Diagn Cytopathol. 2001;25:325–30.PubMedCrossRef Nguyen GK, Akin MR. Cytopathology of insular carcinoma of the thyroid. Diagn Cytopathol. 2001;25:325–30.PubMedCrossRef
42.
go back to reference Albores-Saavedra J, Carrick K. Where to set the threshold between well differentiated and poorly differentiated follicular carcinomas of the thyroid. Endocr Pathol 2004;15:297–305.PubMedCrossRef Albores-Saavedra J, Carrick K. Where to set the threshold between well differentiated and poorly differentiated follicular carcinomas of the thyroid. Endocr Pathol 2004;15:297–305.PubMedCrossRef
43.
go back to reference Raphael SJ. The meanings of markers: ancillary techniques in diagnosis of thyroid neoplasia. Endocr Pathol. 2002;13:301–11.PubMedCrossRef Raphael SJ. The meanings of markers: ancillary techniques in diagnosis of thyroid neoplasia. Endocr Pathol. 2002;13:301–11.PubMedCrossRef
44.
go back to reference Basolo F, Pisaturo F, Pollina LE, et al. N-ras mutation in poorly differentiated thyroid carcinomas: correlation with bone metastases and inverse correlation to thyroglobulin expression. Thyroid. 2000;10:19–23.PubMedCrossRef Basolo F, Pisaturo F, Pollina LE, et al. N-ras mutation in poorly differentiated thyroid carcinomas: correlation with bone metastases and inverse correlation to thyroglobulin expression. Thyroid. 2000;10:19–23.PubMedCrossRef
45.
go back to reference Garcia-Rostan G, Zhao H, Camp RL, et al. ras mutations are associated with aggressive tumor phenotypes and poor prognosis in thyroid cancer. J Clin Oncol. 2003;21:3226–35.PubMedCrossRef Garcia-Rostan G, Zhao H, Camp RL, et al. ras mutations are associated with aggressive tumor phenotypes and poor prognosis in thyroid cancer. J Clin Oncol. 2003;21:3226–35.PubMedCrossRef
Metadata
Title
Update in Thyroid Fine Needle Aspiration
Authors
William C. Faquin
Massimo Bongiovanni
Peter M. Sadow
Publication date
01-12-2011
Publisher
Springer US
Published in
Endocrine Pathology / Issue 4/2011
Print ISSN: 1046-3976
Electronic ISSN: 1559-0097
DOI
https://doi.org/10.1007/s12022-011-9182-7

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