Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings.

IF 1.6 4区 医学 Q3 PATHOLOGY Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI:10.1159/000535907
C Christofer Juhlin, Zubair W Baloch
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Abstract

Background: Thyroid nodules are prevalent among the general population, thus imposing substantial demands upon healthcare providers to establish effective management paradigms when investigating these lesions. A pivotal component in the diagnostic process involves the cytomorphological evaluation of fine-needle aspiration (FNA) specimens extracted from the nodule under scrutiny. This examination serves the critical purpose of enabling a comprehensive assessment for the risk of either a neoplasm or malignancy, thereby providing the clinical team with the requisite information to render decisions regarding potential surgical intervention and/or a structured clinical follow-up. A subset of FNA specimens obtained from the thyroid gland present a vexing challenge for interpretation and cannot be classified based on cytomorphology as either benign or malignant and are classified as "indeterminate" for neoplasm or malignancy. The indeterminate thyroid FNA diagnosis in the third iteration of the Bethesda classification is termed as "atypia of undetermined significance" (AUS).

Summary: The thyroid FNA specimens classified as "atypical" constitute a perplexing category, necessitating considerations such as repeated cytological evaluations, supplementary molecular analyses, diagnostic lobectomy, or vigilant surveillance. This review article draws upon the most recent Bethesda classification guidelines and delineates various potential pitfalls encountered during the interpretation of atypia observed in thyroid fine-needle aspiration and histopathologic counterparts. Additionally, it proffers strategic algorithms devised to effectively navigate these diagnostic challenges.

Key messages: It is important to recognize the value of an integrated approach when triaging AUS lesions, considering various clinical, morphological, and sometimes also immunocytochemical or molecular features.

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甲状腺细针抽吸细胞病理学的陷阱:非典型发现的处理方法。
背景:甲状腺结节在普通人群中很常见,因此要求医疗服务提供者在检查这些病变时建立有效的管理模式。诊断过程中的一个关键环节是对从受检结节中提取的细针穿刺(FNA)标本进行细胞形态学评估。这项检查的关键目的是对肿瘤或恶性肿瘤的风险进行全面评估,从而为临床团队提供必要的信息,就潜在的手术干预和/或结构化临床随访做出决定。从甲状腺获取的 FNA 标本中有一部分在判读上存在难题,无法根据细胞形态学将其分为良性或恶性,而是被归类为肿瘤或恶性 "不确定"。摘要:被归类为 "非典型 "的甲状腺 FNA 标本是一个令人困惑的类别,需要考虑重复细胞学评价、补充分子分析、诊断性腺叶切除术或警惕性监测等因素。这篇综述文章借鉴了最新的贝塞斯达分类指南,阐述了在解读甲状腺细针穿刺和组织病理学检查中观察到的非典型时可能会遇到的各种陷阱。此外,文章还提出了一些策略性算法,以有效地应对这些诊断挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta Cytologica
Acta Cytologica 生物-病理学
CiteScore
3.70
自引率
11.10%
发文量
46
审稿时长
4-8 weeks
期刊介绍: With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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