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Updates in Thyroid Cytology

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Evidence-Based Endocrine Surgery

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Abstract

The last decade has seen many positive changes in the practice of thyroid cytology, chief of which is the global move towards standardised classification systems for cytology reporting. This has formed the basis for a more evidence-based approach to the management of thyroid nodules stemming from a common language within the multidisciplinary team. One of the catalysts for this change has been the publication of the Bethesda System for Reporting Thyroid Cytology (TBSRTC), which spearheaded the worldwide move towards a more unified terminology. Following this, the literature has seen a proliferation of large-scale follow-up studies evaluating the usefulness of this classification system, in particular amongst the indeterminate diagnostic categories. We will discuss the main classification systems for thyroid cytology that are in practice and provide an overview of large-scale follow-up results as well as future directions for the updated Bethesda system.

Simultaneously, in recent years, there has been rapid progress in the understanding of molecular alterations in thyroid neoplasms. This has fuelled much interest in evaluating the role of preoperative molecular testing on cytologic material, particularly in triaging indeterminate nodules for surgical management. A discussion on the existing commercially available platforms, their feasibility and the overall role of molecular testing in thyroid cytologic material will be presented.

Lastly, in 2016, the newly coined term “non-invasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP) resulted in an important paradigm shift amongst pathologists and clinicians and also caused some concern amongst patients. The diagnostic criteria and clinical rationale behind the new terminology will be discussed, as well as the implications on preoperative evaluation of potential NIFTPs when using TBSRTC.

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  1. Department of Pathology, National University of Singapore and National Univeristy Hospital, Singapore, Singapore

    Min En Nga

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  1. Division of Endocrine Surgery, National University Hospital, Singapore, Singapore

    Rajeev Parameswaran

  2. Department of Endocrine Surgery, SGPGI Hospital, Lucknow, India

    Amit Agarwal

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Nga, M.E. (2018). Updates in Thyroid Cytology. In: Parameswaran, R., Agarwal, A. (eds) Evidence-Based Endocrine Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-10-1124-5_6

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