Abstract
This article corresponds to a lecture delivered during the Endocrine Pathology Society symposium held in Boston on 21 March 2015 (104th USCAP meeting, March 21–27). It focuses on the importance of cytopathology in endocrine thyroid pathology and the limits and pitfalls of diagnosis in follicular cell lesions. Lights and shadows are present in each diagnostic technique: Fine needle aspiration has imposed itself as a gold standard in thyroid nodules thanks to its easiness of execution and high cost-effectiveness ratio. A milestone in this field is represented by the National Cancer Institute (NCI) Thyroid Fine Needle Aspiration (FNA) State of the State of the Science Conference hosted in October 22–23, 2007 by the NCI, followed by a series of documents published in Diagnostic Cytopathology and Cytojournal (2008) as well as in an atlas entitled: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): terminology and criteria (2010, Springer). “Gray” zones still remain, causing difficulties and anxiety to the cytopathologist when facing challenging cases. Each diagnostic category of TBSRTC is analyzed and discussed in a concise fashion with special emphasis on challenging cases such as atypia of undetermined significance (AUS), suspicion for follicular neoplasms (SFNs), diagnoses of papillary thyroid carcinoma (PTC) in Hashimoto thyroiditis and follicular variant of papillary carcinoma (FVPTC). Our aim was to better define and clarify the spectrum of follicular cell lesions in thyroid nodule samplings and to underline the diagnostic limits in order to avoid pitfalls. New emerging molecular biology techniques may represent useful tools in selected morphological challenging cases and lead to new therapeutic approaches in line with drug-tailored therapy and personalized medicine.
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References
Russ G, Bigorgne C, Royer B, Rouxel A, Bienvenu-Perrard M. The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid. J Radiol. 92(7–8):701–713, 2011.
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 19:1167–1214, 2009.
Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology: definitions, criteria and explanatory notes. New York, NY: Springer, 2010.
Guidance on the reporting of thyroid cytology specimens. The Royal College of Pathologists. Review in November 2011; http://www.rcpath.org/Resources/RCPath/Migrated%20Resources/Documents/G/g089guidanceonthereportingofthyroidcytologyfinal.pdf . Accessed 30th May 2015
Nardi F., Basolo F., Crescenzi A., et al. Italian consensus for the classification and reporting of thyroid cytology. Journal of Endocrinol Invest. 37(6):593–599,2014.
Kocjan G, Cochand-Priollet B, de Agustin PP, Bourgain C, Chandra A, Daneshbod Y, Deery A, Duskova J, Ersoz C, Fadda G, Fassina A, Firat P, Jimenez-Ayala B, Karakitsos P, Koperek O, Matesa N, Poller D, Thienpont L, Ryska A, Schenck U, Sauer T, Schmitt F, Tani E, Toivonen T, Tötsch M, Troncone G, Vass L, Vielh P. Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009. Cytopathology. 21(2):86–92, 2010.
The Bethesda terminology for reporting thyroid cytopathology: from theory to practice in Europe. Cochand-Priollet B, Schmitt FC, Tötsch M, Vielh P; European Federation of Cytology Societies’ Scientific Committee. Acta Cytol. 55(6):507–11,2011.
Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”—screening and overdiagnosis. N Engl J Med. 371(19):1765–1767, 2014.
Vanderlaan WP. The occurence of carcinoma of the thyroid gland in autopsy material. N Engl J Med 237:221–222, 1947.
Esserman LJ, Thompson IM, Reid B, Nelson P, Ransohoff DF, Welch HG, Hwang S, Berry DA, Kinzler KW, Black WC, Bissell M, Parnes H, Srivastava S. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol. 15(6):234–42, 2014.
Gibelli B, Dionisio R, Ansarin M. Role of hemithyroidectomy in differentiated thyroid cancer. Curr Opin Otolaryngol Head Neck Surg. 23(2):99–106, 2015.
Stelow EB, Bardales RH, Crary GS, Gulbahce HE, Stanley MW, Savik K, Pambuccian SE. Interobserver variability in thyroid fine-needle aspiration interpretation of lesions showing predominantly colloid and follicular groups. Am J Clin Pathol. Aug;124(2):239–44, 2005.
Cibas ES, Baloch ZW, Fellegara G, LiVolsi VA, Raab SS, Rosai J, Diggans J, Friedman L, Kennedy GC, Kloos RT, Lanman RB, Mandel SJ, Sindy N, Steward DL, Zeiger MA, Haugen BR, Alexander EK. A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Ann Intern Med. 159(5):325–332, 2013.
Elsheikh TM, Asa SL, Chan JK, DeLellis RA, Heffess CS, LiVolsi VA, Wenig BM. Interobserver and intraobserver variation among experts in the diagnosis of thyroid follicular lesions with borderline nuclear features of papillary carcinoma. Am J Clin Pathol. 130(5):736–44, 2008.
Kholová I, Ludvíková M. Thyroid atypia of undetermined significance or follicular lesion of undetermined significance: an indispensable Bethesda 2010 diagnostic category or waste garbage? Acta Cytol. 58(4):319–29,2014.
Spectrum of follicular nuclear size and amount of colloid in follicular lesions of the thyroid. Thyroid Cytopathology: an atlas and text. Kini SR, Wolters & Kluwer Health, 2nd ed, 2015.
Lee J, Hasteh F. Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto’s thyroiditis: a case report and review of the literature. Diagn Cytopathol. 37(8):600–606, 2009.
Roh MH, Jo VY, Stelow EB, Faquin WC, Zou KH, Alexander EK, Larsen PR, Marqusee E, Benson CB, Frates MC, Gawande A, Moore FD Jr, Cibas ES. The predictive value of the fine-needle aspiration diagnosis “suspicious for a follicular neoplasm, Hürthle cell type” in patients with Hashimoto thyroiditis. Am J Clin Pathol. 135(1):139–45, 2011.
Baloch ZW, LiVolsi VA. Follicular-patterned afflictions of the thyroid gland: reappraisal of the most discussed entity in endocrine pathology. Endocr. Pathol. 25:12–20, 2014.
Auger M. Hürthle Cells in Fine-Needle Aspirates of the Thyroid Cancer Cytopathol.;122(4):241–249, 2014.
Ghossein R. Update to the College of American Pathologists Reporting on Thyroid Carcinomas. Head Neck Pathol. 3(1):86–93, 2009.
Xing M, Haugen BR, Schlumberger M. Progress in molecular-based management of differentiated thyroid cancer. Lancet.;381(9871):1058–69, 2013.
Lastra RR, Pramick MR, Crammer CJ, LiVolsi VA, Baloch ZW. Implications of a suspicious Afirma test result in thyroid fine-needle aspiration cytology: an institutional experience. Cancer Cytopathol.122(10):737–744, 2014.
Nikiforov YE, Carty SE, Chiosea SI, Coyne C, Duvvuri U, Ferris RL, Gooding WE, Hodak SP, LeBeau SO, Ohori NP, Seethala RR, Tublin ME, Yip L, Nikiforova MN. Highly accurate diagnosis of cancer in thyroid nodules with follicular neoplasm/suspicious for a follicular neoplasm cytology by ThyroSeq v2 next-generation sequencing assay. Cancer. 120(23):3627–3634, 2014.
Choi SH, Baek JH, Lee JH, Choi YJ, Hong MJ, Song DE, Kim JK, Yoon JH, Kim WB. Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration. Eur Radiol.;24(11):2819–2826, 2014.
Yi KS, Kim JH, Na DG, Seo H, Min HS, Won JK, Yun TJ, Ryoo I, Kim SC, Choi SH, Sohn CH. Usefulness of Core Needle Biopsy for Thyroid Nodules with Macrocalcifications: Comparison with Fine-Needle Aspiration Thyroid 2015. doi:10.1089/thy.2014.0596.
Paja M, Del Cura JL, Zabala R, Corta I, Lizarraga A, Oleaga A, Expósito A, Gutiérrez MT, Ugalde A, López JI. Ultrasound-guided core-needle biopsy in thyroid nodules. A study of 676 consecutive cases with surgical correlation. Eur Radiol. doi 10.1007/s00330-015-3821-1, 2015.
Yoon R, Baek JH, Lee JH, Choi YJ, Hong MJ, Song DE, Kim JK, Yoon JH, Kim WB. Diagnosis of thyroid follicular neoplasm: fine-needle aspiration versus core-needle biopsy. Thyroid. 24(11):1612–1617, 2014.
Fadda G, Rossi ED, Raffaelli M, Pontecorvi A, Sioletic S, Morassi F, Lombardi CP, Zannoni GF, Rindi G. Follicular thyroid neoplasms can be classified as low- and high-risk according to HBME-1 and Galectin-3 expression on liquid-based fine-needle cytology. Eur J Endocrinol. 165(3):447–453, 2011.
Immunocytochemistry with cytokeratin 19 and anti-human mesothelial cell antibody (HBME1) increases the diagnostic accuracy of thyroid fine-needle aspirations: preliminary report of 150 liquid-based fine-needle aspirations with histological control. Cochand-Priollet B, Dahan H, Laloi-Michelin M, Polivka M, Saada M, Herman P, Guillausseau PJ, Hamzi L, Poté N, Sarfati E, Wassef M, Combe H, Raulic-Raimond D, Chedin P, Medeau V, Casanova D, Kania R. Thyroid;21(10):1067–73, 2011.
Lastra RR, LiVolsi VA, Baloch ZW. Aggressive variants of follicular cell-derived thyroid carcinomas: a cytopathologist’s perspective. Cancer Cytopathol.;122(7):484–503, 2014.
Cheng S, Serra S, Mercado M, Ezzat S, Asa SL. A high-throughput proteomic approach provides distinct signatures for thyroid cancer behavior. Clin Cancer Res. 15;17(8):2385–2394, 2011.
Xing M, Haugen BR, Schlumberger M. Progress in molecular-based management of differentiated thyroid cancer. Lancet. 23;381(9871):1058–69, 2013.
Schlumberger M, Brose M, Elisei R, Leboulleux S, Luster M, Pitoia F, Pacini F. Definition and management of radioactive iodine-refractory differentiated thyroid cancer. Lancet Diabetes Endocrinol. 2(5):356–8, 2014.
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Damiani, D., Suciu, V. & Vielh, P. Cytopathology of Follicular Cell Nodules. Endocr Pathol 26, 286–290 (2015). https://doi.org/10.1007/s12022-015-9386-3
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DOI: https://doi.org/10.1007/s12022-015-9386-3