A Strategy to Search for New Cytologic Criteria in the Differential Diagnostics of Thyroid Cancers Based on Current (Post-Chernobyl) Practice in Ukraine
The rising incidence of thyroid cancer observed after the Chernobyl accident of 1986 in Ukraine necessitates improving early diagnostics of the disease. Respective diagnostic criteria used currently in FNA cytology have a limited specificity. They usually lack a monocausal relation to the medical condition they represent. These limitations are evident in the identification of radiation-related thyroid cancers. In this chapter, a strategy for the search of new FNA indicators for thyroid malignancy is proposed. Cancers are known to evolve by a reiterative process of clonal expansion, genetic diversification, and clonal selection. Yet insufficient attention is given to FNA features reflecting multiclonal nature of thyroid malignancy. Several new FNA indicators providing diagnostically relevant information on early events of an invasive/metastatic process are proposed. They include specific patterns observed in epithelial cell sheets as well as cells of two unusual phenotypes that form such patterns. These enlarged and pleomorphic cells of epithelial origin demonstrate 100% specificity in the identification of the PTC. The conclusion was made that FNA markers reflecting core aspects of an invasive/metastatic process show a higher specificity in the identification of the disease. The strategy to search for cytologic indicators of diagnostic value should account for this fact.
KeywordsCell pattern Cytopathology Fine needle aspiration Papillary thyroid carcinoma Thyroid neoplasia
The authors gratefully acknowledge histologic confirmation provided by the Laboratory of Pathology, Institute of Endocrinology and Metabolism (the head—Dr. T.I. Bogdanova, Ph.D., D.Sc.).
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