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Kamboj M, Mehta A, Pasricha S, Gupta G, Sharma A, Durga G. Cytomorphological categorization of thyroid lesions according to the bethesda system for reporting thyroid cytology and correlation with their histological outcome: An indian oncology centre experience. J Cytol 2022; 39:44-50. [PMID: 35341109 PMCID: PMC8955694 DOI: 10.4103/joc.joc_79_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/17/2021] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
Abstract
Objective: Material and Methods: Results: Conclusion:
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Dixit S, Diwaker P, Wadhwa N, Arora VK. Galectin-3 and CD117 immunocytochemistry in the diagnosis of indeterminate thyroid lesions: A pilot study. Diagn Cytopathol 2021; 49:1129-1137. [PMID: 34297482 DOI: 10.1002/dc.24835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/13/2021] [Accepted: 07/13/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Indeterminate thyroid lesions have always been a grey zone in the field of thyroid cytopathology. Immunocytochemistry (ICC) has emerged as a promising tool to correctly classify these indeterminate thyroid lesions into benign and malignant. Hence we planned to assess a panel of immune markers in the diagnosis of indeterminate thyroid lesions consisting of Galectin-3, considered positive for malignancy and CD117 which is positive in benign follicular epithelial cells and negative in malignant lesions. METHODS All the thyroid aspirates reported as indeterminate lesions over a period of 3 years were evaluated. Galectin-3 and CD117 immunocytochemistry was done in 50 alcohol fixed Pap stained smears of AUS/FLUS, FN/SFN and SM category lesions. The expression of both immune markers was assessed by semi-quantitative method and ICC score was calculated. RESULT Of 50 indeterminate lesions, 29 were positive for Galectin-3 and 21 were negative. CD117 was positive in 19 cases and rests 31 were negative. With the use of this ICC panel 29/30 indeterminate lesions in which histopathological correlation was available could be recategorized correctly into benign and malignant. The combined sensitivity and specificity of Galectin-3 and CD117 for categorising the indeterminate lesions into malignant category was 100%. CONCLUSION The combined use of positive and negative immune markers for thyroid malignancy increases the sensitivity and specificity of ICC to categorise the indeterminate thyroid lesions into benign and malignant. In cases with discordant ICC results we propose that inclusion of one additional positive and/or negative marker may resolve the diagnostic dilemma.
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Affiliation(s)
- Sonali Dixit
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Preeti Diwaker
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Neelam Wadhwa
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vinod K Arora
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Abram M, Huhtamella R, Kalfert D, Hakso-Mäkinen H, Ludvíková M, Kholová I. The Role of Cell Blocks and Immunohistochemistry in Thyroid Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance Bethesda Category. Acta Cytol 2021; 65:257-263. [PMID: 33789274 DOI: 10.1159/000514906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Thyroid cytology is a widely accepted tool in the clinical triaging of nodular lesions. Cell blocks (CBs) can help in the diagnosis of atypical lesions, namely, thyroid Bethesda category of Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). METHODS In a series of 224 AUS/FLUS thyroid samples with CB, we studied CB cellularity and feasibility of 3 immunohistochemical markers (cytokeratin 19 [CK19], HBME-1, and galectin-3) apart and in combination. RESULTS The CBs were non-diagnostic in 34 cases. Twenty-four CBs contained <10 cells, 45 CBs 10-50 cells, and 121 CBs >50 cells. Notably, more cellularity was found in CBs performed by plasma-thrombin and in-house techniques (p < 0.001). The diagnostic accuracy to detect malignancy was 65.1% for CK19, 72.1% for HBME-1, and 70.3% for galectin-3. CONCLUSION In conclusion, CB cellularity is essential for successful immunohistochemistry application and further diagnostic workup of AUS/FLUS cases.
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Affiliation(s)
- Mikk Abram
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Roope Huhtamella
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, Prague, Czechia
| | | | - Marie Ludvíková
- Department of Biology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czechia
| | - Ivana Kholová
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
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Ooi LY, Nga ME. Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience. Gland Surg 2020; 9:1764-1787. [PMID: 33224854 DOI: 10.21037/gs-20-555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.
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Affiliation(s)
- Li Yin Ooi
- Department of Pathology, National University Hospital, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
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Zhu Y, Song Y, Xu G, Fan Z, Ren W. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): A report of 2,781 cases in a Chinese population. Chin J Cancer Res 2020; 32:140-148. [PMID: 32410792 PMCID: PMC7219100 DOI: 10.21147/j.issn.1000-9604.2020.02.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the diagnostic utility of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) at Peking University Cancer Hospital, the incidence of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and the impact of reclassification on cytopathological outcomes. Methods We performed a retrospective study of thyroid fine-needle aspiration (FNA) cases between April 2014 and March 2019. The FNA results were classified according to TBSRTC. Post-surgery histological findings were followed up. Results A total of 2,781 thyroid FNAs were performed. The incidences of the 6 diagnostic categories (DCs I-VI) were 14.8%, 17.1%, 15.8%, 2.3%, 11.6% and 38.5%, respectively. A total of 1,122 patients (40.3%) had corresponding histological results. NIFTP accounted for 0.4% of papillary thyroid carcinoma (PTC) cases, and there was no significant difference in the risk of malignancy (ROM) for each TBSRTC DC between "NIFTP=carcinoma (Ca)" and "NIFTP≠Ca". When "NIFTP=Ca", the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TBSRTC were 98.0%, 84.0%, 99.4%, 58.3%, and 97.5%, respectively. When "NIFTP≠Ca", the sensitivity, specificity, PPV, NPV and accuracy of the TBSRTC were 98.1%, 81.5%, 99.3%, 61.1%, and 97.5%, respectively. Conclusions TBSRTC is effective in the preoperative diagnosis of thyroid nodules in Peking University Cancer Hospital. The impact of the reclassification of NIFTP on cytopathological outcomes is limited because of its low incidence, and the revised ROMs are not suitable for Asian patients.
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Affiliation(s)
| | | | | | - Zhihui Fan
- Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China
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Maity P, Jha AK, Sengupta M, Basu K, Chatterjee U, Ghosh S. Thyroid Bethesda Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS/FLUS): A Heterogenous Group. J Cytol 2019; 36:200-204. [PMID: 31741578 PMCID: PMC6844015 DOI: 10.4103/joc.joc_160_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 01/21/2023] Open
Abstract
Background: The Bethesda system of reporting thyroid cytopathology (BSRTC) was introduced in 2007. The third category of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) poses difficulties for the pathologist, and different papers have been published varying the risks of malignancy. Aims: (1) Evaluation of the cytological features of thyroid lesions according to BSRTC. (2) After resection, correlation with histopathological report to evaluate the risk of malignancy (ROM) and the risk of neoplasm (RON). (3) Division of category III into six subgroups based on cytological findings and assessment of ROM and RON. Materials and Methods: A total of 282 patients with diagnosed thyroid lesions underwent fine-needle sampling under ultrasound guidance. Smears were prepared and stained with May–Grunwald–Giemsa stain and Papanicolaou stain. Results: Of 282 cases, there were 9 cases (3.1%) of category I, 157 cases (55.8%) of category II, 24 cases (8.5%) of category III, 20 cases (7.1%) of category IV, 14 cases (4.8%) of category V, and 58 cases (20.7%) of category VI. The RON was 60, 17.1, 63.1, 77.7, 91.7, and 98.2% and the ROM was 60, 14.3, 26.3, 38.9, 91.7, and 96.3% in categories I, II, III, IV, V, and VI, respectively. The RON was 0, 75, 50, 100, 66.6, and 100% and the ROM was 0, 25, 50, 100, 16.6, and 0% in subgroups 1, 2, 3, 4, 5, and 6, respectively. We have proposed a system of subgrouping AUS/FLUS that may help to dispel the confusion generated by an AUS/FLUS report, and provide with a more exact and reproducible diagnostic and prognostic tool.
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Affiliation(s)
- Priyanka Maity
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Calcutta Medical College, Kolkata, West Bengal, India
| | - Ashish Kumar Jha
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Calcutta Medical College, Kolkata, West Bengal, India
| | - Moumita Sengupta
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Calcutta Medical College, Kolkata, West Bengal, India
| | - Keya Basu
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Calcutta Medical College, Kolkata, West Bengal, India
| | - Uttara Chatterjee
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Calcutta Medical College, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Calcutta Medical College, Kolkata, West Bengal, India
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Quaglino F, Marchese V, Mazza E, Gottero C, Lemini R, Taraglio S. When Is Thyroidectomy the Right Choice? Comparison between Fine-Needle Aspiration and Final Histology in a Single Institution Experience. Eur Thyroid J 2017; 6:94-100. [PMID: 28589091 PMCID: PMC5422848 DOI: 10.1159/000452622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/14/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare SIAPEC-IAP-based cytological reports with their corresponding histological diagnoses to establish when thyroidectomy is the right choice in the management of thyroid diseases. STUDY DESIGN This is a retrospective review of all the consecutive thyroidectomies/lobectomies performed at Maria Vittoria Hospital during the 10-year period between January 2005 and December 2015. Patients who underwent both fine-needle aspiration (FNA) and surgical procedures in our institution were included in the study. RESULTS A total of 260 patients underwent both FNA and a thyroid surgical procedure at Maria Vittoria Hospital; 111 (42.69%) had a malignant histological report. The final cytological diagnosis was nondiagnostic (TIR-1) in 19 cases (7.31%), benign (TIR-2) in 83 cases (31.92%), indeterminate (TIR-3) in 96 cases (36.92%), suspicious for malignancy (TIR-4) in 22 cases (8.46%), and diagnostic for malignancy (TIR-5) in 40 cases (15.38%). Among the 96 cases with TIR-3 cytology, after the review, 44 (16.92%) were classified as TIR-3A and 52 (20%) as TIR-3B. The prevalence of malignancy among TIR-3A cases was 20.45% (9/44) and among TIR-3B cases 53.85% (28/52). The difference was statistically significant (p = 0.0007). CONCLUSIONS Our data suggest that follow-up alone is not sufficient in TIR-3A patients given the high prevalence of malignancy within that diagnostic category (20.45%) and the low sensitivity (75.68%) and specificity (59.32%) in the distinction between TIR-3A and TIR-3B. Regarding patients with a multinodular goiter and TIR-2 at FNA, the surgical approach should not be excluded.
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Affiliation(s)
| | | | - Enrico Mazza
- Endocrinology and Metabolism Unit, Maria Vittoria Hospital ASL TO2, Turin, Italy
| | - Cristina Gottero
- Endocrinology and Metabolism Unit, Maria Vittoria Hospital ASL TO2, Turin, Italy
| | - Riccardo Lemini
- General Surgery Unit, Maria Vittoria Hospital ASL TO2, Turin, Italy
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Garg S, Naik LP, Kothari KS, Fernandes GC, Agnihotri MA, Gokhale JC. Evaluation of thyroid nodules classified as Bethesda category III on FNAC. J Cytol 2017; 34:5-9. [PMID: 28182068 PMCID: PMC5259932 DOI: 10.4103/0970-9371.197590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5–15%, however, the probability of malignancy remains variable. Aim: To evaluate category III with respect to its rate and risk of malignancy and substratify it. Settings and Design: Atypia of undetermined significance/Follicular lesion of undetermined significance (AUS/FLUS) percentage, cytohistological correlation, and risk of malignancy were analyzed and substratification was done. Material and Methods: Category III cases over a 2-year period were analyzed retrospectively. Statistical Analysis: Two-tailed Fisher exact test, with a level of significance set at 0.05, was performed for data analysis. Results: Of 1169 thyroid fine needle aspirations (FNAs), 76 (6.5%) were category III. A total of 48 patients had follow up; 24 patients underwent surgery, 12 repeat FNA, and 12 were clinically followed. Repeat FNA cytology was unsatisfactory in 8.3%, benign in 66.7%, AUS in 8.3%, and follicular neoplasm in 16.7%. Of the 24 operated, 8 (33.3%) were malignant (follicular variants of papillary thyroid carcinoma), 5 (20.8%) were follicular adenomas, and 11 (45.8%) were non-neoplastic. Among all AUS/FLUS nodules with follow-up, malignancy was confirmed in 16.7% (8/48) whereas with nodules triaged to surgery only, the malignancy rate was 33.3% (8/24). Substratification into categories of “cannot exclude PTC” and “favor benign” helped detect malignancy better, as 85.7% cases in the first subcategory (P < 0.001) and none (P < 0.02) in the last proved malignant. Conclusion: Though the rate of Category III in our study is in accordance to BSRTC, the risk of malignancy in AUS/FLUS nodules is higher. Substratification of AUS/FLUS may help better patient management.
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Affiliation(s)
- Shiwani Garg
- Department of Pathology, Seth G.S.M.C. and KEM Hospital, Mumbai, Maharashtra, India
| | - Leena P Naik
- Department of Pathology, Seth G.S.M.C. and KEM Hospital, Mumbai, Maharashtra, India
| | - Kanchan S Kothari
- Department of Pathology, Seth G.S.M.C. and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Mona A Agnihotri
- Department of Pathology, Seth G.S.M.C. and KEM Hospital, Mumbai, Maharashtra, India
| | - Jagruti C Gokhale
- Department of Pathology, Seth G.S.M.C. and KEM Hospital, Mumbai, Maharashtra, India
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Krauss EA, Mahon M, Fede JM, Zhang L. Application of the Bethesda Classification for Thyroid Fine-Needle Aspiration: Institutional Experience and Meta-analysis. Arch Pathol Lab Med 2016; 140:1121-31. [DOI: 10.5858/arpa.2015-0154-sa] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA.
Objective.—To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data.
Data Sources.—Data sources were PubMed, a manual search of references, and institutional data.
Conclusions.—The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P < .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%–14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%–23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%–29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.
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Affiliation(s)
- Elliot A. Krauss
- From the Department of Pathology, University Medical Center of Princeton, Plainsboro, New Jersey (Drs Krauss, Fede, and Zhang); the Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (Drs Krauss, Fede, and Zhang, and Ms Mahon); the Department of Chemical Biology, Rutgers Ernest Mario School of Pharmacy, Piscataway, New Jersey (Dr Zhang); and the Cancer
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Kim SJ, Roh J, Baek JH, Hong SJ, Shong YK, Kim WB, Song DE. Risk of malignancy according to sub-classification of the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category in the Bethesda system for reporting thyroid cytopathology. Cytopathology 2016; 28:65-73. [DOI: 10.1111/cyt.12352] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 01/21/2023]
Affiliation(s)
- S. J. Kim
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - J. Roh
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - J. H. Baek
- Department of Radiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S. J. Hong
- Department of Surgery; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Y. K. Shong
- Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - W. B. Kim
- Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - D. E. Song
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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A Pilot Study of Galectin-3, HBME-1, and p27 Triple Immunostaining Pattern for Diagnosis of Indeterminate Thyroid Nodules in Cytology With Correlation to Histology. Appl Immunohistochem Mol Morphol 2016; 23:481-90. [PMID: 25221953 PMCID: PMC4530731 DOI: 10.1097/pai.0000000000000106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Supplemental Digital Content is available in the text. Indeterminate thyroid nodules form a heterogenous group of lesions that constitute 5% to 30% of thyroid cytology diagnoses. We introduce a triple immunostaining protocol for subtyping. Galectin-3, HBME-1, and p27 triple immunostaining, performed on destained cytology slides and formalin-fixed paraffin-embedded tissue, was developed and applied to 51 patients retrospectively with preoperative cytologic diagnoses of follicular lesion of undetermined significance (n=40), atypia of undetermined significance (n=6), and suspicious for follicular neoplasm (n=5). The malignant rate in this series was 43.1% (22/51). A hierarchal evaluation algorithm was generated based on digital image quantitation of triple-stained histologic sections, and applied to both cytology and histology specimens. Fifty of 51 cytology cases have triple staining validated by internal controls. In cytology specimens, the individual sensitivities and specificities of p27, Galectin3, and HBME1 for cancer with 95% confidence interval are: 86.2% (0.674, 0.955)/66.7% (0.431, 0.845); 77.3% (0.542, 0.913)/72.4% (0.525, 0.866); and 72.7% (0.496, 0.884)/93.1% (0.758, 0.988), respectively. Sensitivity is increased to 95.5% (0.751, 0.998), but specificity is decreased to 69.0% (0.490, 0.840), if Galectin3 and HBME1 are both used in combination as markers for malignancy. However, the level of specificity is increased to 86.2% (0.674, 0.955) and sensitivity remains high 100% (0.808, 1) if in addition, using the Galectin3/HBME1:p27 ratio (ratio ≥2 indicating malignancy) for 2 or 3 markers positive cases. Thus, the triple staining method on cytology slides and histology sections shows a similar sensitivity/specificity/positive predictive value/negative predictive value of 100.0%/86.2%/84.0%/100.0% and 95.5%/86.2%/84.0%/96.2%, respectively (P=0.92). Overall, p27 is the most frequent single positive marker (19/50, 38% in cytology), consistent with benign nature of most indeterminate thyroid nodules. Galectin-3 and HBME-1 colocalization (positive in the same cell) was demonstrated in thyroid cancer in 45.5% (10/22) of histology sections, but in none of the normal thyroid tissues and benign thyroid lesions. This supports the notion that synchronous activation of Galectin-3 and HBME-1 occurs in thyroid malignancy and is highly specific for malignancy. We have demonstrated the performance and pattern of triple immunostaining for subtyping indeterminate thyroid nodules. Further studies and validation in different larger populations are warranted.
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Brandler TC, Aziz MS, Coutsouvelis C, Rosen L, Rafael OC, Souza F, Jelloul FZ, Klein MA. Young investigator challenge: Atypia of undetermined significance in thyroid FNA: Standardized terminology without standardized management-a closer look at repeat FNA and quality measures. Cancer Cytopathol 2016; 124:37-43. [DOI: 10.1002/cncy.21648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/02/2015] [Accepted: 10/19/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Tamar C. Brandler
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Mohamed S. Aziz
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | | | - Lisa Rosen
- Department of Biostatistics; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Oana C. Rafael
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Fabiola Souza
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Fatima-Zahra Jelloul
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
| | - Melissa A. Klein
- Department of Pathology; Hofstra North Shore-LIJ School of Medicine; Lake Success New York
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Brophy C, Mehanna R, McCarthy J, Tuthill A, Murphy MS, Sheahan P. Outcome of Subclassification of Indeterminate (Thy-3) Thyroid Cytology into Thy-3a and Thy-3f. Eur Thyroid J 2015; 4:246-51. [PMID: 26835428 PMCID: PMC4716411 DOI: 10.1159/000441221] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/18/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The British Thy system is a widely used classification system for reporting thyroid fine-needle aspiration (FNA) cytology. The Royal College of Pathologists in 2009 recommended the subdivision of the Thy-3 (indeterminate) category into Thy-3a (atypia) and Thy-3f (follicular neoplasm). Our objective was to examine the malignancy rates of Thy-3a and Thy-3f cases at our institution and to investigate whether the risk of malignancy in Thy-3a cases is reduced by FNA on a different occasion showing benign cytology. METHODS This is a retrospective study of 748 thyroid nodules undergoing 1,032 FNAs, with indeterminate (Thy-3) cytology subdivided into Thy-3a and Thy-3f. Cases were correlated with final histology in surgical cases. Incidental carcinomas occurring outside the biopsied nodule were discounted. RESULTS A total of 109 nodules had a final cytological diagnosis of Thy-3a, of which 67 underwent surgery, with an incidence of malignancy of 13.4% (9/67); 90 nodules had a final cytological diagnosis of Thy-3f, of which 84 underwent surgery, with an incidence of malignancy of 17.9% (15/84). The difference in malignancy rates was not significant (p = 0.51). The incidence of malignancy in nodules with benign and Thy-3a cytology on separate occasions was not significantly different from cases with a single Thy-3a cytology. CONCLUSIONS Thyroid nodules with Thy-3a cytology have a slightly lower risk of malignancy than Thy-3f cases. However, the difference is not significant and does not appear to be reduced by FNA on a separate occasion showing benign cytology. Management decisions for patients with Thy-3a cytology should be taken carefully to avoid missing cancers.
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Affiliation(s)
- Catherine Brophy
- Department of Otolaryngology – Head and Neck Surgery, Cork, Ireland
| | - Rania Mehanna
- Department of Otolaryngology – Head and Neck Surgery, Cork, Ireland
| | - Julie McCarthy
- Department of Cytopathology, Cork University Hospital, Cork, Ireland
| | | | - Matthew S. Murphy
- Department of Endocrinology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Patrick Sheahan
- Department of Otolaryngology – Head and Neck Surgery, Cork, Ireland
- *Patrick Sheahan, Department of Otolaryngology – Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork (Ireland), E-Mail
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Ugurluoglu C, Dobur F, Karabagli P, Celik ZE. Fine needle aspiration biopsy of thyroid nodules: cytologic and histopathologic correlation of 1096 patients. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:14800-14805. [PMID: 26823807 PMCID: PMC4713593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
Via routinely used thyroid function tests, scintigraphy and ultrasonography (USG), important information is obtained in the clinical and diagnostic practice for thyroid nodules. However, the distinction between benign and malignant lesions cannot precisely be performed with these tests. Thyroid fine needle aspiration biopsy (FNAB) is considered the most reliable diagnostic method in the differentiation between benign and malignant thyroid nodules. It has recently been likely to perform aspiration from deeper nodules via the implemention of FNAB along with USG. Today, in cytopathological examination of thyroid FNAB, standardized Bethesda System for Reporting Thyroid Cytopathology (BSRTC) system is used. Here, FNAB was performed in 1096 patients with thyroid nodules in the Medical School of Selcuk University between January 2009 and July 2014. Patients consisted of 919 women and 177 men between 12 and 87 years of age. Evaluated via BSRTC, the results were classified as unsatisfactory, benign, atypia (or follicular lesions) of undetermined significance (AUS), follicular neoplasm or lesions suspicious for follicular neoplasm (FN), suspected malignant and malignant. After FNAB, 183 patients were operated and evaluated histopathologically. Histological malignancy rates of the categories were as follows: 16% (5), 15% (6) 14% (1) 60% (9), 72% (18) and 97% (63), respectively. In our study, we aimed to compare FNAB results of thyroid nodules with histopathology results after thyroidectomy and to show the sensitivity and specificity of FNAB technique to be higher in the follow-up and diagnosis of thyroid lesions. Given the malignancy detection rate in the follow-up of patients whose cytology was reported as inadequate, we also consider follow-ups are important in these patients.
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Affiliation(s)
- Ceyhan Ugurluoglu
- Department of Pathology, Faculty of Medicine, Selcuk University Turkey
| | - Fatma Dobur
- Department of Pathology, Faculty of Medicine, Selcuk University Turkey
| | - Pinar Karabagli
- Department of Pathology, Faculty of Medicine, Selcuk University Turkey
| | - Zeliha Esin Celik
- Department of Pathology, Faculty of Medicine, Selcuk University Turkey
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15
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Bobanga ID, McHenry CR. Evaluation and management of thyroid nodules with atypia/follicular lesion of undetermined significance on fine-needle aspiration. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since the introduction of the Bethesda System for Reporting Thyroid Cytopathology in 2008, the management of thyroid nodules has become more standardized, with clearly defined algorithms based on risk of malignancy for each of the six cytologic categories. However, the management of a thyroid nodule with a fine-needle aspiration biopsy classified as Bethesda III, or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), remains controversial due to the cytologic heterogeneity and the variability in the reported rates of malignancy. In this review, the history and rationale for the new Bethesda III category is examined, the reported incidence and risk of malignancy from published studies is reviewed and recommendations for management of patients with a thyroid nodule and AUS/FLUS are provided. Recent advances in molecular analysis and their role in the evaluation of patients with AUS/FLUS are also discussed.
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Affiliation(s)
- Iuliana D Bobanga
- Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Christopher R McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA
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16
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Gerhard R, Boerner SL. Evaluation of indeterminate thyroid cytology by second-opinion diagnosis or repeat fine-needle aspiration: which is the best approach? Acta Cytol 2015; 59:43-50. [PMID: 25612736 DOI: 10.1159/000369332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/25/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study investigated a published series evaluating the role of second-opinion diagnosis (SOD) or repeat fine-needle aspiration cytology (RFNA) for indeterminate thyroid aspirates. STUDY DESIGN Twenty-three studies were selected and the following parameters were analyzed: disagreement between SOD or RFNA and the original diagnosis (OD), reclassification of OD according to the Bethesda system for reporting thyroid cytopathology, the rate of definitive diagnosis and the diagnostic performance of SOD and RFNA. RESULTS 7,154 thyroid FNAs were retrieved from 9 studies that investigated the role of SOD, including 1,048 (14.6%) cases originally reported as indeterminate. The 14 studies that analyzed the role of thyroid RFNA comprised 67,581 FNAs and included 7,246 (10.7%) indeterminate cases. A definitive diagnosis was achieved by SOD in 450 cases (42.9%) and RFNA in 1,645 cases (57.2%, p=0.0001). Based on cases with histological follow-up, SOD demonstrated significantly higher rates of positive predictive value and accuracy than RFNA (55.8 vs. 37.7%, p=0.0001; 67.4 vs. 56.0%, p=0.0034, respectively). CONCLUSIONS Both SOD and RFNA demonstrated an improvement in the diagnosis of initially indeterminate thyroid FNAs. RFNA achieved a definitive diagnosis for the majority of indeterminate cases. Regarding histological follow-up, SOD was shown to be more accurate than RFNA.
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Affiliation(s)
- Rene Gerhard
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont., Canada
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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 2014; 58:319-29. [PMID: 25195864 DOI: 10.1159/000366498] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/07/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was introduced in thyroid cytology in 2007 and is now generally accepted. BSRTC categories include a morphologic description and risk of malignancy as well as follow-up suggestions in each group. However, the category entitled 'atypia of undetermined significance or follicular lesion of undetermined significance' (AUS/FLUS) is problematic. This category is heterogeneous and has been overused so far. STUDY DESIGN Twenty-six studies were included in a meta-analysis. In addition to AUS/FLUS percentage, we analysed repeated AUS/FLUS percentage, cytological and histological correlations, and risk of malignancy and neoplasm for AUS/FLUS. Furthermore, stratification, inter- and intra-observer variability, and the possibility of a switch to another category and its clinical consequences were reviewed. RESULTS Out of a total of 81,833 cases, AUS/FLUS accounted for 10.9%, with a 34% risk of malignancy. Persistent AUS/FLUS was found in 21.6% in repeated cytology. Cytohistological correlation was analysed from 16 studies (4,964 cases), revealing 10.4% as AUS/FLUS and a 21.5% risk of malignancy. CONCLUSIONS An AUS/FLUS category seems to be currently reasonable with clearly defined cytomorphological criteria which do not correspond unequivocally with those of the other categories. An AUS/FLUS category is justified and possible means of its improvement with immunohistochemistry, molecular analysis and imaging are discussed.
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Affiliation(s)
- Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
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Addati T, Achille G, Centrone M, Petroni S, Popescu O, Russo S, Grammatica L, Simone G. TROP-2 expression in papillary thyroid cancer: a preliminary cyto-histological study. Cytopathology 2014; 26:303-11. [DOI: 10.1111/cyt.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 12/30/2022]
Affiliation(s)
- T. Addati
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - G. Achille
- Otorhinolaryngology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - M. Centrone
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - S. Petroni
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - O. Popescu
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - S. Russo
- Otorhinolaryngology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - L. Grammatica
- Otorhinolaryngology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
| | - G. Simone
- Anatomic Pathology Unit; National Cancer Research Centre Istituto Tumori ‘Giovanni Paolo II’; Bari Italy
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Calò PG, Medas F, Santa Cruz R, Podda F, Erdas E, Pisano G, Nicolosi A. Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option? BMC Surg 2014; 14:12. [PMID: 24597765 PMCID: PMC3946766 DOI: 10.1186/1471-2482-14-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/28/2014] [Indexed: 12/18/2022] Open
Abstract
Background Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. Methods The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. Results Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. Conclusions The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy.
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Affiliation(s)
- Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, S,S, 554, Bivio Sestu, 09042 Monserrato, (CA), Italy.
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Abedi-Ardekani B, Vielh P. Is liquid-based cytology the magic bullet for performing molecular techniques? Acta Cytol 2014; 58:574-81. [PMID: 25277086 DOI: 10.1159/000366260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/31/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The role of pathology has evolved from the first microscopic definitions of diseases by Virchow to the new concept of molecular cytopathology. The management of diseases is now a multidisciplinary approach with the translation of morphological, imagery and molecular findings to therapeutic protocols. Obtaining the most reliable diagnostic material is the essential part of the medical management of patients. STUDY DESIGN Here, we try to gain a concise insight into the available data regarding the role of cytology in the application of molecular techniques, focusing on cancer cytopathology. RESULTS Obtaining cytological material is now feasible by different methods, and in some cases it is the only possible approach to a lesion which is not easily accessible for tissue sampling. The methods of obtaining cytological material have evolved in recent years in parallel with rapid advances in high-throughput molecular techniques, opening new windows for the diagnosis and management of diseases. CONCLUSIONS Different kinds of cytological material are reliable for the application of molecular techniques. Cytological material obtained in a liquid base has advantages such as the better preservation of cytomorphological features and the use of the remaining liquid for nucleic acid extraction even after long storage and the application of molecular methods.
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Affiliation(s)
- Behnoush Abedi-Ardekani
- Translational Research Laboratory, Personalized Medicine, Gustave Roussy Cancer Campus, Villejuif, France
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