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Vuorisalo A, Huhtala H, Paavonen T, Kholová I. Insufficient endobronchial ultrasound-guided transbronchial needle aspiration specimens. When and why? The analysis of criteria and reasons behind the insufficient specimens. Diagn Cytopathol 2024; 52:271-287. [PMID: 38348643 DOI: 10.1002/dc.25284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The classification terminology systems for pulmonary cytology specimens have recently emerged. Inadequate samples, classified as "nondiagnostic," raise challenges in determining the threshold of cell numbers and the risk of malignancy (ROM). METHODS The study retrospectively reviewed 248 endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples: 46 insufficient samples, 60 low cellularity samples, and 142 adequate samples. Characteristics as cellularity, number of benign and malignant cells, and background features were assessed. Receiver operating characteristic curve analysis was performed to establish cell sufficiency thresholds for the diagnosis. RESULTS Out of the 248 samples analyzed, 108 were classified as benign, 94 as malignant, and 46 as insufficient. The study found that the cellularity thresholds for diagnosis in cell blocks and cytological samples were ≥50 cells and ≥100 cells, respectively. The thresholds for tumor cell counts were ≥1 - 10 cells for both types of cells, respectively. Considerably, some low cellularity samples were initially classified as insufficient despite meeting the diagnostic thresholds upon revision. The ROM varied across sample categories, with insufficient samples having a ROM of 10.9%, benign samples 15.7%, suspicious samples 92.0%, and malignant samples 100%. CONCLUSION Insufficient EBUS-TBNA samples raise challenges in diagnosis and management. This study identified the root cause of insufficient samples, including factors related to humans, diagnostic methods, sampling, and laboratory processing. By understanding the root causes, diagnostic recommendations can be developed to improve the diagnostic process. The findings emphasize the importance of standardized classification and terminology systems for clear communication among healthcare professionals and institutions, ultimately improving patient care and enabling quality assurance measures.
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Affiliation(s)
- Antti Vuorisalo
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Timo Paavonen
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Fine-needle aspiration cytology repetition in thyroid nodules with non-diagnostic findings or atypia of undetermined significance/follicular lesions of undetermined significance: Does time matters? ANNALES D'ENDOCRINOLOGIE 2022; 83:232-236. [PMID: 35489413 DOI: 10.1016/j.ando.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION After a nondiagnostic (ND) result or findings of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), the current recommendation is for fine-needle aspiration cytology (FNAC) of the thyroid nodule to be repeated after at least 3 months. The aim of this study was to evaluate whether the interval between FNACs has any influence on the final cytological diagnosis. METHODS This was a retrospective study including all patients who underwent FNAC for the first time between January 2016 and December 2019 with ND or AUS/FLUS cytological results and then underwent a second FNAC procedure. Demographic, clinical, ultrasound and cytological data were retrieved. 1,497 nodules were evaluated; 535 had a first FNAC result of ND or AUS/FLUS, and 246 of these were re-evaluated with a second FNAC. The cases were grouped according to the timing of the repeat FNAC in two different analyses: < vs. ≥ 3 months and < vs. ≥ 6 months after initial FNAC. RESULTS Two hundred forty-six repeat FNACs were performed in 186 patients (76% female, median age 59.5 years). Twenty-two of these procedures (8.9%) were performed within 3 months, and 115 (46.2%) within 6 months of the first FNAC. Second FNAC findings were ND in 121 (49.2%) cases, benign in 103 (41.9%), AUS/FLUS in 8 (3.3%), follicular neoplasm/suspicious follicular neoplasm in 9 (3.7%), suspicious malignancy in 4 (1.6%) and malignancy in 1 (0.4%). Early repetition of FNAC did not significantly influence the final cytological result (< 3 vs. ≥ 3 months, P=0.51; and < 6 vs. ≥ 6 months, P=0.20). CONCLUSION This study suggests that the interval in repeat FNAC procedures is not relevant to overall diagnostic performance.
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Clinicopathological and Molecular Features of Secondary Cancer (Metastasis) to the Thyroid and Advances in Management. Int J Mol Sci 2022; 23:ijms23063242. [PMID: 35328664 PMCID: PMC8955551 DOI: 10.3390/ijms23063242] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/19/2022] Open
Abstract
Secondary tumours to the thyroid gland are uncommon and often incidentally discovered on imaging. Symptomatic patients often present with a neck mass. Collision tumours of secondary tumours and primary thyroid neoplasms do occur. Ultrasound-guided fine-needle aspiration, core-needle biopsy, and surgical resection with histological and immunohistochemical analysis are employed to confirm diagnosis as well as for applying molecular studies to identify candidates for targeted therapy. Biopsy at the metastatic site can identify mutations (such as EGFR, K-Ras, VHL) and translocations (such as EML4-ALK fusion) important in planning target therapies. Patients with advanced-stage primary cancers, widespread dissemination, or unknown primary origin often have a poor prognosis. Those with isolated metastasis to the thyroid have better survival outcomes and are more likely to undergo thyroid resection. Systemic therapies, such as chemotherapy and hormonal therapy, are often used as adjuvant treatment post-operatively or in patients with disseminated disease. New targeted therapies, such as tyrosine kinase inhibitors and immune checkpoint inhibitors, have shown success in reported cases. A tailored treatment plan based on primary tumour features, overall cancer burden, and co-morbidities is imperative. To conclude, secondary cancer to the thyroid is uncommon, and awareness of the updates on diagnosis and management is needed.
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Karakas HM, Bicer G, Findik O, Kahraman AN. Comparison of Two Different Methods of Fine Needle Aspiration Biopsy and Histopathology for Thyroid Nodules. Cureus 2020; 12:e6740. [PMID: 32133262 PMCID: PMC7034764 DOI: 10.7759/cureus.6740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/22/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Two different methods for fine needle aspiration biopsy (FNAB) of thyroid nodules (multi-pass conventional smear, MPCS; single-pass liquid-based cytology, SPLBC) were evaluated regarding the magnitude of nondiagnostic/unsatisfactory sampling ratio, and basic demographic and ultrasonographic (USG) factors to predict such outcome. METHODS One thousand FNAB patients were retrospectively assessed. Of them, 517 nodules were evaluated with the conventional smear method, and the rest were evaluated with liquid-based cytology method using the Bethesda System for Reporting Thyroid Cytopathology. FNAB technique had certain procedural differences for both pathological methods. For conventional smear, a modified "needle-only" technique with three independent passes was performed, whereas a single pass was used for liquid-based cytology. The reduction of nondiagnostic/unsatisfactory results constituted the basis of this study. Pathological results, therefore, were subgrouped under "nondiagnostic/unsatisfactory" (Category I), "benign" (Category II), and "atypia/neoplasia/malignancy" (Category III-VI). RESULTS Both FNAB groups were not statistically different or only slightly different regarding size (P = 0.196), echogenicity (P = 0.014), and the presence of echogenic foci (P = 0.11), therefore considered to have equal USG properties. In MPCS method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 24%. Other cytological results were as follows: Category II (67.1%), Category III-VI (8.8%). In SPLBC method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 14.5%. Other cytological results were as follows: Category II (77.6%), Category III-VI (7.8%). A significant difference was found between two sampling methods regarding pathological results (Independent samples t-test, P < 0.0001). The demographic and USG factors, considered in this study, did not offer a successful prediction of nondiagnostic/unsatisfactory outcomes. CONCLUSION SPLBC has significantly lower (14.5% vs 24%) nondiagnostic rate than MPCS, and higher 77.6% vs 67.1%) Category II rate than MPCS. This may point to the possibility that MPCS method undercategorizes many benign (i.e., Category II) nodules under nondiagnostic/unsatisfactory category. The success of the former is due to the elimination of confounding material during the process. Single pass, also, increases patient comfort and compliance, and has additional advantages for the interventionalist, as it obviates the need to smear aspirates. This dramatically decreases the actual duration of the biopsy procedure and is free of interventionalist expertise for smearing.
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Affiliation(s)
- Hakki M Karakas
- Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Gulsah Bicer
- Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Ozge Findik
- Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Ahmet Nedim Kahraman
- Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
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Paja M, del Cura JL, Zabala R, Korta I, Ugalde A, López JI. Core-needle biopsy in thyroid nodules: performance, accuracy, and complications. Eur Radiol 2019; 29:4889-4896. [DOI: 10.1007/s00330-019-06038-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/23/2018] [Accepted: 01/23/2019] [Indexed: 12/14/2022]
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Kotowski U, Brkic FF, Koperek O, Nemec SF, Perisanidis C, Altorjai G, Grasl MC, Erovic BM. Accuracy of fine‐needle aspiration cytology in suspicious neck nodes after radiotherapy: Retrospective analysis of 100 patients. Clin Otolaryngol 2019; 44:384-388. [DOI: 10.1111/coa.13271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/29/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ulana Kotowski
- Department of Otolaryngology, Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Faris F. Brkic
- Department of Otolaryngology, Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Oskar Koperek
- Department of Clinical Pathology Medical University of Vienna Vienna Austria
| | - Stefan F. Nemec
- Department of Biomedical Imaging and Image‐guided therapy Medical University of Vienna Vienna Austria
| | - Christos Perisanidis
- Department of Maxillofacial Surgery and Medical University of Vienna Vienna Austria
| | - Gabriela Altorjai
- Department of Radiation Oncology Medical University of Vienna Vienna Austria
| | - Matthaeus Ch. Grasl
- Department of Otolaryngology, Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases Evangelical Hospital Vienna Vienna Austria
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Geramizadeh B, Bos-Hagh S, Maleki Z. Cytomorphologic, Imaging, Molecular Findings, and Outcome in Thyroid Follicular Lesion of Undetermined Significance/Atypical Cell of Undetermined Significance (AUS/FLUS): A Mini-Review. Acta Cytol 2018; 63:1-9. [PMID: 30380529 DOI: 10.1159/000493908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/19/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Since the introduction of the entity of "Atypical cell of undetermined significance /follicular lesion of undetermined significance" (AUS/FLUS) by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) in 2007, there have been many published studies about the cytomorphologic criteria, subclassification, outcome, and management of patients with the diagnosis of AUS/FLUS. There have been many studies in different aspects of this indeterminate category, i.e., cytologic and molecular findings, ultrasonographic findings, and in some instances even core-needle biopsy to address a better and safer way of the management of patients with this fine-needle aspiration cytology diagnosis. The second edition of TBSRTC and the 2015 American Thyroid Association guidelines provide an update on the follow-up and management of AUS/FLUS. A multidisciplinary team consisting of pathologists, endocrinologists, surgeons, and radiologists should be involved in the diagnosis and management of AUS/FLUS, and all of them should be aware of the heterogeneity of this lesion for the prediction of the treatment and outcome. STUDY DESIGN In this review, we consider different research platforms (2008-2017) to find the best and key reports for the above-mentioned challenging aspects of AUS/FLUS. CONCLUSION AUS/FLUS is now a well-defined group of thyroid lesions, which can be most accurately diagnosed and managed with cytomorphology, molecular, and ancillary studies.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Bos-Hagh
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland,
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Chieng JSL, Lee CH, Karandikar AA, Goh JPN, Tan SSS. Accuracy of ultrasonography-guided fine needle aspiration cytology and significance of non-diagnostic cytology in the preoperative detection of thyroid malignancy. Singapore Med J 2018; 60:193-198. [PMID: 30182131 DOI: 10.11622/smedj.2018105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Thyroid fine-needle aspiration cytology (FNAC) is an established investigation for the preoperative evaluation of thyroid nodules and is often done under ultrasonography guidance. While its accuracy has been widely reported, there is little evidence in the literature on the approach to non-diagnostic cytology results. In our study, we aimed to determine the diagnostic performance of ultrasonography-guided thyroid FNAC for the preoperative diagnosis of thyroid cancer at our institution and evaluate the significance of a non-diagnostic thyroid FNAC. METHODS We retrospectively reviewed the thyroid ultrasonography studies and medical records of all patients who underwent both thyroid FNAC and subsequent thyroid surgery at our institution from 2011 to 2013. FNAC results were correlated with the final histological diagnosis from surgery and the ultrasonography studies were reviewed for suspicious sonographic features. RESULTS FNAC predicted malignancy with sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and total accuracy of 90.7%, 53.6%, 43.3%, 93.7%, 46.4%, 9.3% and 64.1%, respectively. We found that only one of 26 nodules with non-diagnostic FNAC results was proven malignant on a second FNAC and subsequent thyroidectomy. CONCLUSION The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.
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Affiliation(s)
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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Ahn S, Jung S, Kim JY, Shin JH, Hahn SY, Oh YL. Evaluation of Modified Core-Needle Biopsy in the Diagnosis of Thyroid Nodules. Korean J Radiol 2018; 19:656-664. [PMID: 29962871 PMCID: PMC6005953 DOI: 10.3348/kjr.2018.19.4.656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 12/03/2017] [Indexed: 01/08/2023] Open
Abstract
Objective Core needle biopsy (CNB) of the thyroid is an additional diagnostic method for non-diagnostic or indeterminate cytology samples. We sought to evaluate a new modified core biopsy technique and compare the concordance of its diagnosis with the final diagnosis of the surgically resected specimen. Materials and Methods A retrospective analysis was conducted on 842 patients who had a thyroid CNB with or without a previous fine-needle aspiration from August 2002 to March 2015; 38% of patients ultimately underwent thyroidectomy. We divided the patients into two groups for comparison: conventional group (n = 329) and new modified technique group (n = 513) that enabled sampling of not only the lesion but also the margin and surrounding parenchyma. The diagnostic conclusiveness of CNB and concordant rate with thyroidectomy was compared between the two groups. Results The overall diagnostic conclusiveness did not exhibit a significant increase (77% in the conventional technique group and 75% in the modified technique group, p = 0.408). In terms of the diagnostic concordance rate between CNB and thyroidectomy, no overall significant increase was observed (83% in the conventional technique group and 88% in the modified technique group, p = 0.194). However, only in follicular-patterned lesions (nodular hyperplasia, follicular neoplasm, and follicular variant of papillary thyroid carcinoma), a significant increase in the diagnostic concordance rate was observed (83% in the conventional group and 94% in the modified technique group, p = 0.033). Conclusion Modified CNB technique can be beneficial for the accurate diagnosis of follicular-patterned thyroid lesions.
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Affiliation(s)
- Soomin Ahn
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sejin Jung
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ji-Ye Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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Choe JY, Kwak Y, Kim M, Chung YR, Kim HJ, Kim YK, Park SY. Utility of a formatted pathologic reporting system in thyroid core needle biopsy: A validation study of 1998 consecutive cases. Clin Endocrinol (Oxf) 2018; 88:96-104. [PMID: 28618022 DOI: 10.1111/cen.13397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/02/2017] [Accepted: 06/11/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Thyroid core needle biopsy (CNB) is increasingly being used as a tool for evaluating thyroid nodules; thus, standardization of its diagnostic terminology is called for. We aimed to analyse the pathologic reporting system of thyroid CNB based on the recently proposed protocol by the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group and evaluate its usefulness. DESIGN/METHODS A total of 1998 consecutive cases of thyroid CNBs were reviewed and divided into six categories according to the protocol. Malignancy rate in each category and the diagnostic performance of thyroid CNB were calculated using 705 resected cases. RESULTS Thyroid CNB yielded 132 nondiagnostic (6.6%), 791 benign (39.6%), 328 indeterminate (16.4%), 227 follicular neoplasm (11.4%), 69 suspicious for malignancy (3.5%) and 451 malignant lesions (22.6%). In resected specimens, all of the cases designated as suspicious for malignancy and malignant categories in CNB were proven to be true malignant lesions. Lesions diagnosed with follicular neoplasm in CNB were identified as malignant lesions in 57.0%. Malignancy rate was significantly higher in indeterminate lesions with nuclear atypia compared to those with architectural atypia (80.0% vs 28.2%). When CNB diagnoses of indeterminate lesions or higher categories were considered positive, the sensitivity and positive predictive value for final malignant diagnoses were 99.2% and 81.3%, respectively. CONCLUSIONS CNB is an accurate method of evaluating thyroid nodules and can serve as an alternative to fine needle aspiration when it is used and reported according to standardized diagnostic categories.
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Affiliation(s)
- Ji-Young Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mimi Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Yul Ri Chung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Paschke R, Cantara S, Crescenzi A, Jarzab B, Musholt TJ, Sobrinho Simoes M. European Thyroid Association Guidelines regarding Thyroid Nodule Molecular Fine-Needle Aspiration Cytology Diagnostics. Eur Thyroid J 2017; 6:115-129. [PMID: 28785538 PMCID: PMC5527175 DOI: 10.1159/000468519] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/02/2017] [Indexed: 01/19/2023] Open
Abstract
Molecular fine-needle aspiration (FNA) cytology diagnostics has the potential to address the inherent limitation of FNA cytology which is an indeterminate (atypia of undetermined significance/follicular lesion of undetermined significance follicular neoplasm) cytology. Because of the emerging role of molecular FNA cytology diagnostics, the European Thyroid Association convened a panel of international experts to review methodological aspects, indications, results, and limitations of molecular FNA cytology diagnostics. The panel reviewed the evidence for the diagnostic value of mutation panel assessment (including at least BRAF, NRAS, HRAS, KRAS, PAX8/PPARG, RET/PTC) of targeted next generation sequencing and of a microarray gene expression classifier (GEC) test in the diagnostic assessment of an indeterminate cytology thyroid nodule. Moreover, possible surgical consequences of molecular FNA diagnostic results of thyroid nodules and the evidence that analysis of a molecular FNA diagnostic panel of somatic mutations or a microarray GEC test can alter the follow-up were reviewed. Molecular tests may help clinicians to drive patient care and the surgical decision if the analysis is performed in specialized laboratories. These molecular tests require standardization of performance characteristics and appropriate calibration as well as analytic validation before clinical interpretation.
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Affiliation(s)
- Ralf Paschke
- Division of Endocrinology and Metabolism, Departments of Medicine, Pathology, Oncology and Arnie Charbonneau Cancer Institute, Calgary, AB, Canada
- *Ralf Paschke, MD, PhD, Division of Endocrinology, Cumming School of Medicine, University of Calgary, HMRB, Room 382B, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 (Canada), E-Mail
| | - Silvia Cantara
- Department of Medical, Surgical, and Neurological Sciences, Endocrinology Section, University of Siena, Siena, Italy
| | - Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Thomas J. Musholt
- Endocrine Surgery Section, Department of General, Visceral, and Transplantation Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Adequacy criteria for thyroid FNA evaluated by ThinPrep slides only. Cancer Cytopathol 2017; 125:534-543. [DOI: 10.1002/cncy.21858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 01/21/2023]
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A Different Perspective on Evaluating the Malignancy Rate of the Non-Diagnostic Category of the Bethesda System for Reporting Thyroid Cytopathology: A Single Institute Experience and Review of the Literature. PLoS One 2016; 11:e0162745. [PMID: 27627674 PMCID: PMC5023124 DOI: 10.1371/journal.pone.0162745] [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] [Received: 06/12/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023] Open
Abstract
Objective To determine the malignancy rate in the non-diagnostic (ND) category of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) based on a different approach in relation to histopathology diagnoses. Study Design All ND fine needle aspirations (FNAs) that were performed under ultrasound guidance by an interventional radiologist with rapid on-site evaluation were included in the study. Slides were reevaluated to identify the cause of inadequacy as “qualitative” or “quantitative.” The malignancy rate of the ND category was assessed. Nodule/patient characteristics were compared between benign and malignant cases within the study cohort. Results The study cohort consisted of 192 ND aspirations. Overall there were 156 (81.3%) women and 36 (18.7%) men with a mean age of 50.6 years (range 24–82 years). The malignancy rate was 4.7%. None of the nodules (size, consistency, and number) or patient characteristics (gender and age) were found to be predictive of malignancy. Conclusion The malignancy rate of the ND category was high when compared to BSRTC predictions, but at the low end of the reported malignancy rates in the literature. Our results revealed that cyto-histopathologic correlation and method of malignancy rate estimation could have an effect on a wide range of reported malignancy rates. Furthermore, patient/nodule dependent factors were not statistically found to be predictive of malignancy.
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Kim YH, Kwon HJ, Kim EK, Kwak JY, Moon HJ, Yoon JH. Applying Ultrasound-Guided Core Needle Biopsy for Diagnosis of Thyroid Masses: Preliminary Results From a Single Institution. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1801-8. [PMID: 26324755 DOI: 10.7863/ultra.15.14.12028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/10/2015] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the level of conclusive results obtained with ultrasound (US)-guided core needle biopsy (CNB) and how this method should be applied for diagnosis of thyroid nodules. METHODS From January 2013 to November 2014, US-guided CNB was performed in 84 thyroid lesions of 83 patients. Based on CNB pathologic reports, thyroid nodules were divided into 2 categories: conclusive (nodules reaching a definite pathologic diagnosis suggesting benignity or malignancy) and inconclusive (nodules that were not able to reach a definite diagnosis because of ambiguous results). Medical records and US examinations were reviewed and compared. RESULTS The mean age of the 83 patients ± SD was 49.7 ± 14.1 years. Of the 84 thyroid nodules, 73 (86.9%) were diagnosed as benign or malignant and 11 (13.1%) as inconclusive by CNB pathologic analysis. Among the 11 nodules with inconclusive results, the possibility of a follicular neoplasm was suggested in 8 nodules (72.7%). No significant difference was seen in tumor size and US features when comparing the nodules with conclusive and inconclusive results (all P >.05). CONCLUSIONS Ultrasound-guided CNB may have supplemental roles in addition to US-guided fine-needle aspiration for diagnosis of selected cases. A considerable proportion of inconclusive results are seen on US-guided CNB, especially for diagnosis of follicular lesions, which must be considered when using this method for diagnosis of thyroid nodules.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Hyeong Ju Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.).
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15
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Yoon JH, Kim EK, Kwak JY, Moon HJ. Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules: review of current literature. J Pathol Transl Med 2015; 49:230-5. [PMID: 26018514 PMCID: PMC4440934 DOI: 10.4132/jptm.2015.03.21] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/20/2015] [Indexed: 01/06/2023] Open
Abstract
Fine needle aspiration (FNA) is currently accepted as an easy, safe, and reliable tool for the diagnosis of thyroid nodules. Nonetheless, a proportion of FNA samples are categorized into non-diagnostic or indeterminate cytology, which frustrates both the clinician and patient. To overcome this limitation of FNA, core needle biopsy (CNB) of the thyroid has been proposed as an additional diagnostic method for more accurate and decisive diagnosis for thyroid nodules of concern. In this review, we focus on the effectiveness and limitations of CNB, and what factors should be considered when CNB is utilized in the diagnosis of thyroid nodules.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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16
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Brister KJ, Singh RS, Wang HH. Reporting thyroid FNA before and after implementation of the Bethesda system-one institution's experience. Diagn Cytopathol 2014; 43:28-31. [DOI: 10.1002/dc.23182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/14/2014] [Accepted: 05/09/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Kathriel J. Brister
- Beth Israel Deaconess Medical Center; Department of Pathology; Boston Massachusetts
| | - Remmi S. Singh
- Northside Hospital; Department of Pathology; Atlanta Georgia
| | - Helen H. Wang
- Beth Israel Deaconess Medical Center; Department of Pathology; Boston Massachusetts
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17
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Ferreira MA, Gerhard R, Schmitt F. Analysis of nondiagnostic results in a large series of thyroid fine-needle aspiration cytology performed over 9 years in a single center. Acta Cytol 2014; 58:229-34. [PMID: 24662526 DOI: 10.1159/000360066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/23/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Thyroid fine-needle aspiration cytology (FNAC) is the most valuable, cost-effective and accurate method for the evaluation of patients with thyroid nodules. One of its limitations is that up to 20% of results are nondiagnostic or unsatisfactory. The aim of this study was to analyze the number of thyroid FNAC specimens with nondiagnostic results obtained on an outpatient basis and how many of these had to be repeated according to their results. STUDY DESIGN This was a retrospective analysis of diagnostic reports of nondiagnostic thyroid FNAC specimens obtained between 1 January 2004 and 31 December 2012 which were retrieved by means of a computerized search. The FNAC results and the age and sex of the patients were collected. RESULTS From a total of 15,292 thyroid FNAC specimens, 6.8% (n = 1,033) corresponded to nondiagnostic cases. Eligible diagnostic reports for analysis included 877 cases (106 were repetitions of previous nondiagnostic FNAC). After an initial nondiagnostic finding for 771 FNAC smears, 29.5% (n = 225) were repeated with the following results: 43.6% insufficient, 49.3% benign, 6.2% follicular neoplasm, 0.4% suspicious for malignancy and 0.4% malignant. Twenty-two patients underwent a second repeated FNAC. Here the findings were: 36.4% insufficient, 59.1% benign, 4.5% follicular neoplasm, 0.0% suspicious for malignancy and 0.0% malignant. CONCLUSIONS There was a low rate of repeated FNAC among the group of nondiagnostic cases. With repeated FNAC, the rate of nondiagnostic cases and the number of results that potentially demand surgery diminish.
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18
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Mahony GT, Mahony BS. Low nondiagnostic rate for fine-needle capillary sampling biopsy of thyroid nodules: a singular experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2155-2161. [PMID: 24277898 DOI: 10.7863/ultra.32.12.2155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This study examined the hypothesis that sonographically guided fine-needle capillary thyroid biopsies performed by an experienced operator and with constant technique on nodules that meet the Society of Radiologists in Ultrasound criteria warranting biopsy can result in a nondiagnostic rate that is significantly lower than prior published reports. METHODS We retrospectively reviewed the sonographic and pathologic reports from 228 consecutive sonographically guided fine-needle capillary thyroid biopsies performed during a 3-year interval by a single operator with more than 15 years of experience performing fine-needle capillary thyroid biopsies. There were no exclusion criteria. Sonographic and pathologic reports from all nodules biopsied were included in the analysis. The radiologist's protocol included 6 fine-needle capillary biopsies, each with 20 passes of the needle into the periphery and/or solid components of the nodule. The cytologic specimens were reviewed off-site in adherence with the Bethesda system for reporting thyroid cytopathologic findings and classified as diagnostic or nondiagnostic. The nondiagnostic rate in this study was compared with the nondiagnostic rates in prior published reports. RESULTS Among the 228 fine-needle capillary thyroid biopsies performed during the study interval, cytologic analysis showed 1 nondiagnostic biopsy, yielding a nondiagnostic rate of 0.4%. This rate was significantly lower than previously published reports (P < .001). CONCLUSIONS Sonographically guided fine-needle capillary biopsies of the thyroid performed by an experienced radiologist can result in a nondiagnostic rate of less than 1%. This finding warrants further investigation into the reasons for the discrepancy between the results of this study and other previous reports.
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Affiliation(s)
- Gregory T Mahony
- BA, current address: Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA.
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19
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Combined 99mTc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur J Nucl Med Mol Imaging 2013; 41:105-15. [DOI: 10.1007/s00259-013-2546-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
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20
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Zheng B, Tublin ME, Klym AH, Gur D. Classification of thyroid nodules using a resonance-frequency-based electrical impedance spectroscopy: a preliminary assessment. Thyroid 2013; 23:854-62. [PMID: 23259723 PMCID: PMC3704105 DOI: 10.1089/thy.2012.0413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ultrasound and ultrasound-guided fine-needle aspiration biopsy are considered the most effective approaches for both identifying and classifying thyroid nodules. However, despite continuing improvements in scanner technology and refinements in ultrasound/cytological classification guidelines, indeterminate findings still lead to diagnostic lobectomy under general anesthesia. This study aims to investigate the feasibility of applying a modified noninvasive electrical impedance spectroscopy (EIS) approach to classifying thyroid nodules. METHOD To increase nodule classification sensitivity, we developed a new EIS-based model that introduces an optimized inductance component, which increases the measured signal-to-noise ratio of capacitance variation in and about thyroid nodules. Our model then measures the change of resonance frequency when the positive reactance of the system inductor cancels out the negative reactance of the nodule capacitance in a multi-frequency electrical signal scan. The system is termed "resonance-frequency-based electrical impedance spectroscopy" (REIS). A portable REIS system with multiple probes was assembled and preliminarily tested in our clinical facility. From an ongoing prospective study, an initial data set of 160 REIS examinations including 27 verified cancer cases was used. From the data set, a number of EIS signal features was extracted and analyzed. A multi-feature-based Bayesian Belief Network was built to classify the detected thyroid nodules. A receiver operating characteristic data analysis method was applied to evaluate classification performance. RESULTS The results showed that (i) the median resonance frequency measured by the probe nearest to malignant nodules was in general lower than that measured in benign cases, and (ii) the median descending slope of EIS signal sweep curves computed from cancer cases was larger than that computed from benign cases. The Bayesian Belief Network yielded a classification performance as measured by the area under the receiver operating characteristic curve of 0.794 [with a 95% confidence interval of 0.709-0.863]. CONCLUSIONS The study demonstrates that noninvasive measurement of REIS signal features may potentially provide useful supplementary information to assist in classifying between malignant and benign thyroid nodules. Such an approach may ultimately lead to a reduction in the number of unnecessary thyroid surgeries.
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Affiliation(s)
- Bin Zheng
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Abstract
BACKGROUND Thyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC. MATERIALS AND METHODS Retrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included. RESULTS Out of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%). CONCLUSIONS There is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC.
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Patnayak R, Renshaw A, Vijaylaxmi B, Durgasi S, Jena A, Chowhan A. Seeking help from shadows. Am J Clin Pathol 2012; 137:501; author reply 502. [PMID: 22338069 DOI: 10.1309/ajcpnjvexyckt78u] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Context.—Cytology is a success because of the many quality controls used to ensure the accuracy of its results. Nevertheless, additional information is becoming available to the cytologist, often from untraditional sources, and the best way to use that information to improve the quality of cytology is not yet known.
Objective.—To review ways to use new information to improve the quality of cytology.
Data Sources.—Review of relevant literature.
Results.—Information contained in many sources can be used in new ways to improve the quality of cytology. These include the timing of cytologic and histologic correlation, electronic medical records, workload information, prior aspirations, and molecular tests.
Conclusions.—To maintain their high standard of excellence, cytologists should seek to define the most appropriate way to incorporate this new information into their interpretation of individual cases.
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