Thyroid cytology: Difference between revisions

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==Risk stratification==

[[File:Cytopathology of papillary thyroid carcinoma.png|thumb|~~300px~~|Papillary thyroid carcinoma, with typical features shown. Pap stain.]]

[[File:Cytopathology of papillary thyroid carcinoma.png|thumb|380px|'''Papillary thyroid carcinoma''', with typical features shown. Pap stain.]]

~~Classify~~ findings as per the Bethesda system:

Look at least for the following imaged features, and classify findings as per the Bethesda system:

{|class="wikitable"

|+ Bethesda system

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File:Cytology of benign follicular epithelial cells.jpg|Cytology of benign follicular epithelial cells (Bethesda category II), Pap stain, showing cells with significant nuclear pleomorphism but otherwise insignificant features.

File:Relative incidences of histopathologic diagnoses of solitary thyroid nodules.png|Relative incidences of histopathologic diagnoses of solitary thyroid nodules that have undergone fine needle aspiration.<ref>Diagram by Mikael Häggström, MD. Source data: {{cite journal| author=Arul P, Masilamani S| title=A correlative study of solitary thyroid nodules using the bethesda system for reporting thyroid cytopathology. | journal=J Cancer Res Ther | year= 2015 | volume= 11 | issue= 3 | pages= 617-22 | pmid=26458591 | doi=10.4103/0973-1482.157302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26458591 }}</ref>

File:Cytology of benign follicular epithelial cells.jpg|Cytology of '''benign follicular''' epithelial cells (Bethesda category II), Pap stain, showing cells with significant nuclear pleomorphism but otherwise insignificant features.

File:Cytology of microfollicles.jpg|Look for '''microfollicles''', which are flat groups of follicular cells, each having less than 15 follicular cells arranged in a circle that is at least two thirds complete.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicularneoplasm.html|title=Thyroid & parathyroid - Follicular neoplasm|author= Ayana Suzuki, C.T., Andrey Bychkov, M.D., Ph.D.}} Last author update: 21 April 2022. Last staff update: 12 May 2022</ref><ref group=image>{{cite journal|citle=An Analytical study of Fine Needle Aspiration Cytology in Various Thyroid Lesions and their Correlation with Histopathology|url=https://ijhcr.com/index.php/ijhcr/article/view/915%7Cauthor=Anjana Sharma Avishesh Singh , Ajay Sahu|year=2021|volume=4|issue=3}}<br>- "This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)"</ref> They indicate a '''follicular neoplasm'''.

File:Cytology of thyroid spherule.jpg|'''Thyroid spherules''', on the other hand, are benign features. A spherule may mimic a microfollicle, but has a more smooth, round, ball-like contour, and even spacing of the follicular cell nuclei.<ref name="pmid31856389">{{cite journal| author=Costigan DC, Shaar M, Frates MC, Alexander EK, Barletta JA, Cibas ES| title=Defining thyroid spherules: A benign cytomorphologic feature that mimics microfollicles. | journal=Cancer Cytopathol | year= 2020 | volume= 128 | issue= 3 | pages= 171-176 | pmid=31856389 | doi=10.1002/cncy.22219 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31856389 }} </ref>

File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.

File:Cytopathology suspicious for Hürthle cell neoplasm, annotated.png|Cytopathology '''suspicious for Hürthle cell neoplasm''' (Bethesda category IV), Pap stain. However, it cannot distinguish Hürthle cell adenoma from Hürthle cell carcinoma, which requires histopathologic sections to see transcapsular or vascular invasion. Hürthle cell hyperplasia (as seen in Hashimoto's thyroiditis) may show moderate variation in nuclear sizes and prominent nucleoli, but further findings favoring Hürthle cell neoplasm include a large number of Hürthle cells, and discohesiveness.<ref>Image by Mikael Häggström, MD. References for findings:<br>- {{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthlecellneoplasm.html|title=Hürthle cell neoplasm|website=Pathology Outlines|author=Ayana Suzuki, C.T., Andrey Bychkov, M.D., Ph.D.}} Last author update: 7 May 2020. Last staff update: 12 May 2022<br>- {{cite journal| author=Shawky M, Sakr M| title=Hurthle Cell Lesion: Controversies, Challenges, and Debates. | journal=Indian J Surg | year= 2016 | volume= 78 | issue= 1 | pages= 41-8 | pmid=27186039 | doi=10.1007/s12262-015-1381-x | pmc=4848220 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848220/}}</ref>

</gallery>

@@ Line 8: / Line 8: @@
 ==Risk stratification==
-[[File:Cytopathology of papillary thyroid carcinoma.png|thumb|300px|Papillary thyroid carcinoma, with typical features shown. Pap stain.]]
+[[File:Cytopathology of papillary thyroid carcinoma.png|thumb|380px|'''Papillary thyroid carcinoma''', with typical features shown. Pap stain.]]
-Classify findings as per the Bethesda system:
+Look at least for the following imaged features, and classify findings as per the Bethesda system:
 {|class="wikitable"
 |+ Bethesda system
@@ Line 43: / Line 43: @@
 |
 |}
-<gallery mode=packed>
+<gallery mode=packed heights=220>
-File:Cytology of benign follicular epithelial cells.jpg|Cytology of benign follicular epithelial cells (Bethesda category II), Pap stain, showing cells with significant nuclear pleomorphism but otherwise insignificant features.
+File:Relative incidences of histopathologic diagnoses of solitary thyroid nodules.png|Relative incidences of histopathologic diagnoses of solitary thyroid nodules that have undergone fine needle aspiration.<ref>Diagram by Mikael Häggström, MD. Source data: {{cite journal| author=Arul P, Masilamani S| title=A correlative study of solitary thyroid nodules using the bethesda system for reporting thyroid cytopathology. | journal=J Cancer Res Ther | year= 2015 | volume= 11 | issue= 3 | pages= 617-22 | pmid=26458591 | doi=10.4103/0973-1482.157302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26458591  }}</ref>
+File:Cytology of benign follicular epithelial cells.jpg|Cytology of '''benign follicular''' epithelial cells (Bethesda category II), Pap stain, showing cells with significant nuclear pleomorphism but otherwise insignificant features.
+File:Cytology of microfollicles.jpg|Look for '''microfollicles''', which are flat groups of follicular cells, each having less than 15 follicular cells arranged in a circle that is at least two thirds complete.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicularneoplasm.html|title=Thyroid & parathyroid - Follicular neoplasm|author= Ayana Suzuki, C.T., Andrey Bychkov, M.D., Ph.D.}} Last author update: 21 April 2022. Last staff update: 12 May 2022</ref><ref group=image>{{cite journal|citle=An Analytical study of Fine Needle Aspiration Cytology in Various Thyroid Lesions and their Correlation with Histopathology|url=https://ijhcr.com/index.php/ijhcr/article/view/915%7Cauthor=Anjana Sharma  Avishesh Singh , Ajay Sahu|year=2021|volume=4|issue=3}}<br>- "This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)"</ref> They indicate a '''follicular neoplasm'''.
+File:Cytology of thyroid spherule.jpg|'''Thyroid spherules''', on the other hand, are benign features. A spherule may mimic a microfollicle, but has a more smooth, round, ball-like contour, and  even spacing of the follicular cell nuclei.<ref name="pmid31856389">{{cite journal| author=Costigan DC, Shaar M, Frates MC, Alexander EK, Barletta JA, Cibas ES| title=Defining thyroid spherules: A benign cytomorphologic feature that mimics microfollicles. | journal=Cancer Cytopathol | year= 2020 | volume= 128 | issue= 3 | pages= 171-176 | pmid=31856389 | doi=10.1002/cncy.22219 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31856389  }} </ref>
+File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
+File:Cytopathology suspicious for Hürthle cell neoplasm, annotated.png|Cytopathology '''suspicious for Hürthle cell neoplasm''' (Bethesda category IV), Pap stain. However, it cannot distinguish Hürthle cell adenoma from Hürthle cell carcinoma, which requires histopathologic sections to see transcapsular or vascular invasion. Hürthle cell hyperplasia (as seen in Hashimoto's thyroiditis) may show moderate variation in nuclear sizes and prominent nucleoli, but further findings favoring Hürthle cell neoplasm include a large number of Hürthle cells, and discohesiveness.<ref>Image by Mikael Häggström, MD. References for findings:<br>- {{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthlecellneoplasm.html|title=Hürthle cell neoplasm|website=Pathology Outlines|author=Ayana Suzuki, C.T., Andrey Bychkov, M.D., Ph.D.}} Last author update: 7 May 2020. Last staff update: 12 May 2022<br>- {{cite journal| author=Shawky M, Sakr M| title=Hurthle Cell Lesion: Controversies, Challenges, and Debates. | journal=Indian J Surg | year= 2016 | volume= 78 | issue= 1 | pages= 41-8 | pmid=27186039 | doi=10.1007/s12262-015-1381-x | pmc=4848220 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848220/}}</ref>
 </gallery>
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Thyroid cytology: Difference between revisions

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