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Head and Neck: Thyroid

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Atlas of Fine Needle Aspiration Cytology

Abstract

Thyroid nodules are a frequent finding in the general population, with palpable nodules found in 4–7 % of adults and subclinical nodules identified in up to 70 % of adults, although the vast majority (90–95 %) of these nodules are benign. Since its introduction in the early 1950s, fine-needle aspiration (FNA) of the thyroid has proven to be an integral and reliable method of evaluating patients presenting with a thyroid mass. The addition of thyroid FNA to clinical evaluation of a thyroid nodule has dramatically increased the triage efficiency: not only determining which nodules are at greatest risk of malignancy and should undergo surgery but also indicating which nodules are benign, thus sparing the patient unnecessary surgery. As such, thyroid FNA acts as both a diagnostic test and a screening test.

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References

  1. Clarke DP, Faquin WC. Thyroid cytopathology. 2nd ed. New York: Springer; 2010.

    Book  Google Scholar 

  2. Soderstrom N. Puncture of goiters for aspiration biopsy. Acta Med Scand. 1952;144:237–44.

    Article  PubMed  CAS  Google Scholar 

  3. Miller JM, Hamburger JI, Kini S. Diagnosis of thyroid nodules. Use of fine-needle aspiration and needle biopsy. JAMA. 1979;241:481–4.

    Article  PubMed  CAS  Google Scholar 

  4. Jung CK, Lee A, Jung ES, et al. Split sample comparison of a liquid-based method and conventional smears in thyroid fine needle aspiration. Acta Cytol. 2008;52:313–9.

    Article  PubMed  Google Scholar 

  5. Fischer AH, Clayton AC, Bentz JS, et al. Performance differences between conventional smears and liquid-based preparations of thyroid fine-needle aspiration samples: analysis of 47,076 responses in the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytology. Arch Pathol Lab Med. 2013;137:26–31.

    Article  PubMed  Google Scholar 

  6. Sanchez N, Selvaggi SM. Utility of cell blocks in the diagnosis of thyroid aspirates. Diagn Cytopathol. 2006;34:89–92.

    Article  PubMed  Google Scholar 

  7. Na DG, Kim JH, Sung JY, et al. Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid. 2012;22:468–75.

    Article  PubMed  Google Scholar 

  8. Wang HH. Reporting thyroid fine-needle aspiration: literature review and a proposal. Diagn Cytopathol. 2006;34:67–76.

    Article  PubMed  Google Scholar 

  9. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65.

    Article  PubMed  Google Scholar 

  10. Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology: definitions, criteria and explanatory notes. New York: Springer; 2010.

    Book  Google Scholar 

  11. Cross PA, Chandra A, Giles T, et al. Guidance on the reporting of thyroid cytology specimens. 2009. http://www.rcpath.org/resources/pdf/g089guidanceonthereportingofthyroidcytologyfinal.pdf. Accessed 12 July 2012.

  12. Nguyen GK, Lee MW, Ginsberg J, et al. Fine-needle aspiration of the thyroid: an overview. Cytojournal. 2005;2:12.

    Article  PubMed  Google Scholar 

  13. Faquin WC, Cibas ES, Renshaw AA. “Atypical” cells in fine-needle aspiration biopsy specimens of benign thyroid cysts. Cancer. 2005;105:71–9.

    Article  PubMed  Google Scholar 

  14. Tseleni-Balafouta S, Gakiopoulou H, Kavantzas N, et al. Parathyroid proliferations: a source of diagnostic pitfalls in FNA of thyroid. Cancer. 2007;111:130–6.

    Article  PubMed  Google Scholar 

  15. Harvey AM, Truong LD, Mody DR. Diagnostic pitfalls of Hashimoto’s/lymphocytic thyroiditis on fine-needle aspirations and strategies to avoid overdiagnosis. Acta Cytol. 2012;56:352–60.

    Article  PubMed  Google Scholar 

  16. Anderson SR, Mandel S, LiVolsi VA, et al. Can cytomorphology differentiate between benign nodules and tumors arising in Graves’ disease? Diagn Cytopathol. 2004;31:64–7.

    Article  PubMed  Google Scholar 

  17. García Solano J, Giménez Bascuñana A, Sola Pérez J, et al. Fine-needle aspiration of subacute granulomatous thyroiditis (De Quervain’s thyroiditis): a clinico-cytologic review of 36 cases. Diagn Cytopathol. 1997;16:214–20.

    Article  PubMed  Google Scholar 

  18. Wan SK, Chan JK, Tang SK. Paucicellular variant of anaplastic thyroid carcinoma. A mimic of Reidel’s thyroiditis. Am J Clin Pathol. 1996;105:388–93.

    PubMed  CAS  Google Scholar 

  19. Somma J, Schlecht NF, Fink D, et al. Thyroid fine needle aspiration cytology: follicular lesions and the gray zone. Acta Cytol. 2010;54:123–31.

    Article  PubMed  Google Scholar 

  20. Renshaw AA. Hürthle cell carcinoma is a better gold standard than Hürthle cell neoplasm for fine-needle aspiration of the thyroid: defining more consistent and specific cytologic criteria. Cancer. 2002;96:261–6.

    Article  PubMed  Google Scholar 

  21. Elliott DD, Pitman MB, Bloom L, Faquin WC. Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland: a cytomorphologic study of 139 cases with statistical analysis. Cancer. 2006;108:102–9.

    Article  PubMed  Google Scholar 

  22. Wu HH, Clouse J, Ren R. Fine-needle aspiration cytology of Hürthle cell carcinoma of the thyroid. Diagn Cytopathol. 2008;36:149–54.

    Article  PubMed  Google Scholar 

  23. Kaur A, Jayaram G. Thyroid tumors: cytomorphology of papillary carcinoma. Diagn Cytopathol. 1991;7:462–8.

    Article  PubMed  CAS  Google Scholar 

  24. Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration. Acta Cytol. 1980;24:511–21.

    PubMed  CAS  Google Scholar 

  25. Akhtar M, Ali MA, Huq M, Bakry M. Fine-needle aspiration biopsy of papillary thyroid carcinoma: cytologic, histologic, and ultrastructural correlations. Diagn Cytopathol. 1991;7:373–9.

    Article  PubMed  CAS  Google Scholar 

  26. Das DK, Sharma PN. Diagnosis of papillary thyroid carcinoma in fine needle aspiration smears: factors that affect decision making. Acta Cytol. 2009;53:497–506.

    Article  PubMed  Google Scholar 

  27. Mijovic T, Gologan O, Rochon L, et al. Fine-needle aspiration biopsy of the thyroid: review of cytopathologic features predictive of malignancy. J Otolaryngol Head Neck Surg. 2009;38:348–54.

    PubMed  Google Scholar 

  28. Punthakee X, Palme CE, Franklin JH, et al. Fine-needle aspiration biopsy findings suspicious for papillary thyroid carcinoma: a review of cytopathological criteria. Laryngoscope. 2005;115:433–6.

    Article  PubMed  Google Scholar 

  29. Miller TR, Bottles K, Holly EA, et al. A step-wise logistic regression analysis of papillary carcinoma of the thyroid. Acta Cytol. 1986;30:285–93.

    PubMed  CAS  Google Scholar 

  30. Zhang Y, Fraser JL, Wang HH. Morphologic predictors of papillary carcinoma on fine-needle aspiration of thyroid with ThinPrep preparations. Diagn Cytopathol. 2001;24:378–83.

    Article  PubMed  CAS  Google Scholar 

  31. Aron M, Mallik A, Verma K. Fine needle aspiration cytology of follicular variant of papillary carcinoma of the thyroid: morphologic pointers to its diagnosis. Acta Cytol. 2006;50:663–8.

    Article  PubMed  Google Scholar 

  32. Baloch ZW, Gupta PK, Yu GH, et al. Follicular variant of papillary carcinoma. Cytologic and histologic correlation. Am J Clin Pathol. 1999;111:216–22.

    PubMed  CAS  Google Scholar 

  33. VanderLaan PA, Marqusee E, Krane JF. Features associated with locoregional spread of papillary carcinoma correlate with diagnostic category in the Bethesda System for reporting thyroid cytopathology. Cancer Cytopathol. 2012;120:245–53.

    Article  PubMed  Google Scholar 

  34. Chung D, Ghossein RA, Lin O. Macrofollicular variant of papillary carcinoma: a potential thyroid FNA pitfall. Diagn Cytopathol. 2007;35:560–4.

    Article  PubMed  Google Scholar 

  35. Mesonero CE, Jugle JE, Wilbur DC, Nayar R. Fine-needle aspiration of the macrofollicular and microfollicular subtypes of the follicular variant of papillary carcinoma of the thyroid. Cancer. 1998;84:235–44.

    Article  PubMed  CAS  Google Scholar 

  36. Castro-Gómez L, Córdova-Ramírez S, Duarte-Torres R, et al. Cytologic criteria of cystic papillary carcinoma of the thyroid. Acta Cytol. 2003;47:590–4.

    Article  PubMed  Google Scholar 

  37. Muller N, Cooperberg PL, Suen KC, Thorson SC. Needle aspiration biopsy in cystic papillary carcinoma of the thyroid. AJR Am J Roentgenol. 1985;144:251–3.

    Article  PubMed  CAS  Google Scholar 

  38. Harshan M, Crapanzano JP, Aslan DL, et al. Papillary thyroid carcinoma with atypical histiocytoid cells on fine-needle aspiration. Diagn Cytopathol. 2009;37:244–50.

    Article  PubMed  Google Scholar 

  39. Renshaw AA. Histiocytoid cells in fine needle aspirates of papillary carcinoma of the thyroid: frequency and significance of an under-recognized cytologic pattern. Cancer Cytopathol. 2002;96:240–3.

    Article  Google Scholar 

  40. Urano M, Kiriyama Y, Takakuwa Y, Kuroda M. Tall cell variant of papillary thyroid carcinoma: its characteristic features demonstrated by fine-needle aspiration cytology and immunohistochemical study. Diagn Cytopathol. 2009;37:732–7.

    Article  PubMed  Google Scholar 

  41. Das DK, Mallik MK, Sharma P, et al. Papillary thyroid carcinoma and its variants in fine needle aspiration smears. A cytomorphologic study with special reference to tall cell variant. Acta Cytol. 2004;48:325–36.

    Article  PubMed  Google Scholar 

  42. Solomon A, Gupta PK, LiVolsi VA, Baloch ZW. Distinguishing tall cell variant of papillary thyroid carcinoma from usual variant of papillary thyroid carcinoma in cytologic specimens. Diagn Cytopathol. 2002;27:143–8.

    Article  PubMed  Google Scholar 

  43. Bocklage T, DiTomasso JP, Ramzy I, Ostrowski ML. Tall cell variant of papillary thyroid carcinoma: cytologic features and differential diagnostic considerations. Diagn Cytopathol. 1997;17:25–9.

    Article  PubMed  CAS  Google Scholar 

  44. Leung AK, Chow SM, Law SC. Clinical features and outcome of the tall cell variant of papillary thyroid carcinoma. Laryngoscope. 2008;118:32–8.

    Article  PubMed  Google Scholar 

  45. Montone KT, Baloch ZW, LiVolsi VA. The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review. Arch Pathol Lab Med. 2008;132:1241–50.

    PubMed  Google Scholar 

  46. Lee J, Hasteh F. Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto’s thyroiditis: a case report and review of the literature. Diagn Cytopathol. 2009;37:600–6.

    Article  PubMed  Google Scholar 

  47. Mai KT, Thomas J, Yazdi HM, et al. Pathologic study and clinical significance of Hürthle cell papillary thyroid carcinoma. Appl Immunohistochem Mol Morphol. 2004;12:329–37.

    Article  PubMed  Google Scholar 

  48. Paker I, Kokenek TD, Yılmazer D, et al. Oncocytic variant of papillary thyroid carcinoma with lymphocytic stroma (Warthin-like variant): report of a case with fine needle aspiration cytology and review of the literature. Cytopathology. 2012;23:408–10.

    Article  PubMed  CAS  Google Scholar 

  49. Baloch ZW, Livolsi VA. Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med. 2000;124:1192–5.

    PubMed  CAS  Google Scholar 

  50. Evans HL. Columnar-cell carcinoma of the thyroid. A report of two cases of an aggressive variant of thyroid carcinoma. Am J Clin Pathol. 1986;85:77–80.

    PubMed  CAS  Google Scholar 

  51. Jayaram G. Cytology of columnar-cell variant of papillary thyroid carcinoma. Diagn Cytopathol. 2000;22:227–9.

    Article  PubMed  CAS  Google Scholar 

  52. Hirokawa M, Maekawa M, Kuma S, Miyauchi A. Cribriform-morular variant of papillary thyroid carcinoma––cytological and immunocytochemical findings of 18 cases. Diagn Cytopathol. 2010;38:890–6.

    Article  PubMed  Google Scholar 

  53. Koo JS, Jung W, Hong SW. Cytologic characteristics and β-catenin immunocytochemistry on smear slide of cribriform-morular variant of papillary thyroid carcinoma. Acta Cytol. 2011;55:13–8.

    Article  PubMed  CAS  Google Scholar 

  54. Lee JY, Shin JH, Han BK, et al. Diffuse sclerosing variant of papillary carcinoma of the thyroid: imaging and cytologic findings. Thyroid. 2007;17:567–73.

    Article  PubMed  CAS  Google Scholar 

  55. Kumarasinghe MP. Cytomorphologic features of diffuse sclerosing variant of papillary carcinoma of the thyroid. A report of two cases in children. Acta Cytol. 1998;42:983–6.

    Article  PubMed  CAS  Google Scholar 

  56. Casey MB, Sebo TJ, Carney JA. Hyalinizing trabecular adenoma of the thyroid gland: cytologic features in 29 cases. Am J Surg Pathol. 2004;28:859–67.

    Article  PubMed  Google Scholar 

  57. Bishop JA, Ali SZ. Hyalinizing trabecular adenoma of the thyroid gland. Diagn Cytopathol. 2011;39:306–10.

    Article  PubMed  Google Scholar 

  58. Casey MB, Sebo TJ, Carney JA. Hyalinizing trabecular adenoma of the thyroid gland identification through MIB-1 staining of fine-needle aspiration biopsy smears. Am J Clin Pathol. 2004;122:506–10.

    Article  PubMed  Google Scholar 

  59. Pietribiasi F, Sapino A, Papotti M, Bussolati G. Cytologic features of poorly differentiated “insular” carcinoma of the thyroid, as revealed by fine-needle aspiration biopsy. Am J Clin Pathol. 1990;94:687–92.

    PubMed  CAS  Google Scholar 

  60. Sironi M, Collini P, Cantaboni A. Fine needle aspiration cytology of insular thyroid carcinoma. A report of four cases. Acta Cytol. 1992;36:435–9.

    PubMed  CAS  Google Scholar 

  61. Bongiovanni M, Boom L, Krane JF, et al. Cytomorphologic features of poorly differentiated thyroid carcinoma: a multi-institutional study of 40 cases. Cancer Cytopathol. 2009;117:185–94.

    Article  Google Scholar 

  62. Barwad A, Dey P, Nahar Saikia U, et al. Fine needle aspiration cytology of insular carcinoma of thyroid. Diagn Cytopathol. 2012;40 Suppl 1:E43–7.

    Article  PubMed  Google Scholar 

  63. Green I, Ali SZ, Allen EA, Zakowski MF. A spectrum of cytomorphologic variations in medullary thyroid carcinoma. Fine-needle aspiration findings in 19 cases. Cancer. 1997;81:40–4.

    Article  PubMed  CAS  Google Scholar 

  64. Papaparaskeva K, Nagel H, Droese M. Cytologic diagnosis of medullary carcinoma of the thyroid gland. Diagn Cytopathol. 2000;22:351–8.

    Article  PubMed  CAS  Google Scholar 

  65. Zeppa P, Vetrani A, Marino M, et al. Fine needle aspiration cytology of medullary thyroid carcinoma: a review of 18 cases. Cytopathology. 1990;1:35–44.

    Article  PubMed  CAS  Google Scholar 

  66. Bose S, Kapila K, Verma K. Medullary carcinoma of the thyroid: a cytological, immunocytochemical, and ultrastructural study. Diagn Cytopathol. 1992;8:28–32.

    Article  PubMed  CAS  Google Scholar 

  67. Rivera M, Sang C, Gerhard R, et al. Anaplastic thyroid carcinoma: morphologic findings and PAX-8 expression in cytology specimens. Acta Cytol. 2010;54:668–72.

    PubMed  Google Scholar 

  68. Brooke PK, Hameed M, Zakowski MF. Fine-needle aspiration of anaplastic thyroid carcinoma with varied cytologic and histologic patterns: a case report. Diagn Cytopathol. 1994;11:60–3.

    Article  PubMed  CAS  Google Scholar 

  69. Guarda LA, Peterson CE, Hall W, Baskin HJ. Anaplastic thyroid carcinoma: cytomorphology and clinical implications of fine-needle aspiration. Diagn Cytopathol. 1991;7:63–7.

    Article  PubMed  CAS  Google Scholar 

  70. Bishop JA, Sharma R, Westra WH. PAX8 immunostaining of anaplastic thyroid carcinoma: a reliable means of discerning thyroid origin for undifferentiated tumors of the head and neck. Hum Pathol. 2011;42:1873–7.

    Article  PubMed  CAS  Google Scholar 

  71. Ha CS, Shadle KM, Medeiros LJ, et al. Localized non-Hodgkin lymphoma involving the thyroid gland. Cancer. 2001;91:629–35.

    Article  PubMed  CAS  Google Scholar 

  72. Derringer GA, Thompson LD, Frommelt RA, et al. Malignant lymphoma of the thyroid gland: a clinicopathologic study of 108 cases. Am J Surg Pathol. 2000;24:623–39.

    Article  PubMed  CAS  Google Scholar 

  73. Smith SA, Gharib H, Goellner JR. Fine-needle aspiration. Usefulness for diagnosis and management of metastatic carcinoma to the thyroid. Arch Intern Med. 1987;147:311–2.

    Article  PubMed  CAS  Google Scholar 

  74. Lee MW, Batoroev YK, Odashiro AN, Nguyen GK. Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology. Cytojournal. 2007;4:5.

    Article  PubMed  Google Scholar 

  75. Haugen BR, Nawaz S, Cohn A, et al. Secondary malignancy of the thyroid gland: a case report and review of the literature. Thyroid. 1994;4:297–300.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Jeffrey F. Krane MD, PhD .

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VanderLaan, P.A., Krane, J.F. (2014). Head and Neck: Thyroid. In: Domanski, H. (eds) Atlas of Fine Needle Aspiration Cytology. Springer, London. https://doi.org/10.1007/978-1-4471-2446-7_5

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