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Objectives:Intraoperative frozen section analysis of surgical margins is widely used in head and neck cancer surgery. This study evaluates frozen section accuracy relative to permanent controls and final margins from the entire specimen, the rate at which frozen sections impact intraoperative management, and the resultant cost. Study Design: Retrospective.

The National Cancer Institute (NCI) sponsored the NCI Thyroid fine-needle aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The 2-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters addressing manual and ultrasound guided FNA technique and related issues. Specific topics covered include details regarding aspiration needles, devices, and methods, including the use of core needle biopsy; the pros and cons of anesthesia; the influence of thyroid lesion location, size, and characteristics on technique; the role of ultrasound in the FNA of a palpable thyroid nodule; the advantages and disadvantages of various specialists performing a biopsy; the optimal number of passes and tissue preparation methods; sample adequacy criteria for solid and cystic nodules, and management of adverse reactions from the procedure. (http://thyroidfna.cancer.gov/pages/info/agenda/)

BACKGROUND: Secondary neoplasms of the thyroid gland (SNTGs) are uncommon, and it is important to recognize them in thyroid fine-needle aspiration biopsy (FNAB). METHODS: The authors report a cohort of 62 SNTGs from 7 institutions in the United States and Europe. Patients were identified retrospectively by searching through medical records of the respective institutions. All initial diagnoses were rendered by FNAB. RESULTS: SNTGs represented 0.16% of all thyroid FNABs and were more frequent among women (ratio of women to men, 1.2:1.0). The mean patient age was of 59 years (range, 7-84 years), the mean tumor size was 3 cm (range, 0.9-7 cm), and the mean interval from diagnosis of the primary tumor was 45 months (range, 0-156 months). Eighty-seven percent of SNTGs were diagnosed as malignant by FNAB, and there was a specific SNTG diagnosis in 93% of patients. Immunocytochemistry and flow cytometry, which were used in 30% of patients, were useful ancillary studies. Adenocarcinomas (n 5 23; 37%) and squamous cell carcinomas (SCCs) (n 5 22; 35.5%) represented the majority of SNTGs, followed by lymphoma (n 5 5; 8%), melanoma (n 5 5; 8%), adenoid cystic carcinoma (n 5 3; 5%), and various sarcomas (n 5 3; 5%). Adenocarcinomas originated from the kidney (n 5 9; 39%), lung (n 5 6; 26%), breast (n 5 5; 22%), and colon (n 5 3; 13%). SCCs originated mostly from the head and neck (n 5 13; 59%), followed by lung (n 5 3; 13%), esophagus (n 5 3; 14%), and unknown primary sites (n 5 3; 14%). CONCLUSIONS:Adenocarcinomas from the kidney, lung, breast, and colon along with SCCs represent the majority of SNTGs. The current results indicate that FNAB is a sensitive and accurate method for diagnosing SNTG; however, diagnostic difficulties can occur. Knowledge of clinical history and the judicious application of ancillary studies can increase the sensitivity and accuracy of FNAB for detecting SNTGs. Cancer (Cancer Cytopathol) 2015;123:19-29. V C 2014 American Cancer Society.KEY WORDS: thyroid; secondary neoplasm; metastasis; renal cell carcinoma; squamous cell carcinoma; adenocarcinoma; lymphoma; adenoid cystic carcinoma; fine-needle aspiration; cytology. INTRODUCTIONSecondary neoplasms of the thyroid gland (SNTGs), representing either metastases or direct extension of tumors from adjacent anatomic structures, are uncommon. Their reported incidence varies substantially, however, ranging from 0.1% to 3% in clinical series. 1-15 They have been reported as incidental findings in autopsy studies [16][17][18] with a frequency of 4.4% to 24% in patients with a known primary cancer or widespread Original Article malignancy in which clinically occult thyroid micrometastases may be detected. 4,[19][20][21][22] In the United States and Europe, the most commonly reported primary tumor resulting in symptomatic SNTG is renal cell carcinoma (RCC), closely followed by carcinomas of the breast, lung, and colon. 5,23-25 Secondary lymphoma, melanoma, sarcoma, and head and neck squamous cell carcinoma (SCC) also account for a significant proportion of SNT...

BACKGROUND: Poorly differentiated thyroid carcinoma (PDTC) is an uncommon and aggressive malignancy. Despite the significant clinical implications of a diagnosis of PDTC, its cytomorphologic features have not been well defined. Statistical analysis was applied to a series of 40 PDTCs to identify a specific set of cytomorphologic features that characterized these tumors on fine-needle aspiration biopsy (FNAB). METHODS: In total, 40 thyroid FNABs that were highly diagnosed histologically as PDTC (19 insular carcinomas and 21 noninsular carcinomas) comprised the study group. A control group of 40 well differentiated thyroid neoplasms were selected for comparison. All FNABs were reviewed and scored for a series of 32 cytomorphologic features. The results were evaluated using univariate and stepwise logistic regression (SLR) analyses. RESULTS: In univariate analysis, 17 cytomorphologic features were identified that characterized the 40 PDTCs: insular, solid, or trabecular cytoarchitecture (P < .001); high cellularity (P ¼ .007); necrosis (P ¼ .025) or background debris (P ¼ .025); plasmacytoid appearance (P ¼ .0007); single cells (P < .0001); high nuclear/cytoplasmic ratio (P < .0001); scant cytoplasm (P ¼ .03); nuclear atypia (P < .0001), including nuclear pleomorphism (P ¼ .0052) and anisokaryosis (P < .0001); granular/coarse chromatin (P ¼ .026); naked nuclei (P ¼ .01); mitotic activity (P ¼ .0001) and apoptosis (P < .0001); endothelial wrapping (P ¼ .0053); and severe crowding (P < .0001). In logistic regression analysis, severe crowding (P ¼ .0008) and cytoarchitecture (P < .0001) were identified as the most significant cytomorphologic features of PDTCs, and the combination of cytoarchitecture, severe crowding, single cells, and high nuclear/cytoplasmic ratio was the most predictive of PDTC. CONCLUSIONS: PDTCs have characteristic cytomorphologic features. By using logistic regression analysis, the features that were identified as the most predictive of PDTC were severe crowding, insular/solid/trabecular morphology, single cells, and high nuclear/cytoplasmic ratio. Cancer ( (617) PDTCs often present at an advanced stage, have a propensity for local recurrence, and tend to metastasize to regional lymph nodes, lung, and bones. 1,6,9 Over the past 2 decades, fine-needle aspiration (FNA) biopsy (FNAB) has emerged as 1 of the most important tests for the initial evaluation of thyroid nodules and for guiding their clinical and surgical management. Because of the significant clinical impact of a diagnosis of PDTC, it would be advantageous to recognize this rare subset of thyroid cancers preoperatively in FNABs. Since the original cytologic description of 6 cases by Pietribiasi at al, 10 only a few small series 11-13 and case reports 14-25 have been published. In an effort to better define the cytomorphologic features of PDTC, we applied statistical analysis to a multi-institutional series of 40 histologically proven cases. To our knowledge, this is the largest FNAB series of PDTCs studied. MATERIALS AND METHODS Case Se...