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/)

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Significant numbers of overdiagnoses of thyroid needle biopsies as “indeterminate” create a risk of surgery for benign disease. Overdiagnoses can be reduced by appropriate criteria and a risk‐adapted approach to cytodiagnosis. Cancer (Cancer Cytopathol) 2010;. © 2010 American Cancer Society

Fine needle aspiration biopsy (FNAB) has become a popular method to diagnose mass lesions of the liver. Although several reports have listed FNAB criteria to be used to diagnose both primary and metastatic tumors of the liver, none have separated key cytologic criteria from secondary criteria. We reviewed the FNAB smears from 35 patients with proven hepatocellular carcinoma and 74 patients with proven metastatic tumors in the liver. All specimens were coded as to the presence or absence of the following variables: polygonal cells with centrally placed nuclei; well-defined, granular cytoplasm; large nucleoli; small cytoplasmic vacuoles; large cytoplasmic vacuoles; bile; polymorphonuclear leukocytes; malignant cells separated by sinusoidal vessels; endothelial cells surrounding tumor cell clusters; multinucleated tumor giant cells; basophilic intracytoplasmic inclusions; eosinophilic intracytoplasmic inclusions; and intranuclear cytoplasmic inclusions. A step-wise logistic regression analysis was performed on the data to determine the variables predictive of hepatocellular carcinoma. The statistical analysis selected polygonal cells with centrally placed nuclei, malignant cells separated by sinusoidal capillaries, and bile as the key cytologic criteria for hepatocellular carcinoma. Endothelial cells surrounding tumor cell clusters and intranuclear cytoplasmic inclusions were selected as secondary criteria by this analysis.

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Fine needle aspiration biopsy of palpable masses yields a variety of specimens. Some are fluid, whereas others are semisolid; some contain numerous particles, whereas others contain no identifiable particulate fragments. Not surprisingly, no single smearing technique can reasonably be expected to provide good results with such a variety of specimens. This article describes a family of techniques, of which one or more are applicable to virtually any fine needle aspiration biopsy specimen. The techniques described and illustrated include the two-step, one-step, absorption, and watch-glass techniques.

This column discusses the issue of specimen adequacy in fine-needle aspiration of breast lesions that appear benign by physical and radiographic criteria. We begin by describing the clinical problem in more detail. Then the question is posed and several related issues are raised. Drs.Abele, Kline, Silverman, and Skoog have shared their thoughts on this subject, using the question as a starting point. Finally, Dr. Stanley will provide a discussion of this question based on the comments of these investigators.