Context.—Fine-needle aspiration (FNA) biopsies have been an important component in the preoperative evaluation of thyroid nodules. Until the introduction of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in 2008, individual institutions had developed their own diagnostic categories. The BSRTC proposed 6 categories in an attempt to standardize reporting of thyroid FNA. Objective.—To present a 15-year experience of thyroid FNA at one institution, including data before and after introduction of the BSRTC. The risk of malignancy is compared with the meta-analysis of high-quality published data. Data Sources.—Data sources were PubMed, a manual search of references, and institutional data. Conclusions.—The diagnostic categories developed at our institution were similar to those proposed by the BSRTC, with best fit into the 6 categories easily accomplished and reported in the final 2 years of the study. Significant differences were noted in the frequencies of cases in diagnostic categories Benign (II; P = .003), Suspicious for follicular neoplasm/Follicular neoplasm (IV; P < .001), and Malignant (VI; P = .003) after the introduction of the BSRTC. Eighteen published articles met the criteria for inclusion in the meta-analysis. The risk of malignancy in each category in our institution was similar to that determined in the meta-analysis, except for Insufficient for diagnosis (I; 20% versus 9%–14%). Meta-analysis showed an overlapping 95% CI of risk of malignancy between Atypia of undetermined significance/Follicular lesion of undetermined significance (III; 11%–23%) and Suspicious for follicular neoplasm/Follicular neoplasm (IV; 20%–29%), suggesting similar risks of malignancy. The use of newer molecular tests for these indeterminate cases may further refine risk assessment.

Recent studies have linked appearance of Paneth cells in colorectal adenomas to adenoma burden and male gender. However, the clinical importance of Paneth cells' associations with synchronous advanced adenoma (AA) and colorectal carcinoma (CRC) is currently unclear. We performed a comprehensive case-control study using 1,900 colorectal adenomas including 785 from females, and 1,115 from males. Colorectal cancer (CRC) is the third leading cause of cancer-related deaths among both men and women in the United States 1 . Colonoscopy guidelines recommend that individuals should start having a colonoscopy at the age of 50 years, and a potential follow-up colonoscopy depending on the endoscopic findings, particularly the polyp number and characteristics 2,3 . Certain adenoma characteristics have been associated with an increased CRC risk, including polyp size greater than or equal to 1 cm, villous histology and high-grade dysplasia 2-8 . An adenoma with one or more of the 3 characteristics is considered as advanced adenoma (AA, also known as advanced neoplasia) and should be followed up within 3 years, according to the recent update of the U.S. Multi-society Task Force on Colorectal Cancer 2 . Identification of markers for AA may help with the prevention, early identification and treatment of CRC.Paneth cells are normally present in the small intestine, proximal colon and transverse colon, and contribute to mucosal innate immunity by exerting a number of anti-microbial effects 9-11 . Genetic studies have indicated that Paneth cells upregulate the production of lysozymes, phospholipase A2, the Apc/beta-catenin/Tcf pathway, WNT, and CD166, during colonic tumorigenesis [11][12][13][14][15][16][17] . Paneth cells are also critical for intestinal stem cell homeostasis, as shown by our and others' works [18][19][20] . Recently, more attentions have been focused on the role of Paneth cells in CRC development and diagnosis 9 .

The authors investigated whether students receiving short-term individual counseling at a university counseling center showed progress as evidenced by perceived client and counselor outcomes and the roles that client readiness to change and working alliance played in this setting. The results indicated that the counselor reports, not the client reports, reflected statistically significant change in client symptoms. Changes in symptom severity were not associated with working alliance and readiness to change.