KEY WORDS: Liquid-based cytology; noninvasive follicular variant of papillary thyroid cancer; noninvasive follicular thyroid neoplasm with papillary-like nuclear features; thyroid carcinoma; thyroid lesions. INTRODUCTIONOver the last decades, the exact nature of thyroid lesions diagnosed as follicular variant of papillary thyroid carcinoma (FVPTC) has been debated. [1][2][3][4][5][6][7][8] Specifically, FVPTCs appear to represent a heterogeneous group of carcinomas and a controversial entity including both encapsulated/noninvasive (NI-FVPTCs) and invasive FVPTCs Based on their multi-institutional histological series, the Endocrine International Working Group recommended the reclassification of these NI-FVPTCs as "noninvasive follicular thyroid neoplasm with papillarylike nuclear features" (NIFTP). This entity was defined by a set of morphological features including nuclear membrane irregularities, ground glass appearance of the nuclei, and larger nuclear size within a context of encapsulated follicular tumor. 10 Conversely, apart from the histological approach and definition of these NIFTPs, its cytological diagnosis is still under evaluation in that this new terminology might significantly affect both the diagnosis of thyroid lesions and the categories of the different cytological classification systems. [11][12][13][14][15][16][17][18] For these reasons, and because none of the classification systems, including The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), accounts for the allocation of NIFTPs, it is crucial to establish in which cytological categories NIFTPs should be diagnosed. 19-23Therefore, a growing number of studies currently are investigating whether these lesions can be identified by fine-needle aspiration (FNA) and more specifically their impact on the ROM in the different diagnostic categories. Nevertheless, currently, the majority of FVPTCs are frequently diagnosed in the cytological categories of follicular neoplasm (FN) or suspicious for malignancy (SM) due to the absence of the undoubtedly nuclear features of PTCs, which may support a conclusive malignant diagnosis. [11][12][13][14][15][16][17][18] For this reason, some authors have analyzed their cytological cases for specific features able to identify the correct cytological categories for NIFTPs. Despite the small number of published series regarding NIFTPs to date, the preliminary results have demonstrated that the presence of nuclear pseudoinclusions and papillary structures are typical features of PTCs whereas a predominantly follicular pattern may be linked to NIFTPs, even if all these authors have not found any differentiation between NIFTPs and I-FVPTCs on FNA. Thus, the purpose of the current study was to examine and compare the morphological features in a series of cytohistological cases processed with liquid-based cytology (LBC) and diagnosed as either NIFTPs or I-FVPTCs. To the best of our knowledge, this study represents the first and largest series on LBC cytology published to date in which all the architectura...

BACKGROUND:The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a 6-tier diagnostic framework using uniform criteria in reports of thyroid aspirates. One of the major advantages of this framework is its association with defined risks of malignancy, allowing standardized management algorithms for each diagnosis. The objective of the current meta-analysis was to demonstrate the feasibility of using TBSRTC among specimens in the atypia of undeter-

Objective: In the field of fine-needle aspiration cytology, the category of suspicious for malignancy (SM) thyroid lesions, that bears 55-85% risk of malignant histology, is a challenging topic in which morphology alone is not always able to make a correct diagnosis. Recently, immunocytochemistry (ICC) has been referred to as helpful in differentiating low-and high-malignant risk lesions and BRAF activating mutations have been identified in a significant amount of papillary thyroid carcinomas (PTC). The introduction of the liquid-based cytology (LBC) may simplify the application of these techniques to thyroid cytology. Design: Our aim is to evaluate the diagnostic and prognostic role of both ICC and BRAF mutation for the SM category on LBC. Methods: From October 2010 through June 2011, 113 LBC cytological cases (including 37 SM and 76 PTC) underwent surgery. All cases were studied for BRAF mutation and ICC. Results: ICC resulted positive in 26 (86.6%) histologically malignant SM with 15 of which (40.5%) expressing a BRAF mutation. Overall, 63 cases showed a BRAF mutation resulting in PTC. Concerning the prognostic role of BRAF mutation for the two categories, we reported a significant correlation with multifocality, nodal involvement and extra-capsular invasion (P!0.0001). Conclusions: Special techniques such as ICC and molecular markers might be successfully carried out on LBC-processed material. For both categories, ICC is more sensitive whereas BRAF analysis is an interesting support due to its high specificity adding a prognostic value in both SM and PTCs.

BACKGROUND:It has been generally demonstrated that the valine-to-glutamic acid substitution at position 600 (V600E) in the v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) gene is an effective diagnostic=prognostic marker mainly for papillary thyroid carcinoma (PTC). The detection of this mutation typically has been achieved using DNA-based techniques. The recently introduced monoclonal V600E antibody (clone VE1) is likely to be an alternative strategy for detecting this mutation in thyroid lesions. The authors investigated molecular and immunocytohistochemical BRAF analyses in a prospective series of samples from patients with PTC. METHODS: Fifty-five prospective cytohistologic samples that were diagnosed as PTC were studied using both DNA BRAF testing and the VE1 antibody. The intensity of VE1 expression was graded from 0 (negative) to 31 (strong). RESULTS: All diagnoses were histologically confirmed. In total, 37 samples with mutated BRAF and 18 samples with wild-type BRAF were reported with 100% cytohistologic concordance. Cytologic VE1 expression revealed 25 negative samples (including 16 with 0 expression and 9 with 11 expression) and 30 positive samples (including 16 with 21 expression and 14 with 31 expression). On histology, there were 27 negative samples (20 with 0 expression and 7 with 11 expression) and 28 positive samples (14 with 21 expression and 14 with 31 expression). Four specimens with the BRAF mutation had discrepancies in VE1 intensity between cytology and histology. Furthermore, 6BRAF-mutated samples produced negative VE1 results. CONCLUSIONS: Although it has limitations, the VE1 antibody represents a feasible first-line approach for evaluating BRAF mutation status and may be a valid tool in the selection of samples for molecular analysis. The current report highlights the statistically significant difference between molecular and VE1 positivity in PTC (P <.0001). Nevertheless, in the authors' experience, BRAF mutations are more accurate for identifying VE1-negative cases.

The thyroid is a rare site of clinically detectable tumor metastases; even though the gland is a highly vascularized structure, the frequency of metastases in the routine practice is less than 0.2% of all thyroid malignancies. The purpose of our meta-analysis is to evaluate the frequency of metastatic diffusion from other primary tumors to the thyroid gland and to suggest the best possible treatment through an evidence-based study. Relevant studies were identified by searching the following databases: PubMed, Scopus, and Web of Science. We selected all English-written articles published from 1995 to 2015. Studies were considered eligible if they reported the timing of metastatic spread and the site of the primary tumor in respect to the diaphragmatic region. Case reports were not included. Twenty-eight studies accounted for 514 patients. The rate of metachronous metastases was 69%. Fifty-three percent of primaries originated from the infradiaphragmatic region. Fine needle aspiration biopsy (FNAB) was done in 154 patients and 195 patients were treated mostly with surgery. A prevalence of primary tumors from the infradiaphragmatic region and of metachronous metastases was observed. Knowledge of the clinical history and the ancillary techniques can improve the sensitivity and accuracy of FNAB. Thyroidectomy may be considered a more effective treatment than radio-chemotherapy.

BACKGROUND:The current study was conducted to investigate the role of thyroid fine-needle aspiration cytology

BACKGROUND:The current study compared ThinPrep urinary cytology and conventional cytospin urinary cytology in the diagnosis of bladder cancer, applying the Paris System for Reporting Urinary Cytology. METHODS: Between January 2010and December 2011, a total of 3659 urine samples were processed using conventional cytospin methods. Between January 2012 and December 2013, a total of 4186 urine cytological cases were analyzed using ThinPrep methods. In 131 cases (65 processed by conventional cytospin and 66 processed by ThinPrep), a subsequent biopsy was performed. The authors reclassified these cases according to the Paris System and an analysis between the 2 methods with regard to bladder biopsies was performed. RESULTS: No significant differences were observed in terms of sensitivity and specificity between the 2 methods in cases with positive cytology for high-grade carcinoma. According to the Paris System, cases of atypical urothelial cells (AUC) and atypical urothelial cells suspicious for high-grade carcinoma (AUC-H) that were processed using cytospin did not correlate with urothelial carcinoma or with negative biopsies; conversely, the AUC cases processed using ThinPrep appeared to correlate with negative histological biopsies or low-grade urothelial carcinoma. CONCLUSIONS:The results of the current study demonstrated that according to the Paris System, there were no significant differences in sensitivity or specificity for the diagnosis of high-grade urothelial carcinoma or AUC-H between the 2 methods. Cases of AUC should be easy to recognize using Thin Prep rather than cytospin and only AUCs diagnosed with ThinPrep were found to be statistically linked to negative cases for carcinoma or with low-grade urothelial carcinoma.

Effusions are accumulations of fluid in serous cavities in excess resulting from an imbalance between the production and reabsorption of serous fluid. 1 Thoracentesis, pericardiocentesis, and paracentesis are procedures commonly performed on pleural, pericardial, and peritoneal effusions, respectively, to reduce the amount of the liquid and relieve the clinical symptoms due to compression. The accumulation of excess fluid in body cavities has various aetiologies,