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

Fischer, Andrew H.; Clayton, Amy C.; Bentz, Joel S.; Wasserman, Patricia; Henry, Michael R.; Souers, Rhona J.; Moriarty, Ann

doi:10.5858/arpa.2012-0009-cp

Cited by 52 publications

(39 citation statements)

References 11 publications

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“…More significant is that non-specific cytological features may wrongly suggest tumors other than MTC. These false negative diagnoses result in the failure to cytologically diagnose MTC, and lower cytological sensitivity for MTC (45,(47)(48)(49)(50)(51)(52)(53)(54)). An abstract reporting 14 samples (from 13 patients) that positively expressed the MTC gene expression signature in the Afirma GEC rare neoplasm cassettes found that all 14 were confirmed as MTC on histopathology (55).…”

Section: Rare Neoplasmsmentioning

confidence: 99%

Molecular markers in the diagnosis of thyroid nodules

Ward

Kloos²

2013

Arq Bras Endocrinol Metab

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SUMMARYAn indeterminate thyroid nodule cytology result occurs about every sixth fine-needle aspiration. These indeterminate nodules harbor a 24% risk of malignancy (ROM); too high to ignore, but driving surgery where most nodules are benign. Molecular diagnostics have emerged to ideally avoid surgery when appropriate, and to trigger the correct therapeutic surgery when indicated, as opposed to an incomplete diagnostic surgery. No current molecular test offers both high sensitivity and high specificity. A molecular diagnostic test with high sensitivity (e.g. Afirma Gene Expression Classifier sensitivity 90%) offers a high Negative Predictive Value when the ROM is relatively low, such as < 30%. Only such tests can "rule-out" cancer. In this setting, a molecularly benign result suggests the same ROM as that of operated cytologically benign nodules (~6%). Thus, clinical observation can replace diagnostic surgery; increasing quality of life and decreasing medical costs. However, its low specificity cannot "rule-in" cancer as a suspicious result has a Positive Predictive Value (PPV) of ~40%, perhaps too low to routinely reflex to definitive cancer surgery. Conversely, high specificity tests (BRAF, RAS, PPAR/PAX-8, RET/PTC, PTEN) offer high PPV results, and only these tests can "rule-in" cancer. Here a positive molecular result warrants definitive therapeutic surgery. However, their low sensitivity cannot "rule-out" cancer and a negative molecular result cannot dissuade diagnostic surgery; limiting their cost-effectiveness. Whether or not there is a useful and cost-effective role to sequentially combine these approaches, or to modify existing approaches, is under investigation. Arq Bras Endocrinol Metab. 2013;57(2):89-97 Keywords Biopsy, fine-needle; DNA mutational analysis; gene expression; genomics; molecular diagnostic techniques SUMáRioResultados indeterminados na citologia de um nódulo tireoidiano ocorrem em cerca de um a cada seis punções aspirativas por agulha fina. Esses nódulos indeterminados apresentam risco de malignidade (RM) de cerca de 24%, um valor alto demais para ser ignorado e que leva à cirurgia em casos em que a maioria dos nódulos é benigna. O diagnóstico molecular é uma forma ideal de se evitar a cirurgia quando apropriado e de se levar ao correto procedimento cirúrgico terapêutico quando indicado, em oposição à cirurgia diagnóstica incompleta. Atualmente, não existem testes moleculares com alta sensibilidade e especificidade. Um teste molecular de alta sensibilidade (por exemplo, a sensibilidade do teste Afirma Gene Expression Classifier é de 90%) tem um alto Valor Preditivo Negativo quando o RM é relativamente baixo, por exemplo, < 30%. Apenas esses testes podem "excluir" o câncer. Nesse contexto, um resultado molecular benigno sugere o mesmo RM de nódulos com resultado benigno na citologia e operados (~6%). Assim, a observação clínica pode substituir a cirurgia diagnóstica, aumentando a qualidade de vida e diminuindo os custos médicos. Entretanto, a baixa especificidade não pode "incluir" o cân...

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Section: Rare Neoplasmsmentioning

confidence: 99%

Molecular markers in the diagnosis of thyroid nodules

Ward

Kloos²

2013

Arq Bras Endocrinol Metab

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“…Liquid-based preparation of thyroid FNA samples appears to be more helpful as compared to the conventional smear [13] . At the John Hopkins University, specimens diagnosed as containing Hurthle cells have a 19% (9/47 patients) chance of being malignant if they are classified as atypia of undetermined significance with Hurthle cells [14,15] .…”

Section: Updates On Diagnosis and Investigationsmentioning

confidence: 99%

Overview of Hurthle cell carcinoma of thyroid

Korzeniowski

Mahmud

Kirby³

et al. 2017

Adv Mod Oncol Res

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Abstract:The clinical behaviour of Hurthle cell carcinoma (HCC) of the thyroid is variable and there are many controversies in the literature. Here, we summarize an up-to-date review of the literature on genetics, diagnosis (ultrasound scan, fine needle aspiration, frozen section, etc.), and management. At presentation, treatment decision should be made by a multidisciplinary board. Recurrent HCCs are seldom curable despite salvage treatments, which include radioactive iodine ablation, radiofrequency ablation, ethanol ablation, external radiotherapy, and systemic therapy. Further research is needed to develop more efficacious systemic treatments. Currently, lenvatinib, sunitinib, and sorafenib are available. The completed and ongoing clinical trials for HCC are summarized.

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“…126 A recent nationwide educational survey by the College of American Pathologists found a troubling approximately 40% of circulated FNA slides felt to represent FNs were miscategorized as either benign or malignant. 127 An overall 18% diagnostic discordance was found on review of thyroid FNAs referred to a tertiary care center. 128 High FLUS rates erode the utility of mutation testing and especially gene expression profiling.…”

Section: The Continuing Importance Of the Primary Cytologic Diagnosismentioning

confidence: 99%

Five Top Stories in Cytopathology

Fischer,

Benedict,

Amrikachi

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Cytology relies heavily on morphology to make diagnoses, and morphologic criteria have not changed much in recent years. The field is being shaped predominantly by new techniques for imaging and for acquiring and processing samples, advances in molecular diagnosis and therapeutics, and regulatory issues.Objective.-To review the importance of classical morphology in the future of cytopathology, to identify areas in which cytology is expanding or contracting in its scope, and to identify factors that are shaping the field.Data Sources.-Literature review.Conclusions.-Five stories paint a picture in which classical cytomorphology will continue to have essential importance, both for diagnosis and for improving our understanding of cancer biology. New endoscopy and imaging techniques are replacing surgical biopsies with cytology samples. New molecularly targeted therapies offer a chance for cytology to play a major role, but they pose new challenges. New molecular tests have the potential to synergize with, but not replace, morphologic interpretation of thyroid fine-needle aspirations. Ultrasound-guided fine-needle aspiration performed by cytopathologists is opening a new field of ''interventional cytopathology'' with unique value. For the productive evolution of the field, it will be important for cytopathologists to play an active role in clinical trials that document the ability of cytology to achieve cost-effective health care outcomes.(Arch Pathol Lab Med. 2013;137:894-906; doi: 10.5858/ arpa.2012-0258-SA) THE CONTINUING VALUE OF CYTOMORPHOLOGY C ytopathologists have been primarily morphologists, using the smallest possible biopsy specimen for diagnosis. It is unusual for new diagnostic morphologic features to be discovered. A rare example is the description of intranuclear cytoplasmic inclusions in at least a subset of pancreatic intraductal papillary mucinous neoplasms.1 The new Bethesda system for reporting thyroid cytopathology is certainly important, but the actual morphologic criteria for diagnosing thyroid fine-needle aspirations (FNAs) have scarcely changed in the past several decades. It seems that classical cytomorphology has brought the field about as far as it can go.Though new diagnostic cytomorphologies are not likely to help the productive evolution of cytology, the theme of this first story is that classical morphology will continue to have an essential value. In order to provide new useful clinical applications, cytopathology needs to be redefined as the field that uses the smallest possible biopsy specimen for diagnosis by using any technique. The full value of classical cytomorphology can be boosted by new technologies, including improvements in cell block techniques 2-4 and better microbiopsy needles. 5 The use of ultrasound guidance for cytopathologist-performed FNA and the development of new endoscopic techniques have provided new applications for classical cytomorphology. New immunofluorescent microscopy techniques are promising to synergize with classical cytomorphologic diagnosis...

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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

Cited by 52 publications

References 11 publications

Molecular markers in the diagnosis of thyroid nodules

Molecular markers in the diagnosis of thyroid nodules

Overview of Hurthle cell carcinoma of thyroid

Five Top Stories in Cytopathology

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