Reappraisal of &amp;ldquo;cyst fluid only&amp;rdquo; on thyroid fine-needle aspiration cytology

Takada, Nami; Hirokawa, Mitsuyoshi; Suzuki, Ayana; Higuchi, Miyoko; Kuma, Seiji; Miyauchi, Akira

doi:10.1507/endocrj.ej17-0082

Cited by 22 publications

(13 citation statements)

References 18 publications

(20 reference statements)

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“…1 ). A further modification of the Japanese system is classifying samples that only contain cyst fluid as benign because of an extremely low ROM [ 11 ].…”

Section: Preparation and Staining Of Thyroid Cytology Samplesmentioning

confidence: 99%

Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital

Satoh¹,

Yamashita²,

Kakudo

2017

J Pathol Transl Med

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In Japan, fine-needle aspiration (FNA) cytology is the most important diagnostic modality for triaging patients with thyroid nodules. A clinician (endocrinologist, endocrine surgeon, or head and neck surgeon) generally performs FNA cytology at the outpatient clinic, and ultrasound (US)-guided FNA is widespread because US is extremely common and most clinicians are familiar with it. Although almost all FNA thyroid samples are examined by certified cytopathologists and pathologists, some clinicians assess cytological specimens themselves. In Japan, there are two clinical guidelines regarding the management of thyroid nodules. One is the General Rules for the Description of Thyroid Cancer (GRDTC) published by the Japanese Society of Thyroid Surgery (JSTS) in 2005, and the other is the national reporting system for thyroid FNA cytology published by the Japan Thyroid Association in 2013 (Japanese system). Although the Bethesda System for Reporting Thyroid Cytopathology (Bethesda system) is rarely used in Japan, both the GRDTC and Japanese system tried to incorporate the Bethesda system so that the cytological diagnoses would be compatible with each other. The essential point of the Japanese system is stratification of follicular neoplasm (FN) into three subgroups based on cytological features in order to reduce unnecessary diagnostic thyroidectomy, and this system has been successful in stratifying the risk of malignancy in FN patients at several high-volume thyroid surgery centers. In Japan, the measurement of thyroglobulin and/or calcitonin in FNA needle washings is often used as an adjunct for diagnosis of possible cervical lymph node metastasis when FNA cytology is performed.

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“…1 ). A further modification of the Japanese system is classifying samples that only contain cyst fluid as benign because of an extremely low ROM [ 11 ].…”

Section: Preparation and Staining Of Thyroid Cytology Samplesmentioning

confidence: 99%

Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital

Satoh¹,

Yamashita²,

Kakudo

2017

J Pathol Transl Med

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“…Cyst fluid is more frequently categorized as benign rather than nondiagnostic. 4,15 However, among the cases without follicular cells and colloid representation, cytopathologists are not allowed to classify them as benign. Cell block preparation and cytospin may be good tools to reduce the unsatisfactory rates in those cases.…”

Section: Discussionmentioning

confidence: 99%

An alternative method for smear preparation of fine‐needle aspiration cytology of cystic thyroid lesions: Evaluation of sample adequacy

Xavier‐Júnior

Zogheib

Camilo-Júnior

et al. 2020

Diagnostic Cytopathology

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Background: Cystic thyroid lesions represent one of the most common causes of unsatisfactory fine-needle aspiration sampling. Thus, it is important to access the maximum number of follicular cells from cystic fluid in order to reduce unsatisfactory rates. We compared the traditional method of smearing with an alternative one. Methods: For each thyroid nodule, two smears were collected. Each smear was prepared using a distinct approach: either using the traditional technique or the alternative. Clinical data were taken from cytopathological request forms. The cytological aspects of the smears (eg, adequacy and number of cells) were observed during microscopy analysis. No cases were found to be suspicious for malignancy during ultrasound analysis (categories TR1 or TR2 according to ACR TI-RADS). Results: Thirty-five cases were analyzed. For smears prepared using both the traditional and the alternative techniques, 20 and 4 cases, respectively, were unsatisfactory. In the 20 unsatisfactory traditional smear cases, 9 (45%) showed enough cells for diagnosis in cytospin and/or cell block samples; the four unsatisfactory alternative method cases showed the same. There was a statistical difference between the two methods of collecting a smear concerning sample adequacy (P < .001), but there was no statistical difference regarding the cellularity (P = .842). Conclusion: In our data, the alternative method of using only one slide and the needle tip had higher rates of adequate sampling. Since it is cost effective and does not change the cytological analysis, this proposed alternative method can be useful in cases of cystic thyroid lesions.

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“…tion, it is difficult to estimate the ROM accurately. The ROM of CFO nodules have reportedly ranged from 0% to 14.3% 6,[16][17][18]. Güney and Şahiner reported that, in their study, malignancy was not detected in any of the specimens taken from 14 out of 48 patients who were diagnosed with CFO nodules and had undergone operations 8.…”

mentioning

confidence: 85%

“…5 Thus, CFO nodules have two different clinical managements that can be determined based on ultrasound findings. To date, the availability of extensive research focusing on CFO nodules is limited, [6][7][8] and the ROM in CFO nodules has not been well established. The purpose of the current study was to review cytological and ultrasound findings of CFO nodules, define the ROM, and determine the recommended clinical management of CFO nodules.…”

Section: Introductionmentioning

confidence: 99%

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Risk of malignancy and clinical outcomes of cyst fluid only nodules in the thyroid based on ultrasound and aspiration cytology

Kanematsu

Hirokawa

Higuchi

et al. 2019

Diagnostic Cytopathology

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Background: The number of extensive studies focusing on cyst fluid only (CFO) thyroid nodules is limited, and the risk of malignancy (ROM) in CFO nodules has not been well-established. Thus, the purpose of this study was to investigate CFO nodules using cytology and ultrasound. In addition, we sought to define the ROM and determine the recommended clinical management of CFO nodules. Methods:We retrospectively reviewed cytological preparations of 678 nodules that were originally identified as CFO nodules, including conventional specimens in 209 nodules, liquid based cytology (LBC) specimens in 221 nodules, and both conventional and LBC specimens in 248 nodules. Ultrasound reports with representative photographs were also reviewed.Results: Of the 678 CFO nodules, 214 (31.6%) were reclassified into other categories, including non-diagnostic/unsatisfactory (ND/UNS) except for CFO (n = 15), benign (n = 198), and malignant (n = 1). Conventional preparations (33.5%) were more frequently reclassified than LBC preparations (13.6%; P < .0001). Re-aspiration for diagnosis was performed for only one calcified nodule. The rates of surgical resection and malignancy were 3.0% and 0.2%, respectively. Based on American Thyroid Association guidelines and the Kuma Hospital ultrasound classification, worrisome sonographic features were identified in 5.8% and 0% of CFO nodules, respectively. Conclusion:We propose that CFO nodules should be classified as separate from ND/UNS nodules; they should be categorized as a subtype of benign nodules. However, it is essential that fine-needle aspiration cytology be performed under ultrasound-guided real-time visualization of needle placement in the target nodule in all cases. K E Y W O R D SBethesda system, cyst fluid only, foamy cells, papillary thyroid carcinoma, Thyroid aspiration cytology

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Reappraisal of “cyst fluid only” on thyroid fine-needle aspiration cytology

Cited by 22 publications

References 18 publications

Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital

Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital

An alternative method for smear preparation of fine‐needle aspiration cytology of cystic thyroid lesions: Evaluation of sample adequacy

Risk of malignancy and clinical outcomes of cyst fluid only nodules in the thyroid based on ultrasound and aspiration cytology

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