Skip to main content
SpringerLink
Log in

Approach to Thyroid Cytology

  • Chapter
  • First Online:
Book cover Practical Diagnostic Approaches in Non-Gynaecologic Cytology

  • 574 Accesses

Abstract

Thyroid FNAs are amongst the most commonly encountered cytology samples. Thus, cytologic classification systems are well established in this area. Three major classification systems are presented at a glance, with a brief summary of the most recent Bethesda System updates. This chapter provides an introduction to what cytology can and can’t do in the thyroid gland and lays out a guide to the main morphological patterns seen in thyroid FNAs, moving systematically from cytoarchitectural features to cytomorphology and background elements.

In a dedicated section, specific challenging areas are highlighted, including cystic and lymphoid-rich lesions, amongst others. Diagnostic pitfalls are also discussed, with the inclusion of tips to avoid errors in interpretation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kolata G. It’s not cancer: doctors reclassify a thyroid tumor. The New York Times [Internet]. 2016. [cited 2017 Mar 3]. https://www.nytimes.com/2016/04/15/health/thyroid-tumor-cancer-reclassification.html.

  2. Nikiforov YE, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LDR, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2(8):1023–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Guidelines of the Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. The Papanicolaou Society of Cytopathology Task Force on standards of practice. Diagn Cytopathol. 1996;15(1):84–9.

    Google Scholar 

  4. Royal College of Pathologists (United Kingdom). Guidance on the reporting of thyroid cytology specimens [Internet]. http://ukeps.com/docs/thyroidfna.pdf.

  5. RCPA. Cancer protocols [Internet]. [cited 2017 Mar 8]. http://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Cancer-Protocols.

  6. Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology II. Acta Cytol. 2016;60(5):397–8.

    Article  PubMed  Google Scholar 

  7. Ali SZ, Cibas E, editors. The Bethesda system for reporting thyroid cytopathology: definitions, criteria, and explanatory notes [Internet]. 2nd ed. Berlin: Springer International Publishing; 2018. [cited 2018 Jun 18]. //www.springer.com/gp/book/9783319605692.

    Google Scholar 

  8. Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132(5):658–65.

    Article  PubMed  Google Scholar 

  9. Pusztaszeri M, Rossi ED, Auger M, Baloch Z, Bishop J, Bongiovanni M, et al. The Bethesda system for reporting thyroid cytopathology: proposed modifications and updates for the second edition from an international panel. Acta Cytol. 2016;60(5):399–405.

    Article  PubMed  Google Scholar 

  10. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gan TRX, Nga ME, Lum JHY, Wong WM, Tan WB, Parameswaran R, et al. Thyroid cytology-nuclear versus architectural atypia within the “Atypia of undetermined significance/follicular lesion of undetermined significance” Bethesda category have significantly different rates of malignancy: subclassifying “atypical” thyroid FNACs. Cancer Cytopathol. 2017;125(4):245–56.

    Article  PubMed  Google Scholar 

  12. Ho AS, Sarti EE, Jain KS, Wang H, Nixon IJ, Shaha AR, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid. 2014;24(5):832–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, et al. A meta-analytic review of the Bethesda system for reporting thyroid cytopathology: has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathol. 2015;123(12):713–22.

    Article  PubMed  Google Scholar 

  14. Önder S, Firat P, Ates D. The Bethesda system for reporting thyroid cytopathology: an institutional experience of the outcome of indeterminate categories. Cytopathology. 2014;25(3):177–84.

    Article  PubMed  Google Scholar 

  15. Bychkov A, Keelawat S, Agarwal S, Jain D, Jung CK, Hong S, et al. Impact of non-invasive follicular thyroid neoplasm with papillary-like nuclear features on the Bethesda system for reporting thyroid cytopathology: a multi-institutional study in five Asian countries. Pathology (Phila). 2018;50(4):411–7.

    Google Scholar 

  16. Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012;367(8):705–15.

    Article  CAS  PubMed  Google Scholar 

  17. Harvey AM, Truong LD, Mody DR. Diagnostic pitfalls of Hashimoto’s/lymphocytic thyroiditis on fine-needle aspirations and strategies to avoid overdiagnosis. Acta Cytol. 2012;56(4):352–60.

    Article  PubMed  Google Scholar 

  18. Demay RM. The art & science of cytopathology. 2nd ed. Chicago: American Society for Clinical Pathology; 2011. 2076p.

    Google Scholar 

  19. Sidawy MK, Costa M. The significance of paravacuolar granules of the thyroid. A histologic, cytologic and ultrastructural study. Acta Cytol. 1989;33(6):929–33.

    CAS  PubMed  Google Scholar 

  20. Geddie WR, Bedard YC, Strawbridge HT. Medullary carcinoma of the thyroid in fine-needle aspiration biopsies. Am J Clin Pathol. 1984;82(5):552–8.

    Article  CAS  PubMed  Google Scholar 

  21. Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathologic features of medullary carcinoma of the thyroid. Arch Pathol Lab Med. 1984;108(2):156–9.

    CAS  PubMed  Google Scholar 

  22. Dahlgren M, Khosroshahi A, Nielsen GP, Deshpande V, Stone JH. Riedel’s thyroiditis and multifocal fibrosclerosis are part of the IgG4-related systemic disease spectrum. Arthritis Care Res. 2010;62(9):1312–8.

    Article  Google Scholar 

  23. Falhammar H, Juhlin CC, Barner C, Catrina S-B, Karefylakis C, Calissendorff J. Riedel’s thyroiditis: clinical presentation, treatment and outcomes. Endocrine. 2018;60(1):185–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Nixon IJ, Coca-Pelaz A, Kaleva AI, Triantafyllou A, Angelos P, Owen RP, et al. Metastasis to the thyroid gland: a critical review. Ann Surg Oncol. 2017;24(6):1533–9.

    Article  PubMed  Google Scholar 

  25. Deeken-Draisey A, Yang G-Y, Gao J, Alexiev BA. Anaplastic thyroid carcinoma: an epidemiologic, histologic, immunohistochemical, and molecular single-institution study. Hum Pathol. 2018;82:140–8.

    Article  CAS  PubMed  Google Scholar 

  26. Ng W-K, Ip P, Choy C, Collins RJ. Cytologic and immunocytochemical findings of anaplastic large cell lymphoma: analysis of ten fine-needle aspiration specimens over a 9-year period. Cancer. 2003;99(1):33–43.

    Article  PubMed  Google Scholar 

  27. Pusztaszeri MP, Krane JF, Faquin WC. BRAF testing and thyroid FNA. Cancer Cytopathol. 2015;123(12):689–95.

    Article  PubMed  Google Scholar 

  28. Leslie C, Grieu-Iacopetta F, Richter A, Platten M, Murray J, Frost FA, et al. BRAF p.Val600Glu (V600E) mutation detection in thyroid fine needle aspiration cell block samples: a feasibility study. Pathology (Phila). 2015;47(5):432–8.

    CAS  Google Scholar 

  29. Wobker SE, Kim LT, Hackman TG, Dodd LG. Use of BRAF v600e immunocytochemistry on FNA direct smears of papillary thyroid carcinoma: BRAF immunocytochemistry for FNA smears. Cancer Cytopathol. 2015;123(9):531–9.

    Article  CAS  PubMed  Google Scholar 

  30. Trimboli P, Treglia G, Condorelli E, Romanelli F, Crescenzi A, Bongiovanni M, et al. BRAF-mutated carcinomas among thyroid nodules with prior indeterminate FNA report: a systematic review and meta-analysis. Clin Endocrinol. 2016;84(3):315–20.

    Article  CAS  Google Scholar 

  31. Hirokawa M, Carney JA. Cell membrane and cytoplasmic staining for MIB-1 in hyalinizing trabecular adenoma of the thyroid gland. Am J Surg Pathol. 2000;24(4):575–8.

    Article  CAS  PubMed  Google Scholar 

  32. García-Pascual L, Barahona M-J, Balsells M, del Pozo C, Anglada-Barceló J, Casalots-Casado J, et al. Complex thyroid nodules with nondiagnostic fine needle aspiration cytology: histopathologic outcomes and comparison of the cytologic variants (cystic vs. acellular). Endocrine. 2011;39(1):33–40.

    Article  PubMed  CAS  Google Scholar 

  33. Verma D, Puri V, Agarwal S, Bhaskar A. Primary thyroid lymphoma: a rare disease. J Cytol. 2014;31(4):218–20.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sharma A, Jasim S, Reading CC, Ristow KM, Villasboas Bisneto JC, Habermann TM, et al. Clinical presentation and diagnostic challenges of thyroid lymphoma: a cohort study. Thyroid. 2016;26(8):1061–7.

    Article  PubMed  Google Scholar 

  35. Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, et al. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol. 2007;31(8):1256–64.

    Article  PubMed  Google Scholar 

  36. Kane SV, Sharma TP. Cytologic diagnostic approach to poorly differentiated thyroid carcinoma: a single-institution study. Cancer Cytopathol. 2015;123(2):82–91.

    Article  PubMed  Google Scholar 

  37. Saglietti C, Onenerk AM, Faquin WC, Sykiotis GP, Ziadi S, Bongiovanni M. FNA diagnosis of poorly differentiated thyroid carcinoma. A review of the recent literature. Cytopathology. 2017;28(6):467–74.

    Article  CAS  PubMed  Google Scholar 

  38. Bongiovanni M, Bloom L, Krane JF, Baloch ZW, Powers CN, Hintermann S, et al. Cytomorphologic features of poorly differentiated thyroid carcinoma: a multi-institutional analysis of 40 cases. Cancer. 2009;117(3):185–94.

    PubMed  Google Scholar 

  39. Haberal AN, Toru S, Ozen O, Arat Z, Bilezikçi B. Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases. Cytopathology. 2009;20(2):103–8.

    Article  CAS  PubMed  Google Scholar 

  40. Silva de Morais N, Stuart J, Guan H, Wang Z, Cibas ES, Frates MC, et al. The impact of Hashimoto thyroiditis on thyroid nodule cytology and risk of thyroid cancer. Endocr Soc. 2019;3(4):791–800.

    Article  CAS  Google Scholar 

  41. Wei S, Baloch ZW, LiVolsi VA. Thyroid carcinoma in patients with graves’ disease: an institutional experience. Endocr Pathol. 2015;26(1):48–53.

    Article  CAS  PubMed  Google Scholar 

  42. Mai KT, Landry DC, Thomas J, Burns BF, Commons AS, Yazdi HM, et al. Follicular adenoma with papillary architecture: a lesion mimicking papillary thyroid carcinoma. Histopathology. 2001;39(1):25–32.

    Article  CAS  PubMed  Google Scholar 

  43. Pusztaszeri MP, Krane JF, Cibas ES, Daniels G, Faquin WC. FNAB of benign thyroid nodules with papillary hyperplasia: a cytological and histological evaluation. Cancer Cytopathol. 2014;122(9):666–77.

    Article  PubMed  Google Scholar 

  44. Agarwal C, Kaushal M. Parathyroid lesions: difficult diagnosis on cytology. Diagn Cytopathol. 2016;44(8):704–9.

    Article  PubMed  Google Scholar 

  45. Bondeson L, Bondeson AG, Nissborg A, Thompson NW. Cytopathological variables in parathyroid lesions: a study based on 1,600 cases of hyperparathyroidism. Diagn Cytopathol. 1997;16(6):476–82.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, National University Hospital, Singapore, Singapore

    Min En Nga

Authors
  1. Min En Nga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Min En Nga .

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nga, M.E. (2021). Approach to Thyroid Cytology. In: Practical Diagnostic Approaches in Non-Gynaecologic Cytology. Springer, Singapore. https://doi.org/10.1007/978-981-15-2961-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-2961-0_5

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-2960-3

  • Online ISBN: 978-981-15-2961-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation