ES et al. View an interactive bone marrow clot specimen online. Fine-needle aspiration (FNA) cytology is an important diagnostic tool in patients with thyroid lesions. In: Ali SZ, Cibas ES, editors. Papillary structures are not as common as it was believed, because intact papillae are often too large to enter the fine needle or are disrupted during the preparation of the smears. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. As a result, 3 to 15 glass slides from each patient are taken and examined, which can be either Giemsa- or Papanikolaou-stained slides[14]. Utilization of ancillary studies in thyroid fine needle aspirates: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. WC McHenry Aspirates where malignancy is suspected but cannot be determined due to: Overlapping cytological features with other thyroid lesions, Specimens suspicious for a follicular or Hrthle cell neoplasm (see, Specimens with a minor degree of atypia, primarily cytologic or architectural (see, Frozen section has limited utility for suspicious for malignancy nodules (, 55 year old man with colon cancer metastasis within a NIFTP which was cytologically suspected of PTC (, 58 year old woman with mammary analogue secretory carcinoma of the thyroid which was cytologically suspected of PTC (, 63 year old man with follicular variant of papillary thyroid carcinoma presenting as a toxic nodule which was cytologically suspected of follicular variant of PTC (, 63 year old woman with hyalinizing trabecular tumor which was cytologically suspected of hyalinizing trabecular tumor (, 71 year old man with mixed medullary and follicular cell carcinoma of the thyroid which was cytologically suspected of thyroid carcinoma (, Pattern A (patchy nuclear changes): moderate to high cellularity, nuclei showing enlargement, pallor, grooves, irregularity or molding but absence of nuclear pseudoinclusions, psammoma bodies and papillary architecture, Pattern B (incomplete nuclear changes): nuclei showing enlargement with mild pallor and grooves, absence of nuclear irregularity, nuclear molding, nuclear pseudoinclusions, psammoma bodies and papillary architecture, Pattern C (sparsely cellular specimen): poor cellularity, presence of many findings suggesting papillary thyroid carcinoma, Pattern D (cystic degeneration): cystic degeneration based on foamy histiocytes, scattered clusters of follicular cells with the nuclei showing enlargement, pallor, grooves, absence of nuclear pseudoinclusions, psammoma bodies and papillary architecture, large, atypical, histiocytoid cells with enlarged nuclei and without abundant vacuolated cytoplasm (, Monomorphic population of isolated small or medium sized cells with a high nuclear cytoplasmic ratio, Nuclei are eccentrically located, with smudged chromatin, Numerous monomorphic small to intermediate sized lymphoid cells, Sparsely cellular and contains atypical lymphoid cells, Suspicious for malignancy, not otherwise specified, Other primary thyroid malignancies like anaplastic carcinoma and poorly differentiated carcinoma, Suboptimal cellularity or preservation can lead to uncertainty and result in a suspicious for malignancy interpretation, Usually surgical management similar to that of malignant nodules (, In suspicious for papillary thyroid carcinoma cases with low risk features ( 1 cm, without extrathyroidal extension and clinical metastasis), active surveillance is an option (, Molecular testing with high positive predictive value (, For suspicious for medullary thyroid carcinoma, Measuring serum calcitonin level or calcitonin immunostaining are recommended (, Repeat fine needle aspiration to obtain cells for flow cytometry (, A few follicular cells showing nuclear enlargement, pale and powdery chromatin and nuclear grooves are present, Correlation with serum calcitonin level or immunostaining might be helpful for definitive diagnosis if clinically indicated, Re-aspiration for flow cytometry might be helpful to better characterize the lymphocyte population if clinically indicated, Microfollicular architecture with minimal nuclear features of, Trabecular growth pattern of the cells with nuclear grooves and abundant nuclear pseudoinclusions, intratrabecular hyaline material, Nuclear changes of follicular cells with focal enlargement, grooves, prominent nucleoli and chromatin clearing in the lymphocytic background, An abundance of lymphocytes and plasma cells does not exclude the possibility of a coexisting, Numerous lymphocytes, few follicular cells, Elongated cells with pale chromatin, nuclear grooves and relatively large nucleoli, Spindle shaped morphology of the cell and nucleus, reminiscent of reparative epithelium in cervical Pap smears, Follicular variant of papillary thyroid carcinoma. In general, patients diagnosed with FNA test as having PTC, are usually managed operatively, but the final decision of the type of resection (lobectomy vs total thyroidectomy) depends on numerous coexisting factors. et al. The most common scenarios can be described as follows: There is a prominent population of microfollicles in an aspirate that does not otherwise fulfill the criteria for follicular neoplasm/suspicious for follicular neoplasm. This situation may arise when a predominance of microfollicles is seen in a sparsely cellular aspirate with scant colloid. Lerma E, Arguelles R, Rigla M, Otal C, Cubero JM, Bagu S, Carreras AM, Eulalia E, Gonzalez-Campora R, Galera H, et al. These formalin specimens are embedded in paraffin blocks and sectioned by histotechnologists to provide a two-dimensional cross-section of the clotted tissue. Lymphoepithelial cyst. Extra smeared slides are kept unstained for possible subsequent ancillary staining (e.g., MPO, PAS, esterases). Ghossein This interpretation applies to cellular samples that are composed exclusively (or almost exclusively) of Hrthle cells. Rubenfeld In this study the AUS category was further subdivided into HCLUS (atypical cells rule out Hurthle cell neoplasm) and FLUS. Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Thyroid FNA specimen a. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. Rossi Cibas This category includes specimens with unequivocal cytologic evidence of a malignant neoplasm. Like the marrow aspirate smear, touch imprint preparations provide a quick turnaround time (i.e., do not need decalcification) and great morphologic detail (if the aspirate smears are paucispicular or hemodiluted). Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009. The atypia of undetermined significance/follicular lesion of undetermined significance: malignant ratio: a proposed performance measure for reporting in The Bethesda System for thyroid cytopathology. Nuclear grooves become an important diagnostic feature when associated with an oval, enlarged nucleus with fine chromatin[41]. endstream endobj startxref The 6 general diagnostic categories are shown in bold type in Table 1. SL Half of patients present with significant compression of the upper respiratory and the digestive tract in the neck, resulting in dyspnea, hoarseness, dysphagia, and pain. Handle sparsely cellular specimens ii. It is the hope of all contributors to this project that this terminology proposal will be a valuable first step toward uniformity and consensus in the reporting of thyroid FNA interpretations. These specimens are differentially used to study morphology, assess lineage, perform cell counts and differentials, triage and send for appropriate immunohistochemical stains, perform flow cytometry, and send ancillary cytogenetic and molecular genetic studies. An AUS result is obtained in 3% to 6% of thyroid FNAs.2,10 Higher rates likely represent overuse of this category when other interpretations are more appropriate. VA Fine-needle aspiration cytology (FNAC) has been widely adopted as a meticulous, secure and cost-effective method for the diagnosis of non-toxic thyroid nodules[1,2]. Guidelines for management of thyroid cancer. Herein, all histological types of thyroid carcinoma are included: PTC and its variants, medullary carcinoma, anaplastic carcinoma, lymphoma, and metastatic lesions. A significant proportion of these cases (16%25%) prove not to be neoplasms but rather hyperplastic proliferations of Hrthle cells in nodular goiter or lymphocytic thyroiditis.26,27 About 15% to 45% of nodules are malignant, and the remainder of the neoplasms prove to be Hrthle cell adenomas.22,26,27, Many thyroid cancers, most especially papillary thyroid carcinoma (PTC), can be diagnosed with certainty by FNA. Any specimen that contains abundant colloid is adequate (and benign), even if six groups of follicular cells are not identified: a sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and therefore almost certainly benign. The heterogeneity of this category precludes outlining all scenarios for which an AUS interpretation is appropriate. Yassa This category includes specimens with features characteristic of a malignant neoplasm, which are quantitatively or qualitatively insufficient to make a definitive diagnosis of malignancy (Figure (Figure4).4). To collect as many cells as possible from sparsely cellular urine, the specimen should have which of the following techniques applied? Help . Pedro Patricio de Agustin, MD, PhD, Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain, Erik K. Alexander, MD, Department of Medicine, Brigham and Womens Hospital, Boston, MA, Sylvia L. Asa, MD, PhD, Department of Pathology and Laboratory Medicine, University of Toronto; University Health Network and Toronto Medical Laboratories; Ontario Cancer Institute, Toronto, Canada, Kristen A. Atkins, MD, Department of Pathology, University of Virginia Health System, Charlottesville, Manon Auger, MD, Department of Pathology, McGill University Health Center and McGill University, Montreal, Canada, Zubair W. Baloch, MD, PhD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Katherine Berezowski, MD, Department of Pathology, Virginia Hospital Center, Arlington, Massimo Bongiovanni, MD, Department of Pathology, Geneva University Hospital, Geneva, Switzerland, Douglas P. Clark, MD, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, Batrix Cochand-Priollet, MD, PhD, Department of Pathology, Lariboisire Hospital, University of Paris 7, Paris, France, Barbara A. Crothers, DO, Department of Pathology, Walter Reed Army Medical Center, Springfield, VA, Richard M. DeMay, MD, Department of Pathology, University of Chicago, Chicago, IL, Tarik M. Elsheikh, MD, Ball Memorial Hospital/PA Labs, Muncie, IN, William C. Faquin, MD, PhD, Department of Pathology, Massachusetts General Hospital, Boston, Armando C. Filie, MD, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, Pinar Firat, MD, Department of Pathology, Hacettepe University, Ankara, Turkey, William J. Frable, MD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Kim R. Geisinger, MD, Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, Hossein Gharib, MD, Department of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, Ulrike M. Hamper, MD, Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD, Michael R. Henry, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN, Jeffrey F. Krane, MD, PhD, Department of Pathology, Brigham and Womens Hospital, Boston, MA, Lester J. Layfield, MD, Department of Pathology, University of Utah Hospital and Clinics, Salt Lake City, Virginia A. LiVolsi, MD, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Britt-Marie E. Ljung, MD, Department of Pathology, University of California San Francisco, Claire W. Michael, MD, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Ritu Nayar, MD, Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, Yolanda C. Oertel, MD, Department of Pathology, Washington Hospital Center, Washington, DC, Martha B. Pitman, MD, Department of Pathology, Massachusetts General Hospital, Boston, Celeste N. Powers, MD, PhD, Department of Pathology, Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center, Richmond, Stephen S. Raab, MD, Department of Pathology, University of Colorado at Denver, UCDHSC Anschutz Medical Campus, Aurora, Andrew A. Renshaw, MD, Department of Pathology, Baptist Hospital of Miami, Miami, FL, Juan Rosai, MD, Dipartimento di Patologia, Instituto Nazionale Tumori, Milano, Italy, Miguel A. Sanchez, MD, Department of Pathology, Englewood Hospital and Medical Center, Englewood, NJ, Vinod Shidham, MD, Department of Pathology, Medical College of Wisconsin, Milwaukee, Mary K. Sidawy, MD, Department of Pathology, Georgetown University Medical Center, Washington, DC, Gregg A. Staerkel, MD, Department of Pathology, the University of Texas M.D. The difficulties in securing diagnosis of a diffuse large B-cell lymphoma derive from the inadequate sampling technique and/or insufficient preservation of the specimen. Alexander Since the marrow is abundantly deep red and more viscous than blood, the red cell and platelet components will eventually form clots if no anticoagulant is present. The management of cases with papillary microcarcinomas, i.e., tumors less than 1.0 cm in diameter, is still controversial. French In short, bone marrow analyses yield dynamic results, informing clinical diagnostics and treatment plans. Immunohistochemistry test for specific biomarkers (i.e., calcitonin, thyroglobulin) will easily distinguish MTC from other thyroid malignancies. Deveci Agarwal A, Kocjan G. FNAC thyroid reporting categories: value of using the British Thyroid Association (Thy 1 to Thy 5) thyroid FNAC reporting guidelines. hb```f``jg`e`bf@ a=TbO>9\!@)s\2q F)}w38|)0KQD[Vi>Rc@8[@5ii` .Q@q!d - `' }i@&QAz@%,700g& pL`r, l|Bj2"BTg]((@G@{2L2xVWA0Kk3\2 Ii Because of the densely cellular composition of bone marrow, the imprints impart many cells directly on the slides. Reduce red blood cells in smears iii. However, some three dimensional structures that resemble the epithelial tips of papillae without the fibrovascular cores can be seen[35]. Such atypia may result from a variety of benign cellular changes, but in some cases may reflect an underline malignancy which has been suboptimally sampled or has intermediate diagnostic features[20-22]. However, nuclear grooves can be seen also in several thyroid diseases such, as Hashimotos thyroiditis, multinodular goiter, Hurthle cell tumors and medullary carcinoma[42,43]. Bethesda, MD 20894, Web Policies Various diagnostic terminologies, including indeterminate, atypical, and suspicious for malignancy, were used to describe these challenging cases[5]. EK Some thyroid FNAs are not easily classified into the benign, suspicious, or malignant categories. G Renshaw AA. "Demystifying the Bone Marrow Biopsy: A Hematopathology Primer." If the tumor is small and confined to the thyroid, thyroidectomy may be feasible; however, in most cases the tumor extends outside the thyroid gland preventing adequate resection[35]. The risk of malignancy in the HCLUS category was significantly lower than in the other subtypes of AUS. Goellner Any specimen that contains abundant colloid is considered adequate (and benign), even if 6 groups of follicular cells are not identified: A sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and, therefore, almost certainly benign. A benign result is obtained in 60% to 70% of thyroid FNAs. These alterations were made in order for the British system to be analogous to the BSRTC[11,16], although in other countries these modifications have not be totally embraced. This category is reserved for aspirates with borderline cellularity and is subdivided into two subcategories. The FNA specimens show enlarged follicular cells arranged in monolayer sheets and follicular groups in a background of thin and thick colloid (Figure (Figure6).6). Hay Cibas ES, Ali SZ. Understanding the capabilities and potential within each component may explain both the process and usefulness of obtaining optimal specimens and elucidate exactly how tissue is evaluated. Deveci Report of the Thyroid Cancer Guidelines Update Group. In addition, Ohori et al[61] investigated the utility of the above panel in specimens classified as FLUS. et al. A specimen is considered as suspicious for malignancy (SFM), when some features of malignancy (usually PTC features) exist, but the findings are not sufficient for a definitive diagnosis[9]. In addition, obtaining adequate material at FNA is a very important issue, as the rates of malignancy observed in the nondiagnostic categories of both reporting systems are very high[14]. Contribution of molecular testing to thyroid fine-needle aspiration cytology of follicular lesion of undetermined significance/atypia of undetermined significance. For a thyroid FNA specimen to be satisfactory for evaluation (and benign), at least 6 groups of benign follicular cells are required, each group composed of at least 10 cells.6,7 The minimum size requirement for the groups allows one to determine (by the evenness of the nuclear spacing) whether they represent fragments of macrofollicles. 144 0 obj <>stream A serum protein electrophoresis might have even shown a monotypic expansion. Approximately 3% to 7% of thyroid FNAs have conclusive features of malignancy, and most are papillary carcinomas.1013 Malignant nodules are usually removed by thyroidectomy, with some exceptions (eg, metastatic tumors, non-Hodgkin lymphomas, and undifferentiated carcinomas). It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. official website and that any information you provide is encrypted Proposal of the SIAPEC-IAP Italian Consensus Working Group. Clark DP, Faquin WC. . The nuclear chromatin appears as salt and pepper type in a medullary carcinoma case ( 40 pap stain on ThinPrep slide) (diagnostic categories VI). You can now find us in many convenient retail stores, including select Walmart and Target locations. moc.oohay@sokaisime. (A) A representative case classified as diagnostic category (DC) III (atypia of undetermined significance) showing sparsely cellular specimen (x15; scale bar, 200 m). Krane JF, Vanderlaan PA, Faquin WC, Renshaw AA. Yang (B) A case diagnosed as DC IV (suspicious for a follicular neoplasm) shows moderately cellular specimen with abundant microfollicles (x15; scale bar, 200 m) (C-F) Architectural alterations such as microfollicles (C and D), 3-dimensional branching (E), and architectural crowding (F) are frequently observed in cases categorized as DC IV PU Some categories have 2 alternative names; a consensus was not reached at the NCI conference on a single name for these categories. Bone core biopsy. In this selected population, 20% to 25% of patients with AUS prove to have cancer after surgery, but this is undoubtedly an overestimate of the risk for all AUS interpretations.2,10 The risk of malignancy is certainly lower and probably closer to 5% to 15%. et al. The main purpose of thyroid FNA is to stratify higher risk patients for surgery, and to prevent unnecessary surgeries for benign conditions. VA Q: Can flow cytometry be performed on the core biopsy? The prepared core biopsy slides can be used for immunohistochemical (IHC) investigations (phenotyping the cells using IHC stains), and an initial standard hematoxylin and eosin stain is done to assess baseline histology. Macrofollicular variant of papillary carcinoma: a potential thyroid FNA pitfall, Focal features of papillary carcinoma of the thyroid in fine-needle aspiration material are strongly associated with papillary carcinoma at resection, Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: follow-up and management, American Society for Clinical Pathology, The Clinical Laboratory Is an Integral Component to Health Care Delivery : An Expanded Representation of the Total Testing Process, Transformations of marginal zone lymphomas and lymphoplasmacytic lymphomas: Report from the 2021 SH/EAHP Workshop, Validation of a rapid HLA-DQA1*05 pharmacogenomics assay to identify at-risk resistance to antitumor necrosis factor therapy among patients with inflammatory bowel disease, Lessons learned from patient outcomes when lowering hemoglobin transfusion thresholds during COVID-19 blood shortages, Phenotypic and genotypic infidelity in B-lineage neoplasms, including transdifferentiation following targeted therapy: Report from the 2021 SH/EAHP Workshop, About American Journal of Clinical Pathology, About the American Society for Clinical Pathology, Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance, Follicular Neoplasm or Suspicious for a Follicular Neoplasm, Appendix 1 Bethesda Thyroid Atlas Contributors, Receive exclusive offers and updates from Oxford Academic, Assessment of The Bethesda System for Reporting Thyroid Cytopathology: Surgical and Long-Term Clinical Follow-up of 2,893 Thyroid Fine-Needle Aspirations, Impact of the Reclassification of Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma to Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on the Bethesda System for Reporting Thyroid Cytopathology: A Large Academic Institutions Experience, Neutrophil-Rich Ki-1Positive Anaplastic Large Cell Lymphoma: A Study by Fine-Needle Aspiration Biopsy, Kuttner Tumor of the Submandibular Gland: Fine-Needle Aspiration Cytologic Findings of Seven Cases. BRAF mutation has become a specific marker for PTC and its variants[54]. Thus, our aim was to standardize a manual, simple, cost-effective innovative technique, namely, ACS to process clear/sparsely cellular specimens and also to compare ACS smears along with cytocentrifuged specimens which were used as control smears. Since this is a liquid sample, it does not need to undergo decalcification, can be smeared onto a slide and stained relatively quickly, used for flow cytometry (which needs unfixed, liquid cells), and sent fresh for molecular analysis. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Yang Neither of these patterns fits comfortably into the benign category, but the changes are insufficient for any of the more . Until recently there were no uniform criteria for the various diagnostic categories in thyroid cytopathology. This document summarizes several years of work, begun as a Web-based discussion, followed by a live conference, and culminating in the production of a print and online atlas. Recognizably benign cellular changes (eg, typical cyst lining cells, focal Hrthle cell change, changes ascribed to radioiodine therapy, black thyroid) should not be interpreted as AUS. Lin The presence of true psammoma bodies with concentric laminations is highly suggestive of PTC; however the presence of psammoma bodies in cystic thyroid lesions is not diagnostic. The impact of atypia/follicular lesion of undetermined significance on the rate of malignancy in thyroid fine-needle aspiration: evaluation of the Bethesda System for Reporting Thyroid Cytopathology. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. PK Figure 5. et al. Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, Langer JE, Gupta PK. It is a point of great significance that Ohori et al[56] found a greater percentage of BRAF-mutated (V600E, K601E, and others) cases in the AUS/FLUS and SFN/SFN categories, rendering BRAF mutational testing a useful predictor of PTC diagnosis in these indeterminate cases. VA Giorgadze We thank Diane Solomon, MD, for review of the manuscript and helpful comments. The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. The molecular diagnosis and management of thyroid neoplasms. In part, each component is analyzed and interpreted in correlation together for a final report. How does one separate cellular follicular lesions of the thyroid by fine-needle aspiration biopsy? Some cases may present with diagnostic difficulty if the specimen consists mainly of necrotic debris or if the tumor is extremely sclerotic (the paucicellular variant)[40,53]. T Human immunodeficiency virus (HIV)-associated cystic lymphoepithelial lesions. The Bethesda System for Reporting Thyroid Cytopathology is the most widely used system for the diagnosis of thyroid FNA specimens. PG {t+[O-]:KtJE]+ZhoZo$ZfqemI,W69l]g]EuGnWMGow" elP~G>6?{LsTY?R+-jW:E#x( xtT} . Neutrophils are the same as WBCs, and as you know, it is normal to gave some WBCs in the urine. VA Cystic degeneration also is often found. However in doubtful cases definitive diagnosis can be made if sufficient material is available for immunocytochemical stains, or if it is known that the patient has an elevated serum calcitonin level. In a study that segregated CFO cases and analyzed them separately, the risk of malignancy for a CFO sample was 4%.9 The risk of malignancy for ND/UNS (not including CFO) is 1% to 4%.810, The Bethesda System for Reporting Thyroid Cytopathology: Recommended Diagnostic Categories*, The Bethesda System for Reporting Thyroid Cytopathology: Implied Risk of Malignancy and Recommended Clinical Management, A repeated aspiration with ultrasound guidance is recommended for ND/UNS and clinically or sonographically worrisome CFO cases and is diagnostic in 50% to 88% of cases,2,6,9,11,13,14 but some nodules remain persistently ND/UNS. Once obtained, the core biopsy is used to make touch preps (discussed below) and then is transferred into a container with appropriate fixative (usually formalin) and sent to the laboratory for processing. Fleisher Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L, Kloos RT, LiVolsi VA, Mandel SJ, et al. Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. This category also includes cases with a predominant population of Hurthle cells; these cases are labelled Hurthle cell neoplasm (Figure (Figure3).3). The four components of a routine bone marrow analysis. A uniform reporting system for thyroid FNA will facilitate effective communication among cytopathologists, endocrinologists, surgeons, radiologists, and other health care providers; facilitate cytologic-histologic correlation for thyroid diseases; facilitate research into the epidemiology, molecular biology, pathology, and diagnosis of thyroid diseases, particularly neoplasia; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies. FOIA Preparations for the conference began 18 months earlier with the designation of a steering committee, coordination with cosponsoring organizations, and the establishment of a dedicated, permanent Web site. Vimentin immunoexpression is also a common finding[52].

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