The previous edition of The Bethesda System for Reporting Thyroid Cytopathology provided important updates and advances in the practice of thyroid cytopathology. It was inspired by new developments in the field of thyroid cytopathology since the publication of the first edition in 2010. These included revised clinical guidelines for the management of patients with thyroid nodules, the introduction of molecular testing as an adjunct to cytopathologic examination, and the reclassification of the non-invasive follicular variant of papillary thyroid carcinoma as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).
This new third edition provides updates to the current reporting terminology and diagnostic criteria, including new information on ancillary molecular testing, as well as imaging findings and clinical management. This book provides a more unified approach to diagnosing and reporting thyroid FNA interpretations. It simplifies the reporting structure by settling on just one name for each of the six categories and aligning terminology with the most recent classification of thyroid tumors by the World Health Organization.Written by experts in the field, The Bethesda System for Reporting Thyroid Cytopathology, Third Edition aims to inspire advances in thyroid cytopathologic diagnosis and the betterment of patients with thyroid nodular disease. It serves as a reference guide not just for pathologists, but also endocrinologists, surgeons, and radiologists.
Author(s): Syed Z. Ali, Paul A. VanderLaan
Edition: 3
Publisher: Springer
Year: 2023
Language: English
Pages: 291
City: Cham
Foreword
Contents
1: Overview of Diagnostic Terminology and Reporting
Format of the Report
References
2: Nondiagnostic
Background
Definition
Criteria for Adequacy
Nondiagnostic
Explanatory Notes
Management
Sample Reports
References
3: Benign
Introduction
Follicular Nodular Disease
Background
Definition
Criteria
Explanatory Notes
Graves’ Disease
Lymphocytic Thyroiditis
Background
Definition
Criteria
Granulomatous (de Quervain) Thyroiditis
Criteria
Acute Suppurative Thyroiditis
Criteria
Riedel Thyroiditis/Disease
Criteria
Explanatory Notes
Management
Sample Reports
References
4: Atypia of Undetermined Significance
Background
Definition
Criteria
AUS with Nuclear Atypia
Focal Nuclear Atypia (Fig. 4.1)
Extensive But Mild Nuclear Atypia (Fig. 4.2)
Atypical Cyst Lining Cells (Fig. 4.3)
“Histiocytoid” Cells (Fig. 4.4)
Nuclear and Architectural Atypia (Fig. 4.5)
AUS-Other
Architectural Atypia (Figs. 4.6, 4.7, and 4.8)
Oncocytic/Oncocyte Atypia (Figs. 4.9 and 4.10)
Atypia, Not Otherwise Specified (NOS) (Figs. 4.11, 4.12, and 4.13)
Atypical Lymphoid Cells, Rule Out Lymphoma (Fig. 4.14)
Explanatory Notes
Management
Sample Reports
References
5: Follicular Neoplasm
Background
Definition
Criteria for FN Cases
Cellularity
Architecture
Cytoplasm
Nuclei
Most Common Scenario (i.e., The “Typical” FN Scenario)
Infrequent Scenario (i.e., The “Potential NIFTP/FVPTC” Scenario)
Other Features
Explanatory Notes
More About NIFTP (and FVPTC)
Short Notes About the Molecular Features of FN and NIFTP
Risk of Malignancy
Differential Diagnosis of FN
Cyto-Histologic Correlation
Management
Sample Reports
References
6: Follicular Neoplasm (Oncocytic Follicular Neoplasm)
Background
Definition
Criteria
Explanatory Notes
Minimum Necessary Criteria
The Sparsely Cellular Specimen Composed Entirely of Oncocytes and Frequently in a Background of Blood
The Cellular Specimen Composed Entirely of Oncocytes Without Atypia
The Clearly Abnormal Specimen with Partial or Minimal Oncocytic Differentiation
The Clearly Abnormal Specimen with Colloid
Oncocytic Proliferations in Patients with Multinodular Goiter or Lymphocytic Thyroiditis
Distinction from Other Tumors
Management
Sample Reports
References
7: Suspicious for Malignancy
Background
Definition
Criteria
Suspicious for Papillary Thyroid Carcinoma
Patchy Nuclear Changes Pattern (Figs. 7.1 and 7.2)
Incomplete Nuclear Changes Pattern (Fig. 7.3)
Sparsely Cellular Specimen Pattern
Cystic Degeneration Pattern (Fig. 7.4)
Suspicious for Medullary Thyroid Carcinoma (Figs. 7.5, 7.6, and 7.7)
Suspicious for Lymphoma (Fig. 7.8)
Suspicious for Malignancy, Not Otherwise Specified
Explanatory Notes
Suspicious for Papillary Thyroid Carcinoma
Suspicious for Medullary Thyroid Carcinoma
Suspicious for Lymphoma
Suspicious for Malignancy, Not Otherwise Specified
Management
Role for Ancillary Studies
Sample Reports
References
8: Papillary Thyroid Carcinoma, Subtypes, and Related Tumors
Background
Conventional (Classic) Papillary Thyroid Carcinoma
Definition
Criteria
Liquid-Based Preparations
Explanatory Notes
Subtypes (Variants) of Papillary Thyroid Carcinoma (PTC)
Follicular Variant of PTC and NIFTP (See Also Chap. 5)
Definitions
Background
How to Distinguish NIFTP from PTC on Cytology?
Macrofollicular Variant of PTC
Definition
Criteria
Explanatory Notes
Cystic PTC
Definition
Criteria
Explanatory Notes
Oncocytic PTC
Definition
Criteria
Explanatory Notes
Warthin-Like PTC
Definition
Criteria
Explanatory Notes
Tall Cell PTC
Definition
Criteria
Explanatory Notes
Columnar Cell PTC
Definition
Criteria
Explanatory Notes
Solid/Trabecular PTC
Definition
Criteria
Explanatory Notes
Diffuse Sclerosing PTC
Definition
Criteria
Explanatory Notes
Hobnail PTC
Definition
Criteria
Explanatory Notes
Related Tumors
Cribriform-Morular Thyroid Carcinoma
Definition
Criteria
Explanatory Notes
Hyalinizing Trabecular Tumor
Definition
Criteria
Explanatory Notes
Management
Sample Reports
References
9: Medullary Thyroid Carcinoma
Background
Definition
Criteria
Explanatory Notes
Management
Sample Reports
References
10: High-Grade Follicular Cell-Derived Non-Anaplastic Thyroid Carcinoma
Background
Definition
Criteria
Explanatory Notes
Molecular Genetics
Management
Sample Reports
References
11: Undifferentiated (Anaplastic) Thyroid Carcinoma
Background
Definition
Criteria
Explanatory Notes
Management
Sample Reports
References
12: Metastatic Tumors, Lymphomas, and Rare Tumors of the Thyroid
Background
Metastatic Renal Cell Carcinoma
Criteria
Explanatory Notes
Metastatic Malignant Melanoma
Criteria
Explanatory Notes
Metastatic Breast Carcinomas
Criteria
Explanatory Notes
Metastatic Pulmonary Carcinomas
Criteria
Non-small Cell Carcinomas
Small Cell Carcinomas
Explanatory Notes
Other Metastatic Malignancies [14]
Lymphoma Involving the Thyroid Gland
Criteria
Explanatory Notes
Extranodal Marginal Zone B-Cell Lymphoma (MALT Lymphoma)
Diffuse Large B-Cell Lymphoma
Hodgkin Lymphoma
Rare Neoplasms of the Thyroid Gland
Paraganglioma
Definition
Criteria
Explanatory Notes
Langerhans Cell Histiocytosis
Definition
Criteria
Explanatory Notes
Mucoepidermoid Carcinoma
Definition
Criteria [29, 30]
Explanatory Notes
Sclerosing Mucoepidermoid Carcinoma with Eosinophilia (SMECE)
Definition
Criteria [31, 32]
Explanatory Notes
Secretory Carcinoma of the Thyroid
Definition
Criteria
Explanatory Notes
Ectopic Thymoma
Definition
Criteria [35–38]
Type A Thymoma (Fig. 12.22)
Type B Thymoma (Fig. 12.23)
Explanatory Notes
Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE)
Definition
Criteria [39–41]
Explanatory Notes
Other Rare Primary Neoplasms of the Thyroid Gland
Management
Sample Reports
References
13: Clinical Perspectives and Imaging Studies
Background: Thyroidology
Risk Stratification with Ultrasound
TI-RADS: Definition and Aims
Indications for FNA
Challenges of the Cytopathologist in the Era of TI-RADS. What Is Expected from the Cytopathologist for each TI-RADS Score?
Management of Nodules Post-FNA
References
14: Molecular and Other Ancillary Tests
Background
Overview of Molecular Changes in Thyroid Neoplasia
DNA-Level Alterations
Gene (mRNA) and microRNA Expression Alterations
Current and Emerging Roles of Molecular Testing for Thyroid FNA Specimens
Refining Cancer Probability in Nodules Classified as AUS and FN
Prognostication of Tumors Based on Molecular Profiles
Identification of Systemic Therapy and/or Clinical Trials Tailored to a Tumor’s Molecular Profile
Screening for Germline Alterations Associated with Hereditary Syndromes
Molecular Testing Platforms Available for Thyroid FNA Specimens
Tests for Oncogenic Mutations and Gene Fusions
Combined Testing Platforms Offered by Reference Laboratories
Conclusions and Future Directions
Sample Reports
References
Index
