Guido Fadda

Italian consensus for the classification and reporting of thyroid cytology

Thyroid nodules are diagnosed with increasing frequency in clinical practice. The first step in the management of patients presenting with thyroid nodules is an accurate triage of those who should be referred to surgery [1–5]. In spite of the advances in ultrasound (US) imaging [6–8] and the promising results of molecular analysis [9–16], this basic step still strongly relies on cytology [3]. Among the acronyms used to indicate the sampling technique for thyroid cytology (FNA, FNAB, FNAC, FNC), fine-needle aspiration (FNA) is the most frequently adopted and it will be employed in this document. When the cytologic specimen is obtained without aspiration the term FNC (fine-needle cytology) may be used [2]. In the recent years, a variety of fourto six-tiered reporting schemes for thyroid cytology have been proposed by different societies and institutions, with the aim of improving the communication between cytopathologists and clinicians [17]. With the aim to standardize the diagnostic terminology in thyroid FNA, in 2007 the United States National Cancer Institute (NCI) has proposed a reporting system for thyroid cytology based on the NCI Thyroid FNA State-Of-Science Consensus Conference [18]. This system has gained wide diffusion and the atlas ‘‘The Bethesda System for Reporting Thyroid Cytology’’ (BSRTC) provided well-defined criteria with exhaustive explanatory notes [19]. Following the recommendations of the 2009 European Federation of Cytology Societies (EFCS) symposium aiming at the worldwide unification of the reporting systems for thyroid cytology [20], a working group of the Royal College of Pathologists (RCPath) updated the reporting system already in use in UK since 2007 [21] using criteria that are similar to those used in BSRTC [22]. In Italy, a 5-tiered classification, proposed in 2007 by the Italian Society for Anatomic Pathology and Cytology joint with the Italian Division of the International Academy of Pathology (SIAPEC-IAP) [2], is currently used by most institutions. In 2012 the Italian Societies of Endocrinology, i.e., the Italian Thyroid Association (AIT), the Italian Association of Clinical Endocrinologists (AME), the Italian Society of Endocrinology (SIE) and the SIAPEC-IAP appointed a working panel of experts to update the former consensus in line with the indications of the EFCS. The present document provides a reporting scheme for thyroid cytology and the suggested clinical actions. This Consensus is not meant to address in detail all the morphological All authors contributed equally to this work.

Metastases to the thyroid gland: prevalence, clinicopathological aspects and prognosis: a 10-year experience.

Background  Metastases to thyroid (TM) are rarely observed in the clinical practice.

Antibacterial activity of ozonized sunflower oil (OLEOZON)

L.A. SECHI, I. LEZCANO, N. NUNEZ, M. ESPIM, I. DUPRÈ, A. PINNA, P. MOLICOTTI, G. FADDA AND S. ZANETTI. 2001.

Safety of video‐assisted thyroidectomy versus conventional surgery

Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video‐assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT.

Follicular thyroid neoplasms can be classified as low- and high-risk according to HBME-1 and Galectin-3 expression on liquid-based fine-needle cytology

DESIGN Fine-needle aspiration biopsy (FNAB) is the most reliable diagnostic tool in the diagnosis of thyroid nodules. A cytologic diagnosis of follicular neoplasm with atypical cells of undetermined significance (FN/AUS) implies that the selection of patients between surgery and follow-up is difficult. In this setting immunocytochemical stainings might be helpful. The efficacy of a panel made up of HBME-1 and Galectin-3 antibodies is evaluated in cases processed by liquid-based cytology (LBC). METHODS Out of 7091 thyroid FNAB processed by LBC method, 120 cases undergoing surgery successively were selected. These cases were classified as benign lesion (BL, eight cases), FN, including the ACUS category of the Bethesda classification (FN/AUS, 50 cases), suspicious for malignancy (SM, 59 cases), and malignant neoplasm (MN, three cases). Immunostains for HBME-1 and Galectin-3 were carried out on the LBC slides. RESULTS All MN and BL were histologically confirmed. FN/AUS and SM showed a malignancy risk of 24 and 72.9% respectively. The complete immunocytochemical panel was positive in 83.3% of the cases resulting in malignancy and negative in 87.5% of cases resulting in benign histology. Among the FN/AUS, the complete positive immunocytochemical panel was detected in 76.9% of cases resulting as malignant and the complete negative immunocytochemical panel was observed in 96.8% of cases resulting as benign at histology. CONCLUSIONS The expression of HBME-1 and Galectin-3 in cases classified as FN/AUS on LBC-processed FNABs can effectively distinguish lesions, which need immediate surgery (high risk or FNH or Thy 3h) from those which can be followed-up (low risk or FNL or Thy 3l).

Liquid-based cytology in fine-needle aspiration biopsies of the thyroid gland

Objectives: Fine-needle aspiration biopsy is regarded as the most important diagnostic tool for thyroid lesions because of its simplicity, safety, and cost-effectiveness. However, its pivotal role in the correct characterization of the majority of nodules is impaired by the difficulties in discriminating benign from malignant follicular-patterned lesions. Study Design: Liquid-based cytology (LBC) is a semiautomated device that has recently become widely available and has gained popularity as a method of collecting and processing both gynecologic and nongynecologic cytologic specimens. It achieves a diagnostic sensitivity as accurate as conventional preparations, especially for its excellent cell preservation and lack of background which decrease the amount of inadequate diagnoses. Results: In many cases the cytologic features are similar in both methods, but the colloid film and the lymphocytic component are more easily evaluated on direct smears whereas nuclear details and colloid globules are better evaluated in LBC slides. The material stored in the preservative solution could be effectively used for the application of immunocytochemical and molecular techniques. Conclusions: LBC-processed biopsies represent a valid alternative to conventional cytology. The possibility of applying additional techniques enhances the efficacy of the cytologic diagnosis of thyroid lesions.

Distribution of virulence genes in Aeromonas spp. isolated from Sardinian waters and from patients with diarrhoea

Aims: To characterize 46 isolates of different Aeromonas spp. strains (26 Aeromonas hydrophila, 13 Aeromonas sobria and 7 Aeromonas salmonicida) isolated from coastal water and clinical sources in Sardinia, Italy.

In vitro susceptibility of Vibrio spp. isolated from the environment

Bacteria of the genus Vibrio include harmless aquatic strains as well as strains capable of causing epidemics of cholera and human intestinal diseases. Some of these species may show resistance to different antibiotics including cefotaxime, tetracycline and chloramphenicol. The susceptibility to different antibiotics was tested using 40 Vibrio alginolyticus, eight V. parahaemolyticus and six V. vulnificus strains isolated in the coastal waters of Northern Sardinia (Italy). The frequency of resistance to beta-lactams was unexpectedly high. More than 80% of Vibrio isolates were resistant to ampicillin and 2.5% of V. alginolyticus were resistant to ceftazidime and cefotetan. Forty percent of V. alginolyticus and three V. vulnificus isolates gave a positive nitrocefin test. PCR was also performed using selected primers chosen for having common sequences of bla(TEM) and bla(SHV) genes.

Simultaneous immunohistochemical expression of HBME-1 and galectin-3 differentiates papillary carcinomas from hyperfunctioning lesions of the thyroid

Aims : The histological diagnosis is critical for the postsurgical management and follow‐up of thyroid malignancies. The differential diagnosis between papillary carcinoma and hyperfunctioning lesions, either with papillary hyperplasia or with a follicular architecture, can create real diagnostic difficulty. The aim of this study was to evaluate the expression of several antibodies considered to be markers of malignancy in malignant and hyperfunctioning thyroid neoplasms and to include the most effective of them in a diagnostic panel.

BRAF (V600E) mutation analysis on liquid-based cytology-processed aspiration biopsies predicts bilaterality and lymph node involvement in papillary thyroid microcarcinoma

Activating mutations in the valine‐to‐glutamic acid substitution at position 600 of the v‐raf murine sarcoma viral oncogene homolog B1 (BRAF‐1) gene are detected frequently in patients with papillary thyroid carcinoma (PTC). These mutations have been identified in approximately 29% to 69% of PTCs and in >80% of PTCs of the tall cell variant, whereas they have not been detected in benign lesions or in the majority of those (80%) with the follicular variant of PTC. The objective of the current study was to evaluate the role of liquid‐based cytology (LBC) for the detection of BRAF mutations in the outcome of patients who have thyroid PTC measuring ≤1 cm and, hence, in guiding their clinical and surgical management.