Virginia A. LiVolsi

Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: A synopsis of the National Cancer Institute Thyroid Fine‐Needle Aspiration State of the Science Conference

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine‐needle Aspiration (FNA) State of the Science Conference on October 22–23, 2007 in Bethesda, MD. The two‐day meeting was accompanied by a permanent informational website and several on‐line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding diagnostic terminology/classification scheme for thyroid FNA interpretation and cytomorphologic criteria for the diagnosis of various benign and malignant thyroid lesions. (http://thyroidfna.cancer.gov/pages/info/agenda/). Diagn. Cytopathol. 2008;36:425–437.

Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast‐conserving surgery and definitive irradiation correlation of pathologic parameters with outcome of treatment

Background. To evaluate the pathologic characteristics of the primary tumor relative to local control, survival, and freedom from distant metastases, an analysis was performed of 172 patients with ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast‐conserving surgery and definitive breast irradiation.

Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: Follow-up and management

Thyroid nodules diagnosed as follicular neoplasm on fine‐needle aspiration biopsy (FNAB) may represent hyperplastic/adenomatous nodules, follicular adenoma or carcinoma, and follicular variants of papillary thyroid carcinoma (FVPTC) on histologic follow‐up. In our laboratory, we attempted to identify a subset of cases which showed cellular specimens with focal features (nuclear chromatin clearing, membrane thickening, and rare grooves) suspicious for the follicular variant of papillary thyroid carcinoma. These cases are reported as follicular‐derived neoplasms with nuclear features suspicious for FVPTC to distinguish them from those diagnosed as follicular neoplasm. This study documents our experience with 52 cases so diagnosed and followed prospectively with histologic follow‐up. A neoplastic nodule was confirmed in 45/52 cases (86%), of which 40 were malignant (77%). FVPTC was identified in 35/52 cases (67%). Four cases were usual papillary carcinoma, 3 were follicular adenoma, 2 were Hürthle‐cell adenoma, and 1 was insular carcinoma. In 7 cases, the subsequent histologic findings were nonneoplastic (5 hyperplastic nodules and 2 colloid nodules). Our prospective study shows that in cellular smears from thyroid nodules, a careful search for the nuclear features of papillary carcinoma should be performed, and it is appropriate to diagnose cases as suspicious for FVPTC if the nuclear features of papillary carcinoma are focal. The surgical management of this group may include an intraoperative confirmation of cytologic diagnosis by scrape preparation and/or frozen section in order to avoid a second surgical intervention for completion thyroidectomy. Diagn. Cytopathol. 2000; 23:380–385.

Ultrasound‐guided fine‐needle aspiration biopsy of the thyroid: Role of on‐site assessment and multiple cytologic preparations

Several studies have shown that ultrasound guidance can serve as a valuable aid in improving the diagnostic yield of fine‐needle aspiration (FNA) biopsy of thyroid nodules. In this study, we evaluated the combined impact of ultrasound‐guidance, rapid on‐site evaluation of FNA specimens, and different cytologic preparations (fresh and alcohol‐fixed smears, Millipore filter) and staining methods (Diff‐Quik and Papanicolaou stains) on the diagnostic yield of thyroid FNA. Ultrasound‐guided FNA was performed on 282 patients (313 cases) between November 1997 and April 1999. The diagnostic categories included: benign (198 cases, 63.2%); indeterminate (42 cases, 13.4%); suspicious for follicular variant of papillary carcinoma (26 cases, 8.3%), malignant (32 cases, 10.1%); and nondiagnostic (15 cases, 5%). The nondiagnostic cases also included 6 cystic lesions without any solid component and 3 thyroid‐bed aspirations. After excluding these, the nondiagnostic rate was only 2%. Histological follow‐up was available in 77 (77/313) cases. The concordance rate between cytological and histological diagnosis was 100% in malignant, 67% in suspicious, and 56% in indeterminate cases. All cases with histologic follow‐up were selected to evaluate the independent diagnostic efficacy of each aforementioned cytologic staining method. A definite diagnosis could be made solely on the basis of air‐dried, Diff‐Quik‐stained preparations in 50 (65%), alcohol‐fixed, Papanicolaou stained smears in 68 (88%), and Millipore filter preparations in 70 (91%) cases. We conclude that ultrasound‐guided FNA combined with on‐site evaluation and different cytologic preparations can significantly improve the diagnostic accuracy of thyroid FNA specimens. Diagn. Cytopathol. 2000;23:425–429.

Thyroid carcinoma in children and adolescents in ukraine after the Chernobyl nuclear accident

The increase in the number of childhood thyroid carcinoma cases in Ukraine after the Chernobyl nuclear accident in 1986 prompted the development of a registry of thyroid carcinoma cases at the Institute of Endocrinology and Metabolism in Kiev. In the current study, the authors report the statistical data and clinicomorphologic features of the cases included in this registry.

Expression and mutation analysis of the p53 gene in uterine papillary serous carcinoma.

Background. The status of p53 protein expression was determined by immunohistochemistry and correlated with genetic analysis and clinical outcome in patients with uterine papillary serous carcinoma (UPSC).

c‐Met expression in tall cell variant papillary carcinoma of the thyroid

Tall cell variant papillary carcinoma of the thyroid demonstrates unusually aggressive clinical behavior compared with the usual form of papillary thyroid carcinoma. The proto‐oncogene c‐met encodes a tyrosine kinase receptor known to influence cell invasion. This current study examined c‐Met expression in tall cell variant tumors compared with other types of papillary thyroid carcinoma and benign thyroid disease.

The cooperative human tissue network. An update

Background. During the past decade, the National Cancer Institute became aware of a lack of availability of human tissues for research, especially in the fields of molecular biology, genetics, and immunology.

Guidelines of the Papanicolaou Society of Cytopathology for the Examination of Cytologic Specimens Obtained from the Respiratory Tract

Cytologic examination of specimens obtained from the respiratory tract is a primary and frequently the initial diagnostic technique performed in patients with respiratory symptoms or in those presenting with a pulmonary abnormality. While occasional cytologic specimens are obtained from the upper respiratory tract, the majority of pulmonary diagnostic cytology involves the study of the lower respiratory tract. The guidelines contained within this document will address evaluation of specimens relating to the lower respiratory system (trachea, bronchi, bronchioles, and alveoli). Due to the complexity of the respiratory tract and the location of various target lesions, a variety of cytologic techniques have been developed for the study of diseases involving the respiratory system. Both exfoliative cytology techniques and fine-needle aspiration (FNA) are used extensively for diagnosis of pulmonary lesions. While respiratory cytology is used predominantly for the study of neoplastic or potentially neoplastic disease, it is also variably useful in the investigation of a variety of benign diseases including opportunistic infections, tuberculosis, sarcoidosis, industrial disease (e.g., asbestosis), and lung transplant rejection.1–24