The acetic-acid visualization and VIAM methods are recommended for initial cervical cancer screening in the Philippines.

Fine-needle aspiration (FNA) is a well accepted initial approach in the management of thyroid lesions. It has come a long way since its introduction for nearly a century ago. In the Philippines, FNA of the thyroid was first introduced 30 years ago and has been utilized until now as a mainstay in the diagnosis of thyroid malignancy. The procedure is performed by pathologists, endocrinologists, surgeons, and radiologists. Most pathologists report the cytodiagnosis using a combination of the aspiration biopsy cytology method that closely resembles the histopathologic diagnosis of thyroid disorders and the six-tier nomenclature of The Bethesda System for Reporting Thyroid Cytopathology. Local endocrinologists and surgeons follow the guidelines of the 2015 American Thyroid Association in the management of thyroid disorders. There is still a paucity of local research studies but available data deal with cytohistologic correlations, sensitivity, specificity, and accuracy rates as well as usefulness of ultrasound-guided FNA. Cytohistologic correlations have a wide range of sensitivity from 30.7% to 73% and specificity from 83% to 100%. The low sensitivity can be attributed to poor tissue sampling since a majority of the thyroid FNA is done by palpation only. The reliability can be improved if FNA is guided by ultrasound as attested in both international and local studies. Overall, FNA of the thyroid has enabled the diagnosis of thyroid disorders with an accuracy of 72.8% to 87.2% and it correlates well with histopathology.

To the Editor.-We have read the Letter to the Editor by Warrick and Lengerich 1 on ''Thyroid cancer overdiagnosis and malpractice climate'' with interest, that, in our opinion, explained the key difference in thyroid pathology practice between North America and the rest of the world. Significant interobserver variations in benign and malignant thyroid diagnosis have been noted among American and Japanese pathologists since 2002. 2 Notably, Asian pathologists favored a benign diagnosis for gray-zone cases. 2 Even with active participation in international working groups to establish a consensus and use of standardized diagnostic criteria for thyroid tumor diagnosis, the practice has not changed much according to the content of this letter. 1 So-called defensive medicine practiced in North America is not common among pathologists practicing in other countries. When one of us was invited to provide an expert opinion on a lawsuit for a false-positive diagnosis on thyroid fine-needle aspiration (FNA) cytology in Japan, a database of judicial precedents was searched for similar cases. However, there were no previous cases involving thyroid FNA cytology. 3 We conducted a survey among 19 pathologists in 11 countries (

Objectives We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. Methods Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries. Results Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories. Conclusions Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.