Fine-needle aspiration (FNA) is an important test for triaging patients with thyroid nodules. The 2007 National Cancer Institute Thyroid Fine-Needle Aspiration State-of-the-Science Conference helped instigate the recent publication of The Bethesda System for Reporting Thyroid Cytopathology. We reviewed 3,080 thyroid FNA samples and recorded interpretations according to the proposed standardized 6-tier nomenclature, and pursued follow-up cytology and histology. Of the 3,080 FNAs, 18.6% were nondiagnostic, 59.0% were benign, 3.4% were atypical follicular lesion of undetermined significance (AFLUS), 9.7% were "suspicious" for follicular neoplasm (SFN), 2.3% were suspicious for malignancy (SM), and 7.0% were malignant. Of 574 cases originally interpreted as nondiagnostic, 47.9% remained nondiagnostic. In 892 cases, there was follow-up histology. Rates of malignancy were as follows: nondiagnostic, 8.9%; benign, 1.1%; AFLUS, 17% (9/53); SFN, 25.4%; SM, 70% (39/56), and malignant, 98.1%. Thus, classification of thyroid FNA samples at the University of Virginia Health System, Charlottesville, according to The Bethesda System yields similar results for risk of malignancy as reported by others. Universal application of the new standardized nomenclature may improve interlaboratory agreement and lead to more consistent management approaches.

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BACKGROUND: Fine‐needle aspiration (FNA) is a rapid and accurate procedure for the detection of breast carcinomas. The evaluation of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression by immunohistochemistry (IHC) is performed routinely on formalin‐fixed, paraffin‐embedded needle‐core (NC) or excision tissue block (TB) preparations, according to the American Society of Clinical Oncology/College of American Pathologist guidelines. In this retrospective study, the authors compared expression levels of ER, PR, and HER2 in ethanol‐fixed BC FNA cell block (CB) samples with expression levels in formalin‐fixed NC and TB samples. METHODS: Forty‐one breast carcinoma CB samples with concurrent or subsequent NC and TB samples were identified. Patients who had received neoadjuvant or adjuvant chemotherapy were excluded. CB samples initially were fixed in 50% ethanol (4‐12 hours), and this was followed by formalin fixation (minimum, 6 hours). NC samples were placed promptly in formalin for a minimum of 6 hours. Within 4 to 8 hours, TB samples were fixed in formalin for 6 to 48 hours. Fluorescence in situ hybridization (FISH) results were also compared. RESULTS: IHC for ER on alcohol‐fixed CB samples had good correlation with NC and TB samples. PR results on TB samples had excellent agreement with NC samples. A higher discordance rate wais observed when PR results were compared between CB samples and NC samples. HER2 detection on ethanol‐fixed CB samples resulted in a higher rate of positive and equivocal staining than NC or TB samples. HER2 IHC on TB samples demonstrated better correlation with FISH results than CB or NC samples. CONCLUSIONS: Alcohol fixation did not affect ER results in breast carcinoma, but it may alter tumor cell PR antigenicity. The authors concluded that CB samples could be used to triage patients for tamoxifen therapy, but they are not reliable for the assessment of HER2 status; therefore, CB results should be correlated with results from NC or TB samples. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.