Degenerative atypia in benign thyroid nodules: a potential diagnostic pitfall on fine-needle aspiration

Lam, Hansen; Saoud, Carla; Shi, Qiuying; Wong, Kristine; Cibas, Edmund S.; Rooper, Lisa M.; Baloch, Zubair W.; Ali, Syed Z.

doi:10.1016/j.jasc.2023.04.006

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…Endocrine-Type Degenerative Atypia Pronounced endocrine-type cellular atypia is characterized by marked nuclear pleomorphism and bizarre cellular features and is observed in the subset of cases representing clinically benign conditions such as Graves' disease treated with antithyroid drug regimen, dyshormonogenetic goiter, and normal thyroid tissue exposed to irradiation (Fig. 2) [49,50]. In some instances, the preoperative FNAC may be overinterpreted as malignant based on these cellular features, leading to unnecessary surgical intervention.…”

Section: Other Forms Of Cellular Atypiamentioning

confidence: 99%

“…In some instances, the preoperative FNAC may be overinterpreted as malignant based on these cellular features, leading to unnecessary surgical intervention. In a recent series, 4.1% of cases with endocrine-type atypia were false positive for malignancy on preoperative FNAC, thus highlighting the need for careful assessment and review of clinical features of seemingly benign lesions with pleomorphic features [50].…”

Section: Other Forms Of Cellular Atypiamentioning

confidence: 99%

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Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Juhlin,

Baloch

2023

Acta Cytologica

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Background: Thyroid nodules are prevalent among the general population, thus imposing substantial demands upon healthcare providers to establish effective management paradigms when investigating these lesions. A pivotal component in the diagnostic process involves the cytomorphologic evaluation of fine needle aspiration (FNA) specimens extracted from the nodule under scrutiny. This examination serves the critical purpose of enabling a comprehensive assessment for the risk of either a neoplasm or malignancy, thereby providing the clinical team with the requisite information to render decisions regarding potential surgical intervention and/or a structured clinical follow-up. A subset of FNA specimens obtained from the thyroid gland present a vexing challenge for interpretation and cannot be classified based on cytomorphology as either benign or malignant and are classified as “indeterminate” for neoplasm or malignancy. The indeterminate thyroid FNA diagnosis in the third iteration of the Bethesda classification are termed as "atypia of undetermined significance" (AUS). Summary: The thyroid FNA specimens classified as “atypical” constitutes a perplexing category, necessitating considerations such as repeated cytological evaluations, supplementary molecular analyses, diagnostic lobectomy, or vigilant surveillance. This review article draws upon the most recent Bethesda classification guidelines and delineates various potential pitfalls encountered during the interpretation of atypia observed in thyroid fine needle aspiration and histopathologic counterparts. Additionally, it proffers strategic algorithms devised to effectively navigate these diagnostic challenges.

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Section: Other Forms Of Cellular Atypiamentioning

confidence: 99%

Section: Other Forms Of Cellular Atypiamentioning

confidence: 99%

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Juhlin,

Baloch

2023

Acta Cytologica

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“…Fine needle aspiration cytology (FNAC) is a widely accepted screening procedure in diagnosis of diffuse and solitary thyroid nodules and it is a simple, cost effective, minimally invasive and quick to perform procedure [11] . Widespread use of FNAC has reduced number of patients requiring surgery by more than 50%.…”

Section: Introductionmentioning

confidence: 99%

Cytomorphological Profile of Graves' Disease and its Co-relation with anti-TPO Antibody

Shukla,

Pant,

Singh

et al. 2024

JMSH

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Objective: Thyroid diseases are major health problems in our society, which are manifested by alteration in hormone secretion, enlargement of the thyroid gland. FNAC plays a significant role in the diagnosis of thyroid lesions due to its simplicity and low cost and with a diagnostic accuracy rate of 92%. This study was designed to cytomorphological profile of Graves’ disease and its co relation with anti TPO antibody. Materials and Methods: This is a prospective analytical study of fifty patients with clinically enlarged thyroid gland presenting at STG Hospital, Haldwani, Nainital during Oct 2019 to Oct 2022. FNAC smears of these patients were studied and correlated with cytomorphological findings of different types, grades of thyroiditis and hormone level of T4, T3 and T.S.H. Results: Females were mostly affected by thyroid diseases than males. Female patients were 39 (78%) and male patients were 11 (22%). In the present study, patients were in the age group of 13 to 74 years of age. High T3 levels were noted in 80% high T4 levels were found in 90%. Low TSH level was found in only 64%, normal TSH level found in 34% and 2% presented with high TSH level. 34 patients (68%) found high anti-thyroid peroxidase antibody titre >34 U/ml. Cytomorphology revealed moderate to high cellularity in 88% cases, mild to moderate nuclear atypia in 86% and presence of marginal vacuoles in 82%. Lymphocytic infiltrate found in 24% cases and epithelioid cell granuloma in 14% cases. Conclusion: Thyroid cytology proves to be a reliable, simple, and cost-effective first-line diagnostic procedure with high patient acceptance and with rare, usually easily treated and not life-threatening complications. We recommend further studies with a larger population to validate our study. Keywords: Thyroiditis, Graves' Disease, Malignancy Goiter, Histopathology

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Degenerative atypia in benign thyroid nodules: a potential diagnostic pitfall on fine-needle aspiration

Cited by 2 publications

References 24 publications

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Pitfalls in Thyroid Fine-Needle Aspiration Cytopathology: An Approach to Atypical Findings

Cytomorphological Profile of Graves' Disease and its Co-relation with anti-TPO Antibody

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