Introducing the reporting system for thyroid fine-needle aspiration cytology according to the new guidelines of the Japan Thyroid Association [Review]

Abstract

Abstract. The Japan Thyroid Association (JTA) recently published new guidelines for clinical management of thyroid nodules. This paper introduces their diagnostic system for reporting thyroid fine-needle aspiration cytology. There are two points where the new reporting system that differs from existing internationally-accepted ones. The first is the subclassification of the so-called indeterminate category, which is divided into 'follicular neoplasm' and 'others'. The second is the subclassification of follicular neoplasm into 'favor benign', 'borderline' and 'favor malignant'. It is characterized by self-explanatory terminologies as to histological type and probability of malignancy to establish further risk stratification as well as to facilitate communication between clinicians and cytopathologists. The different treatment strategies adopted for thyroid nodules is deeply influenced by the particular diagnostic system used for thyroid cytology. In Western countries all patients with follicular neoplasms are advised to have immediate diagnostic surgery while patients in Japan often undergo further risk stratification without immediate surgery. The JTA diagnostic system of reporting thyroid cytology is designed for further risk stratification of patients with indeterminate cytology. If a surgeon applies diagnostic lobectomy to all patients with follicular neoplasm unselectively, this subclassification of follicular neoplasm has no practical meaning and is unnecessary. Cytological risk stratification of follicular neoplasms is optional and cytopathologists can choose either a simple 6-tier system without stratification of follicular neoplasm or a complicated 8-tier system depending on their experience in thyroid cytology and clinical management.

Thyroid FNA cytology in Asian practice—Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas

“…In this opinion paper, the authors introduce Asian practices for patients with thyroid nodules and describe Asian clinical practice (active surveillance for indeterminate thyroid nodules and low‐risk thyroid carcinomas), as reliable and valid means for reducing overdiagnosis and overtreatment of borderline thyroid tumours and low‐risk thyroid carcinomas . In addition, there are reports of significant variations in ROM in cytological‐histological correlation studies even when the ATA thyroid cancer management guidelines and the Bethesda system were employed .…”

Odróżnienie brodawkowatego raka tarczycy od tkanki nienowotworowej w oparciu o profilowanie lipidów metodą MALDI-MSI

“…Diagnosis of PTC is based on its histological pattern involving specific papillary architecture, yet some papillary carcinomas show not the typical histological features [2,3]. Moreover, diagnosis of thyroid cancers is initially based on the fine needle aspiration cytology of thyroid nodules [4]. However, morphology-based methods have several limitations restricting correct classification of cancer subtypes [5,6].…”

Reappraisal of “cyst fluid only” on thyroid fine-needle aspiration cytology

“…In the reporting system, CFO is included in the "Benign" classification. Currently, almost all Japanese clinicians are averse to accepting CFO as non-diagnostic [20]. Our study demonstrated that CFO and ND-other nodules differ in clinical management, in the interval before re-aspiration, and in malignancy rates.…”