Preoperative diagnosis of thyroid nodules: An integrated multidisciplinary approach

Abstract

Because of the coronavirus disease 2019 pandemic, the joint session between the European Society of Pathology Working Groups of Endocrine Pathology and Cytopathology, initially scheduled in Glasgow (United Kingdom) for September 1, 2020, was converted into a virtual meeting that took place on December 8, 2020. Chaired by Catarina Eloy (Porto, Portugal) and Philippe Vielh (Paris, France), this session was entitled "Diagnosis of Thyroid Nodules: An Integrated Multidisciplinary Approach." The title reflects how a combined approach is critical to helping us better characterize thyroid nodules preoperatively. Gilles Russ (Paris, France), a radiologist specializing in thyroid ultrasonography, described the various systems for stratifying the risk of malignancy (ROM) in adults, and he was followed by Voichita Suciu (Villejuif, France), an interventional cytopathologist, who reported the extensive experience of the one-stop clinic set up at the Gustave Roussy Cancer Center. Three additional cytopathologists focused on specific thyroid cytopathology issues: Sarah J. Johnson (Newcastle Upon Tyne, United Kingdom) illustrated new entities and potential pitfalls, Esther Diana Rossi (Rome, Italy) talked about indeterminate cytology (especially atypia), and Liron Pantanowitz (Ann Arbor, Michigan) discussed the potential of using both molecular and artificial intelligence (AI) tools. This report summarizes the main ideas and data shared between speakers and attendees during this successful session. RadiologySince the late 2010s, thyroid ultrasound (US) has evolved in 2 directions. First, risk stratification of thyroid nodules with US emerged as a new concept. Second, during the same period, thermal ablation was applied for treating large thyroid nodules and cancer recurrences. In 2017, the European Thyroid Association issued guidelines for US malignancy risk stratification in adults: the European Thyroid Imaging and Reporting Data System (EU-TIRADS). 1 Those guidelines include a standardized illustrated lexicon and report to improve interobserver description agreement. The core of the system is the score that allows a quantitative approach to ROM. It ranges from 1 to 5 with an increasing ROM: 1 is for normal, 2 is for benign (ROM ≈ 0%), 3 is for low risk (ROM ≤ 4%), 4 is for intermediate risk (ROM = 6%-17%), and 5 is for high risk (ROM = 26%-87%). Determining the score is mainly based on looking for features of high suspicion (a taller than wide shape, irregular margins, microcalcifications, and marked hypoechogenicity) and, if none of these are present, on the echogenicity of the solid component of the lesion. A score of 2 corresponds to simple cysts and mainly spongiform nodules. Elsewhere, similar systems have been issued, including the British Thyroid Association System, 2 the American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), 3 the American Thyroid Association System, 4 and the Korean Thyroid Imaging and Reporting Data System (K-TIRADS). 5 Besides malignancy risk stratification, these syst...

Integrated Diagnostics of Thyroid Nodules

“…As thyroid nodules are very frequent while thyroid cancers are rare and relatively indolent in most cases, the main challenge in approaching patients with thyroid nodules is to identify malignant lesions while avoiding inappropriate excess use of thyroid US, scintigraphy, FNAC, and surgery. Unfortunately, a significant lack of standardization in the preoperative characterization of thyroid nodules is reported in the literature and in guidelines, and, in turn, is commonly observed in clinical practice [103].…”

Computer‐assisted urine cytology: Faster, cheaper, better?

“…2,3 In fact, CAD tools are poised to revolutionize pathology, promising more precise diagnoses, faster results and reduced workload for pathologists, [4][5][6] mirroring the advancements in radiology. [7][8][9][10] Despite recognition of CAD's potential in pathology, there is a lack of a comprehensive synthesis regarding recent advancements and challenges about CAD in urine cytopathology.…”

“…23,24 Fortunately, most UC samples are suitable for image acquisition since they are of low-moderate cellularity, show few tridimensional cell groups and are processed with liquid-based cytology, obviating many of the problems of digitizing cytology specimens. 9,25 For these reasons, several teams have begun applying CAD to UC (Figure 1). 26 This review aims to address this gap by offering an examination of the current state of CAD in urine cytopathology for diagnosing urothelial carcinomas.…”