The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The two-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding diagnostic terminology/classification scheme for thyroid FNA interpretation and cytomorphologic criteria for the diagnosis of various benign and malignant thyroid lesions. (http://thyroidfna.cancer.gov/pages/info/agenda/).

Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference.

On October 22 and 23, 2007, the National Cancer Institute (NCI) hosted "The NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference," a two-day gathering in Bethesda, Maryland. Its mission was to establish a comprehensive interdisciplinary informational dialogue dedicated to thyroid FNA. Preparations for the conference began 18 months earlier with the designation of a steering committee, the appointment of nine working committees, coordination with co-sponsoring organizations, and the establishment of a dedicated permanent web site. The function of the website was to serve as a permanent educational tool for health care practitioners and patients alike, as well as to foster on-line dialogue.

Six committees were charged with preparing summary documents based on literature reviews on the following subjects: 1. Indications/Pre-FNA requirements; 2. Training and Credentialing; 3. Technique; 4. Terminology and Morphologic Criteria; 5. Ancillary Studies; and 6. Post-FNA Options for Testing and Treatment. Three additional committees were formed, one each to oversee the website, publications ensuing from the conference and the establishment of an on-line educational cytopathology atlas.

Literature reviews were limited to English language publications dating back to 1995, using PubMed as the search engine, with key words determined by the committee members. The first draft of the committees' summary documents ("Review and Conclusions") was posted on the web site and open for on-line forum discussion from May 1-June 30, 2007. There were several subsequent drafts and on-line discussion periods (Aug 15 – Sept. 30, 2007 and Nov. 30-Dec. 15, 2007). The documents underwent revision after each comment period prior to re-posting on the web. The two-day "live" conference in October, attended by 154 registrants, comprised of pathologists, endocrinologists, surgeons, and radiologists, gave the committees an in-depth opportunity to present their conclusions and debate controversial areas.

This is an abridged version of the topics reviewed at the conference and the website. This is not a "standards of practice" guideline, nor is it endorsed as such by the National Cancer Institute.

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The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation

Background: Although clinically evident metastases of nonthyroid malignancies (NTMs) to the thyroid gland are uncommon, it is important to suspect them in patients who present with a new thyroid mass and a history, however far back, of prior malignancy. In fact, metastases from NTMs to the thyroid gland have been reported in 1.4%–3% of all patients who have surgery for suspected cancer in the thyroid gland. Here we review the literature over the last decade regarding this topic. Summary: Based on recent literature, the most common NTMs that metastasize to the thyroid gland are renal cell (48.1%), colorectal (10.4%), lung (8.3%), and breast carcinoma (7.8%), and sarcoma (4.0%). Metastases of NTMs to the thyroid are more common in women than men (female to male ratio=1.4 to 1) and in nodular thyroid glands (44.2%). The mean and median intervals between diagnosing NTMs and their metastases to thyroid gland are 69.9 and 53 months, respectively. In 20% of cases the diagnosis of the NTM and its metasta...

Metastases to the Thyroid: A Review of the Literature from the Last Decade

Renal cell carcinoma is a potentially lethal cancer with aggressive behavior and a propensity for metastatic spread. Due to the fact that the patterns of metastases from renal cell carcinomas are not clearly defined, there have been several reports of cases of renal cell carcinoma associated with rare metastatic sites and atypical presenting symptoms. The present review focuses on these atypical rare clinical presentations of renal cell carcinomas both at the time of diagnosis of the primary tumor but also in the years after radical nephrectomy.

/pdf/atypical-presentations-and-rare-metastatic-sites-of-renal-1ntvdezb7x.pdf

Atypical presentations and rare metastatic sites of renal cell carcinoma: a review of case reports

The differential diagnosis of a follicular lesion/neoplasm in thyroid FNA specimens includes hyperplastic/adenomatoid nodule, follicular adenoma and carcinoma, and follicular variant of papillary thyroid carcinoma. In our laboratory we separate follicular lesions of thyroid into hyperplastic/adenomatoid nodule (HN), follicular neoplasm (FON) and follicular derived neoplasm with focal nuclear features suspicious for papillary thyroid carcinoma (FDN). This study reports our experience with 339 cases diagnosed as FON and 120 as FDN. All cases were evaluated for histologic diagnosis, age, sex and size of the nodule. Histopathologic follow-up was available in all cases. The malignancy rate was 22% (74/359) and 72% (86/120) for cases diagnosed as FON and FDN, respectively. In the FON category almost half of the malignant cases were papillary carcinoma. The risk of malignancy was higher in patients younger than 40 yr (53% vs. 30%) than in patients 40 year or more years old and greater in males (41% vs. 33%) than females. No statistically significant relationship was noted between the sizes of the nodules and benign vs. malignant diagnosis. According to this study it is important to divide follicular patterned lesions of thyroid into FON and FDN in the cytology specimens due to significantly different risk of malignancy (22% vs. 72%). In addition, clinical features, including gender and age can be part of the decision analysis in selecting patients for surgery.

Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-Up

Thyroid nodules (TN) are a common clinical problem. Fine needle aspiration (FNA) of the thyroid now is practiced worldwide and proves to be the most economical and reliable diagnostic procedure to identify TNs that need surgical excision and TNs that can be managed conservatively. The key for the success of thyroid FNA consists of an adequate or representative cell sample and the expertise in thyroid cytology. The FNA cytologic manifestations of TNs may be classified into seven working cytodiagnostic groups consisting of a few heterogenous lesions each to facilitate the differential diagnosis. Recent application of diagnostic molecular techniques to aspirated thyroid cells proved to be useful in separating benign from malignant TNs in several cases of indeterminate lesions.

Fine-needle aspiration of the thyroid: an overview

Three men and 2 women with ages ranging from 37 to 70 years, clinically and histologically confirmed solitary, palpable metastatic cancers to the thyroid (SMCT) and preoperative cytologic investigation of their thyroid lesions by fine-needle aspiration (FNA), were reviewed. Four patients were known to have a solid cancer treated by radical surgery 1 to 4 years prior [1 bronchogenic squamous cell carcinoma, 1 parotid adenoid cystic carcinoma, 1 renal cell carcinoma (RCC) and 1 cutaneous melanoma], and 1 patient had no past history of cancer. Direct smears prepared from the patients' thyroid FNAs were fixed in 95% ethanol and stained with the Papanicolaou method. In 3 cases, immunostaining of the aspirated tumor cells with thyroglobulin antibody was performed, and in 1 case an aspiration smear was stained with commercial HMB-45 antibody. A correct cytodiagnosis of metastatic cancer to the thyroid was made in all 5 cases. In 1 patient the thyroid FNA revealed a metastatic RCC that led to the discovery of a clinically occult RCC. All 5 patients died of metastatic disease 27 to 40 months after surgical resection of their SMCTs.

Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology

Inflammatory pseudotumour, or inflammatory myofibroblastic tumour (IMT), occurs in various organs, with the lung being the commonest anatomic site.1 IMT is currently regarded as a neoplasm with a wide spectrum of biological behaviour.1 We present a case of pancreatic IMT in a patient with rectal bleeding.

http://canjsurg.ca/wp-content/uploads/2014/03/51-1-E23.pdf

Inflammatory myofibroblastic tumour of the pancreas.

Solid/trabecular variant papillary carcinoma of the thyroid: Report of three cases with fine-needle aspiration.

Competing interests: None declared.

Accepted for publication Apr. 10, 2006

Correspondence to: Dr. Mark Lee, Department of Laboratory Medicine and Pathology, Royal Alexandra Hospital, 10240 Kingsway Ave. NW, Edmonton AB T5H 3V9; ac.htlaehlatipac@eel.kram

Mark W Lee

Papers

Fine-needle aspiration of the thyroid: an overview

Solitary metastatic cancer to the thyroid: a report of five cases with fine-needle aspiration cytology

Inflammatory myofibroblastic tumour of the pancreas.

Solid/trabecular variant papillary carcinoma of the thyroid: Report of three cases with fine-needle aspiration.

Leiomyoma of iliac bone.