“Must Read” Articles on Thyroid Cytology for 2012

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This year, there have been several articles about thyroid cytology published in Cancer Cytopathology (2012) that I definitely think are a “must read”, and are worthy of your time (and effort) to both read and digest. I have listed 5 articles and one editorial on thyroid cytology from this journal for your review. I do not list them in any particular order, but I will add some particular comments about each one. To best appreciate them, YOU MUST READ them. My hope is that by posting them here, it will help facilitate your desire to read and investigate further. If you have an interest in posting other articles, please add them in the comment section at the end of this post or contact me directly. Prior to reading the articles on thyroid cytology listed below, you may want to read my previous blog post regarding atypical thyroid diagnoses, based on the editorial article listed below.

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Here is your “MUST READ” list on thyroid cytology (feeling guilty yet?): 

1. Thyroid FNA and Molecular Testing. Hassel et. al.

Hassell, L. A., Gillies, E. M. and Dunn, S. T. (2012), Cytologic and molecular diagnosis of thyroid cancers. Cancer Cytopathology, 120: 7–17. doi: 10.1002/cncy.20186

This is a really nice summary article discussing thyroid FNA cytology and the uses of molecular testing. I probably like it more because Dr. Hassell was my Chief Resident at MGH many years ago. Putting my admitted personal bias aside, the article provides a nice summary of the molecular tests currently available and their application. A few tables summarize these items nicely. This is a handy desktop reference on the topic…it is going into my quick reference bucket.

2. Role of BRAFV600E Mutation Analysis and Second Cytologic Review of Fine-Needle Aspiration for Evaluating Thyroid Nodule. Kang et. al.

Kang, G., Cho, E. Y., Shin, J. H., Chung, J.-H., Kim, J. W. and Oh, Y. L. (2012), Role of BRAFV600E mutation analysis and second cytologic review of fine-needle aspiration for evaluating thyroid nodule. Cancer Cytopathology, 120: 44–51. doi: 10.1002/cncy.20179

This is an interesting article comparing the performance of initial cytologic review, second cytologic review, and molecular BRAF analysis in the evaluation of thyroid nodules. Second cytologic review appears to increase FNA effectiveness, circumventing the need for repeat biopsy or intraoperative frozen section. Pre-op BRAF testing may supplement routine cytology in selecting cases for surgery.

3. The Atypical Thyroid Fine-Needle Aspiration: Past, Present, and Future, Bongiovanni, et.al.

Bongiovanni, M., Krane, J. F., Cibas, E. S. and Faquin, W. C. (2012), The atypical thyroid fine-needle aspiration: Past, present, and future. Cancer Cytopathology, 120: 73–86. doi: 10.1002/cncy.20178

This is another great article to put in your quick access pile next to your scope. The authors review the cytomorphologic features of [glossary]AUS/FLUS[/glossary] lesions and provide a summary of the results of various studies conducted since implementation of The Bethesda System for Reporting Thyroid Cytopathology ([glossary]TBSRTC[/glossary]). The authors also provide some nice photomicrographs to describe this difficult category. The use of the term [glossary]AUS/FLUS[/glossary] is discussed, along with the clinical significance and management of this category, and why use it. A brief discussion of molecular markers is also provided. This article is also briefly discussed in my prior post.

4. The Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance:Malignant Ration: A Proposed Performance Measure for Reporting in the Bethesda System for Thyroid Cytopathology. Krane, et.al.

Krane, J. F., VanderLaan, P. A., Faquin, W. C. and Renshaw, A. A. (2012), The atypia of undetermined significance/follicular lesion of undetermined significance:malignant ratio. Cancer Cytopathology, 120: 111–116. doi: 10.1002/cncy.20192

The authors propose a performance measure for use with [glossary]TBSRTC[/glossary] as part of a quality tool. The AUS:M ratio is described and discussed by the authors, with some nice summary tables, and suggestions of possible benchmark values. I also briefly discussed in my prior post.

5. Comparison of 5-Tiered and 6-Tiered Diagnostic Systems for the Reporting of Thyroid Cytopathology: A Multi-Institutional Study. Bongiovanni, et. al.

In this article, the 6-tiered TBSRTC in the United States is compared with the 5-tiered European Thyroid Reporting System, composed of modifications recommended by the British Thyroid Association-Royal College of Physicians (BTA-RCP) and the Italian Society for Anatomic Pathology and Cytopathology-International Academy of Pathology (SIAPEC-IAP). This is a also a classic paper to help explain systems used elsewhere in the world, and what differences they pose. This would be important when reviewing the literature.

6. The Potential for Overuse of Atypical Throid Diagnoses, M. Henry.

Henry, M. (2012), The potential for overuse of atypical thyroid diagnoses. Cancer Cytopathology, 120: 108–110. doi: 10.1002/cncy.20191

I recently blogged about this editorial. You may want to read that blog post.

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About Jana Sullinger

GYN Pathologist and Cytopathologist. Special interest in quality assessment and use of online social media in sharing educational information about cytology and quality.


  1. […] of thyroid cytology quality was the advent of TBSRTC, which I recently discussed here and here. Not only does this system attempt to standardize terminology, it also provides an assessment of […]

  2. […] for your  desktop references on thyroid FNA. (Are you getting the theme here…yup…I have been reviewing and studying this topic…again, so, I am just sharing the […]

  3. […] Original Article (Funded by Veracyte) along with an Editorial. I have previously blogged about the evaluation of thyroid nodules and discussions regarding quality tools for use. In addition, these previous blog articles touched […]

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