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Thyroid Fna,bethesda system

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Thyroid Fna,bethesda system

  1. 1. THYROID FNA DR ZAHID MAHMOOD FCPS(HISTOPATHOLOGY) KING EDWARD MEDICAL UNIVERSITY LAHORE
  2. 2. Thyroid FNA Procedure • US guidance • 25 gauge needle • 3-4 passes FNA Thyroid
  3. 3. Fine Needle Non Aspiration (FNNA) biopsy showing needle, position & direction for biopsy. Immediately after FNA, firm pressure is applied to biopsy sites
  4. 4. Technique and Equipment (Contd…) Biopsy Procedure without aspiration
  5. 5. Difference between core and FNA biopsy
  6. 6. Needle is removed from syringe Air is aspirated into the syringe Aspirated material is expelled onto the slides & smears are prepared
  7. 7. Technique and Equipment (Contd…) Material in the hub of needle
  8. 8. Thyroid FNA Preparations • Direct smears - Air-dried, Diff Quik stained - Ethanol fixed, Pap stained • Cytospins • Cell block • Liquid-based preparation FNA Thyroid DQ PAP CB Core Biopsy
  9. 9. Thyroid FNA The Cell Pattern Approach • CELLS – Arrangement – Nuclear features – Cytoplasmic features • COLLOID • BACKGROUND FEATURES
  10. 10. Clues to Diagnosis! • More colloid ….more likely benign • More cells …. more likely neoplastic
  11. 11. The Bethesda System for Reporting Thyroid Cytopathology: 6 Diagnostic Categories • I. NONDIAGNOSTIC or UNSATISFACTORY • • II. BENIGN • III. ATYPIA OF UNDETERMINED SIGNIFICANCE or FOLLICULAR LESION OF UNDETERMINED SIGNIFICANCE • IV. FOLLICULAR NEOPLASM or SUSPICIOUS FOR A FOLLICULAR NEOPLASM • - specify if Hürthle cell (oncocytic) type • V. SUSPICIOUS FOR MALIGNANCY • VI. MALIGNANT •
  12. 12. TBRTC: Relationship to Clinical Algorithms Category Cancer Risk Management Nondiagnostic or Unsatisfactory 1-4% Repeat FNA with U/S Benign <1-3 % Follow-up clinically AUS, FLUS ~5-15 % Repeat FNA Follicular Neoplasm, or Suspicious for a Follicular Neoplasm* 20-30 % Lobectomy Suspicious for Malignancy (usually papillary CA) 60-75 % Lobectomy or total thyroidectomy Malignant 97-99 % Total thyroidectomy * Specify if Hürthle cell type
  13. 13. Thyroid FNA: made Easy • Granulomatous Thyroiditis Giant cells munching on colloid • Hashimoto’s Thyroiditis Lymphocytes and oncocytes • Papillary carcinoma Papillae, nuclei and cytoplasm • Medullary carcinoma Carcinoid and amyloid • Anaplastic carcinoma Ugly giant and spindle cells • Follicular lesions? Colloid vs. follicular cells
  14. 14. Follicular Neoplasm CYTOMORPHOLOGY • Marked cellularity • Discohesion, single cells • Predominantly microfollicles and/or trabeculae • Uniformly enlarged cells • Crowding • Scant colloid • Marked nuclear atypia, mitosis and necrosis is uncommon
  15. 15. Papillary carcinoma Follicular variant
  16. 16. VI: Malignant Papillary thyroid carcinoma • Papillae- not very common • Sheets: flat or syncytial • Sheets/ clusters with well defined borders • Clusters: 3-D
  17. 17. VI: Malignant Medullary thyroid carcinoma Plasmacytoid cells Spindle cells
  18. 18. VI: Malignant Anaplastic carcinoma
  19. 19. FNA Breast lesions (reporting Categories) C-1 Inadequate C-2 Benign C-3 Atypia (probably benign) C-4 Suspicious for malignancy C-5 Malignant

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