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Thyroid Fna,bethesda system
The document discusses the thyroid FNA procedure and diagnostic categories. It provides details on: - Performing thyroid FNA under ultrasound guidance using a 25 gauge needle with 3-4 passes. - Preparing direct smears, cytospins, cell blocks and liquid-based preparations from the aspirated material. - The Bethesda system for reporting thyroid cytopathology which includes 6 diagnostic categories and their associated cancer risks to guide clinical management. - Key cytologic features that help diagnose common thyroid lesions and cancers.
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Thyroid Fna,bethesda system
- 1. THYROID FNA DRZAHID MAHMOOD FCPS(HISTOPATHOLOGY) KING EDWARD MEDICAL UNIVERSITY LAHORE
- 2. Thyroid FNA Procedure • US guidance • 25 gauge needle • 3-4 passes FNA Thyroid
- 3. Fine Needle NonAspiration (FNNA) biopsy showing needle, position & direction for biopsy. Immediately after FNA, firm pressure is applied to biopsy sites
- 4. Technique and Equipment(Contd…) Biopsy Procedure without aspiration
- 5. Difference between coreand FNA biopsy
- 6. Needle is removedfrom syringe Air is aspirated into the syringe Aspirated material is expelled onto the slides & smears are prepared
- 7. Technique and Equipment(Contd…) Material in the hub of needle
- 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. Thyroid FNA TheCell Pattern Approach • CELLS – Arrangement – Nuclear features – Cytoplasmic features • COLLOID • BACKGROUND FEATURES
- 10. Clues to Diagnosis! • More colloid ….more likely benign • More cells …. more likely neoplastic
- 11. The Bethesda Systemfor 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. TBRTC: Relationship toClinical 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. Thyroid FNA: madeEasy • 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
- 15. 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
- 16.
- 17. VI: Malignant Papillarythyroid carcinoma • Papillae- not very common • Sheets: flat or syncytial • Sheets/ clusters with well defined borders • Clusters: 3-D
- 18. VI: Malignant Medullarythyroid carcinoma Plasmacytoid cells Spindle cells
- 19. VI: Malignant Anaplasticcarcinoma
- 20. FNA Breast lesions(reporting Categories) C-1 Inadequate C-2 Benign C-3 Atypia (probably benign) C-4 Suspicious for malignancy C-5 Malignant