Transcript
THYROID FNA
DR ZAHID MAHMOODFCPS(HISTOPATHOLOGY)
KING EDWARD MEDICAL UNIVERSITY LAHORE
Thyroid FNA Procedure
• US guidance
• 25 gauge needle
• 3-4 passes
FNA Thyroid
Fine Needle Non Aspiration (FNNA) biopsy showing needle, position & direction for biopsy.
Immediately after FNA, firm pressure is applied to biopsy sites
Technique and Equipment (Contd…)
Biopsy Procedure without aspiration
Difference between core and FNA biopsy
Needle is removed from syringe Air is aspirated into the syringe
Aspirated material is expelled onto the slides & smears are prepared
Technique and Equipment (Contd…)
Material in the hub of needle
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
Thyroid FNA The Cell Pattern Approach
• CELLS– Arrangement– Nuclear features– Cytoplasmic features
• COLLOID
• BACKGROUND FEATURES
Clues to Diagnosis!
• More colloid ….more likely benign• More cells …. more likely neoplastic
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•
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, orSuspicious 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
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
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
Papillary carcinoma
Follicular variant
VI: Malignant Papillary thyroid carcinoma
• Papillae- not very common
• Sheets: flat or syncytial
• Sheets/ clusters with well defined borders
• Clusters: 3-D
VI: Malignant Medullary thyroid carcinoma
Plasmacytoid cells Spindle cells
VI: Malignant Anaplastic carcinoma
FNA Breast lesions (reporting Categories)
C-1 Inadequate C-2 Benign
C-5 Malignant
C-3 Atypia (probably benign) C-4 Suspicious for malignancy
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