thyroid


Expand All | Collapse All

  • Clinical

    • who to FNA: cold nodules > 1 cm or have microcalcifications (look up TSH and ultrasound)
    • 5 passes, 5 seconds, lidocaine optional
    • thyroid will bleed, so suction optional
    • complications: hematoma (uncommon), biopsy site artifacts later on, needle tract seeding (virtually nonexistent)
    • stains: Pap (better nuclear features) or Romanowsky (better cytoplasmic and extracellular features)
    • prognosis
      • nondiagnosis: repeat FNA with US guidance
      • benign: clinical followup
      • FLUS: repeat FNA
      • suspicious for follicular neoplasm: lobectomy
      • suspicious for malignancy: lobectomy or thyroidectomy
      • malignant: thyroidectomy
    • false negative and false positive both at 1-3%
    • molecular
      • BRAF in 44% of papillary ca
      • used for atypical/indeterminant cytology: PPV 88%, NPV 94%

  • Bathesda categories

    • 1: nondiagnostic
    • 2: benign
    • 3: FLUS
    • 4: follicular neoplasm
    • 5: suspicious for malignancy
    • 6: malignant

  • Nondiagnostic

    • cyst fluid only
    • virtually acellular specimen
    • other
      • obscuring blood
      • clotting artifact
    • diagnostic criteria
      • 6 groups of 10 well preserved follicular cells
      • or sparsely cellular with abundant colloid (colloid nodule)
      • or diagnostic of an entity

  • Benign

  • FLUS

  • Follicular neoplasm

  • Hurthle cell neoplasm

  • Suspicious for malignancy

  • Malignant

  • Parathyroid neoplasm

    		•