Practical and challenging issue in thyroid cytopathology

Area of Science:

• Endocrinology and Pathology
• Diagnostic Cytopathology

Background:

• Thyroid lesions are prevalent, particularly in adults, with a high percentage being benign.
• Increasingly sophisticated ultrasonography detects smaller nodules, including suspicious ones.
• Indeterminate thyroid lesions, comprising about 20%, present diagnostic challenges and potential pitfalls.

Purpose of the Study:

• To review practical issues and morphological challenges in thyroid fine needle aspiration cytology (FNAC).
• To discuss diagnostic pitfalls leading to false positive and false negative results in thyroid nodule evaluation.
• To examine the application of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in managing indeterminate lesions.

Main Methods:

• Review of literature on thyroid FNAC and TBSRTC.
• Analysis of diagnostic pitfalls due to overlapping morphological features.
• Discussion of TBSRTC classification for indeterminate lesions (AUS, FN, SFM).

Main Results:

• Fine needle aspiration cytology (FNAC) is a primary diagnostic tool for thyroid nodules with high predictive value.
• The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aids in classifying lesions and guiding management.
• Diagnostic errors in FNAC can arise from overlapping cellular and background morphology.

Conclusions:

• Accurate diagnosis of thyroid nodules is crucial, despite high FNAC accuracy.
• Morphological challenges and application of TBSRTC require careful consideration to minimize diagnostic errors.
• Addressing pitfalls in thyroid FNAC evaluation can improve patient management and outcomes.