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Suspicious for Malignancy

  • Helen H. Wang
  • Armando C. Filie
  • Douglas P. Clark
  • Celeste N. Powers
Chapter

Abstract

Most primary thyroid malignancies have distinctive cytologic features and are easily recognizable on fine needle aspiration (FNA). The exceptions are follicular and Hürthle cell carcinomas (addressed in Chaps. 5 and 6). Although the cytologic features of papillary thyroid carcinoma (PTC), medullary thyroid carcinoma (MTC), and lymphoma are well-established (see Chaps. 8, 9, and 12), in any given specimen they may be quantitatively and/or qualitatively insufficient for a definitive diagnosis. Reasons for diagnostic uncertainty in such cases include suboptimal sampling or preservation, an unusual variant of PTC and MTC, and overlapping cytomorphologic (particularly nuclear) features with other thyroid conditions. The benign follicular cells in some cases of lymphocytic (Hashimoto) thyroiditis (LT) can be difficult to distinguish from those of PTC, and the lymphoid cells of LT can be difficult to distinguish from those of a lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). A category that conveys a strong suspicion for malignancy, therefore, is a necessity for thyroid FNA, and in the Bethesda System, it is called “Suspicious for Malignancy (SFM).” SFM is a heterogeneous category because it includes a variety of different malignancies. Most SFM cases are suspicious for PTC, although in many published series the type of suspected malignancy is not specified. When specified, the percentage of total thyroid FNA cases that fall into the “suspicious for PTC” category ranges from 2.4% to 7.9%. This category should be used judiciously so that patients are managed as appropriately as possible.

Keywords

Positive Predictive Value Papillary Thyroid Carcinoma Fine Needle Aspiration Medullary Thyroid Carcinoma Malt Lymphoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Helen H. Wang
    • 1
  • Armando C. Filie
    • 2
  • Douglas P. Clark
    • 3
  • Celeste N. Powers
    • 4
  1. 1.Department of PathologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  2. 2.Laboratory of PathologyNational Cancer InstituteBethesdaUSA
  3. 3.Department of PathologyThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Department of Pathology, Medical College of Virginia HospitalsVirginia Common wealth University Medical CenterRichmondUSA

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