Suspicious for Malignancy

  • Rana S. HodaEmail author
  • Rema Rao
  • Theresa Scognamiglio


The majority of thyroid nodules are benign, but a small percentage, about 10–15%, are malignant. According to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), 3% of all thyroid fine needle aspiration (FNA) specimens are classified as Suspicious for Malignancy (SM).


Suspicious for malignancy Suspicious for papillary thyroid carcinoma PTC Suspicious for medullary thyroid carcinoma MTC Suspicious for lymphoma Immunocytochemistry Suspicious for malignancy not otherwise specified 


  1. 1.
    Adamczewski Z, Lewiński A. Proposed algorithm for management of patients with thyroid nodules/focal lesions, based on ultrasound (US) and fine-needle aspiration biopsy (FNAB); our own experience. Thyroid Res. 2013;6:6. Scholar
  2. 2.
    Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology; definitions, criteria, and explanatory notes. 2nd ed. Cham: Springer International Publishing AG; 2018.CrossRefGoogle Scholar
  3. 3.
    Azar N, Lance C, Nakamoto D, Michael C, Wasman J. Ultrasonographic thyroid findings suspicious for malignancy. Diagn Cytopathol. 2013;41:1107–14. Scholar
  4. 4.
    Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27:1341–6. Scholar
  5. 5.
    Clark DP, Faquin WC. Thyroid cytopathology. 2nd ed. New York: Springer; 2010.CrossRefGoogle Scholar
  6. 6.
    Cochand-Priollet B, Prat JJ, Polivka M, Thienpont L, Dahan H, Wassef M, et al. Thyroid fine needle aspiration: the morphological features on ThinPrep slide preparations. Eighty cases with histological control. Cytopathology. 2003;14:343–9.CrossRefGoogle Scholar
  7. 7.
    Duncan LD, Forrest L, Law WM Jr, Hubbard E, Stewart LE. Evaluation of thyroid fine-needle aspirations: can ThinPrep be used exclusively to appropriately triage patients having a thyroid nodule? Diagn Cytopathol. 2011;39:341–8. Scholar
  8. 8.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1–133. Review.CrossRefGoogle Scholar
  9. 9.
    Hoda RS. Non-gynecologic cytology on liquid-based preparations: a morphologic review of facts and artifacts. Diagn Cytopathol. 2007;35:621–34.CrossRefGoogle Scholar
  10. 10.
    Hoda RS, VandenBussche C, Hoda SA. Diagnostic liquid-based cytology. New York: Springer; 2017.CrossRefGoogle Scholar
  11. 11.
    Jackson BS. Controversy regarding when clinically suspicious thyroid nodules should be subjected to surgery: review of current guidelines. Medicine (Baltimore). 2018;97:e13634. Scholar
  12. 12.
    Jung CK, Lee A, Jung ES, Choi YJ, Jung SL, Lee KY. Split sample comparison of a liquid-based method and conventional smears in thyroid fine needle aspiration. Acta Cytol. 2008;52:313–9.CrossRefGoogle Scholar
  13. 13.
    Lin F, Chen Z. Standardization of diagnostic immunohistochemistry: literature review and Geisinger experience. Arch Pathol Lab Med. 2014;138:1564–77. Scholar
  14. 14.
    Luu MH, Fischer AH, Pisharodi L, Owens CL. Improved preoperative definitive diagnosis of papillary thyroid carcinoma in FNAs prepared with both ThinPrep and conventional smears compared with FNAs prepared with ThinPrep alone. Cancer Cytopathol. 2011;119:68–73. Scholar
  15. 15.
    Malle D, Valeri RM, Pazaitou-Panajiotou K, Kiziridou A, Vainas I, Destouni C. Use of a thin-layer technique in thyroid fine needle aspiration. Acta Cytol. 2006;50:23–7.CrossRefGoogle Scholar
  16. 16.
    Nikiforov YE, Biddinger PW, Thompson LDR. Diagnostic pathology and molecular genetics of the thyroid: a comprehensive guide for practicing thyroid pathology. 3rd ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2019.Google Scholar
  17. 17.
    Pusztaszeri MP, Krane JF, Cibas ES, Daniels G, Faquin WC. FNAB of benign thyroid nodules with papillary hyperplasia: a cytological and histological evaluation. Cancer Cytopathol. 2014;122:666–77. Scholar
  18. 18.
    Rekhtman N, Buonocore DJ, Rudomina D, Friedlander M, Dsouza C, Aggarwal G, et al. Novel modification of HistoGel-based cell block preparation method: improved sufficiency for molecular studies. Arch Pathol Lab Med. 2018;142:529–35. Scholar
  19. 19.
    Rossi ED, Zannoni GF, Moncelsi S, Stigliano E, Santeusanio G, Lombardi CP, et al. Application of liquid-based cytology to fine-needle aspiration biopsies of the thyroid gland. Front Endocrinol (Lausanne). 2012;3:57. Scholar
  20. 20.
    Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111:306–15.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.CBLPathRye BrookUSA
  2. 2.Department of Pathology and Laboratory MedicineNew York Presbyterian Hospital, Weill Cornell Medical CollegeNew YorkUSA

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