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Translational Aspects of Thyroid

Cytology

Armando Filie, M.D.

Cytopathology Section

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Expertise and Methods

Areas of Expertise Cytopathology Section

Cytomorphologic evaluation, immunocytochemical evaluation and diagnosis of cervical/vaginal, exfoliative non-

gynecologic and (superficial and image-guided) fine needle aspirate (FNA) samples; on-site adequacy assessment of

image-guided FNAs; perform FNA of superficial/palpable lesions

Cytomorphologic and immunocytochemical evaluation of research cytology samples

Cytology services to NIH patients and principal investigators (PI), support NIH PIs protocols, and support NIH PIs

research involving cytology material

Non-neoplastic and neoplastic disease of the thyroid gland

Cytomorphologic and immunocytochemical evaluation of FNAs of thyroid lesions for the clinical

management of thyroid nodules

Technologies and methodologies Light microscopy

Smears, cytospins, cell blocks, thin-layer preparations

Diff-Quik (DQ), Papanicolaou (PAP), H&E stains

Immunocytochemistry

In Collaboration

Molecular testing for diagnostic and predictive markers of thyroid carcinoma

Bentz et al. Am J Clin Pathol 2002;117:457-63

PAP ThinPrep slide

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Translational Aspects of Thyroid Cytology

The Bethesda System for Reporting Thyroid Cytopathology

Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology. Definitions,criteria and explanatory notes. Springer Science + Business Media, LLC, 2010

AUS

Follicular Neoplasm

AUS/FLUS: paucicellular aspirate, focal cytologic/architectural atypia

Follicular neoplasm/Suspicious for a follicular neoplasm Cannot distinguish follicular adenoma from follicular carcinoma

Differential includes follicular variant of papillary thyroid carcinoma

Follicular Neoplasm

Current Reporting System for Thyroid Aspirates

Indeterminate Categories

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Research Implications

Provide additional relevant information for the management of thyroidnodules to clinicians and surgeons without the need to obtain

additional material

Potentially decrease the number of thyroid aspirates diagnosed as

AUS/FLUS or Follicular Neoplasm/Suspicious for a Follicular

Neoplasm according to the Bethesda System for reporting thyroidcytopathology

Reduce the morbidity of patients with thyroid nodules by placing them

into a more relevant category

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Future Directions

Use existing archival cytology resources as source of diagnostic and

predictive molecular markers in thyroid cytology, including noveltechniques

Laser capture microdissection (LCM) of single cells or a small group of cells for

next generation sequencing (NGS) analysis

Apply LCM and NGS analysis of archival cytology slides to diseases

from other organs/systems, including those where aspirates are oftenused for the initial diagnosis

Lung

Pancreas

Challenges and Obstacles

Increase the number of aspirates

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Collaborators

Laboratory of Pathology Mark Roth, M.D.

Mark Raffeld, M.D.

Intramural Francesco Celi, M.D. (NIDDK)

Monica Skarulis, M.D. (NIDDK)