Sule Canberk1,2,3, Diana Montezuma4, Umit Ince5, Ebru Tastekin6, Paula Soares7,8,9, Massimo Bongiovanni10, Fernando C Schmitt7,8,9. 1. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal, sulecanberk@icloud.com. 2. Institute of Pathology and Molecular Immunology, University of Porto, Porto, Portugal, sulecanberk@icloud.com. 3. Subdivision of Cytopathology, Department of Pathology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey, sulecanberk@icloud.com. 4. Department of Pathology, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal. 5. Subdivision of Cytopathology, Department of Pathology, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey. 6. Department of Pathology, Trakia University, Edirne, Turkey. 7. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. 8. Institute of Pathology and Molecular Immunology, University of Porto, Porto, Portugal. 9. Cancer Signaling and Metabolism, Medical Faculty of Porto University, Porto, Portugal. 10. Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland.
Abstract
BACKGROUND: Thyroid cancer accounts for 1% of cancer cases in developed countries, in which papillary thyroid carcinoma (PTC) is the most common type. There are multiple variants of PTC described to date, some of them with aggressive behavior and poor clinical outcome. These variants are well described and accepted in recent guidelines of many international societies, and the prognostic and management implications are well laid out. Due to their established clinical importance and to guide appropriate surgical management, it is now imperative in clinical practice, including cytopathology, to differentiate aggressive variants from nonaggressive ones. This review aims to describe the variants of PTC and to provide a practical algorithmic approach to facilitate the cytological diagnosis of these variants. SUMMARY: Subtyping PTC variants on fine needle aspiration cytology (FNAC) is challenging even for the most experienced cytopathologist. To facilitate a correct subtyping on FNAC, we propose a stepwise approach that is mainly designed for conventional smear methodology. This approach requires first to stratify the lesions into oncocytic and nononcocytic features before analyzing further details in cell morphology and pattern. Key Messages: (1) Subtyping in PTC is possible on cytopathology. (2) The main aim of the cytopathologist is to differentiate aggressive from nonaggressive variants. (3) The subtyping of PTC can help in the surgical management of the patients.
BACKGROUND:Thyroid cancer accounts for 1% of cancer cases in developed countries, in which papillary thyroid carcinoma (PTC) is the most common type. There are multiple variants of PTC described to date, some of them with aggressive behavior and poor clinical outcome. These variants are well described and accepted in recent guidelines of many international societies, and the prognostic and management implications are well laid out. Due to their established clinical importance and to guide appropriate surgical management, it is now imperative in clinical practice, including cytopathology, to differentiate aggressive variants from nonaggressive ones. This review aims to describe the variants of PTC and to provide a practical algorithmic approach to facilitate the cytological diagnosis of these variants. SUMMARY: Subtyping PTC variants on fine needle aspiration cytology (FNAC) is challenging even for the most experienced cytopathologist. To facilitate a correct subtyping on FNAC, we propose a stepwise approach that is mainly designed for conventional smear methodology. This approach requires first to stratify the lesions into oncocytic and nononcocytic features before analyzing further details in cell morphology and pattern. Key Messages: (1) Subtyping in PTC is possible on cytopathology. (2) The main aim of the cytopathologist is to differentiate aggressive from nonaggressive variants. (3) The subtyping of PTC can help in the surgical management of the patients.