Reporting fine-needle aspiration of thyroid nodules in the Bethesda classification is a practice widely used internationally and by us. The revised third edition of the Bethesda System of Reporting Thyroid Cytopathology brings changes in terminology, content, and new chapters. In terms of terminology, an obvious change is the removal of the two-word names of three categories while maintaining the six diagnostic categories of the previous versions - new: BI - non-diag- nostic, BIII - atypia of undetermined significance, BIV - follicular neoplasia. In the detailed description of the findings within the individual categories, the ter- minological changes adopted by the fifth edition of the WHO classification of thyroid neoplasia are respected - in particular, the recommended name follicular thyroid nodular disease for the most frequently represented category BII - benign. In the evaluation itself, the diagnostic specifications accepted by the current WHO classification of histopathological findings are reflected in the individual categories - if they are applicable at the cytological level. Targeted attention will need to be paid to high grade features. The revised version brings new chapters dedicated to molecular testing and evaluation of the paediatric population.
- Klíčová slova
- thyroid nodules, neoplasms of thyroid gland, FNAB of thyroid gland, thyroid cancer, The Bethesda system for reporting thyroid cyto-logy 2023,
- MeSH
- cytologie MeSH
- lidé MeSH
- nádory štítné žlázy * patologie diagnóza klasifikace MeSH
- štítná žláza patologie MeSH
- tenkojehlová biopsie MeSH
- terminologie jako téma MeSH
- uzle štítné žlázy * patologie diagnóza klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.
- MeSH
- biopsie tenkou jehlou pod endosonografickou kontrolou MeSH
- endosonografie metody MeSH
- gastrointestinální endoskopie * výchova MeSH
- kurikulum * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
A middle-aged man in his 50s, active smoker, presented to the pulmonary office for lung cancer evaluation. On a low-dose computed tomography for lung cancer screening, he was found to have an 8 mm endobronchial lesion in the right main stem bronchus. A PET-CT revealed no endobronchial lesion, but incidentally, fluorodeoxyglucose (FDG) avidity was present in the right hilar (SUV 13.2) and paratracheal lymph nodes (LNs). He underwent bronchoscopy and EBUS-TBNA of station 7 and 10 R LNs. The fine needle aspiration (FNA) revealed necrotizing epithelioid granuloma. The acid-fast bacilli (AFB) and Grocott methenamine silver (GMS) stains were negative. He had suffered from pneumonic tularemia 13 months ago and immunohistochemical staining for Francisella tularensis on FNA samples at Center for Disease Control and Prevention was negative. The intense positron emission tomography (PET) avidity was attributed to prior tularemic intrathoracic lymphadenitis without active tularemia, a rare occurrence. To the best of our knowledge, PET-positive intrathoracic lymph node beyond one year without evidence of active tularemia has not been previously reported.
- Klíčová slova
- Lymph nodes, PET-CT, Pneumonia, Tularemia,
- MeSH
- biopsie tenkou jehlou pod endosonografickou kontrolou metody MeSH
- časná detekce nádoru MeSH
- fluorodeoxyglukosa F18 MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické uzliny diagnostické zobrazování patologie MeSH
- nádory plic * diagnóza patologie MeSH
- PET/CT metody MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- tularemie * diagnóza patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- fluorodeoxyglukosa F18 MeSH
Fine needle aspiration cytology (FNAC) is an integral part in the diagnostic work up of thyroid nodules. FNAC reports are based on Bethesda system for thyroid cytopathology which is one of the most commonly used systems worldwide. The main objective of the present study was to evaluate the malignancy rates in Bethesda category III and IV thyroid nodules over a six-year period. 642 thyroid FNAC were performed over a six-year period. The medical records of all these patients were reviewed using electronic patient records. Cases reported to have Bethesda category III and IV were included in the study. Data for these patients were reviewed to determine the relationship between these categories and thyroid cancer. There were 41 cases of category III of which 19 underwent surgery and the malignancy rates were found to be 26.3%. Category IV consisted of 50 cases of which 45 underwent surgery and the malignancy rates were 26.6%. The results from our study are similar to findings in larger multicentric studies which found that malignancy rates for Bethesda category III and IV were 10-30% and 25-40%, respectively.
- Klíčová slova
- Bethesda system, FNAC, Thyroid cancer, Thyroidectomy,
- MeSH
- lidé MeSH
- tenkojehlová biopsie MeSH
- uzle štítné žlázy * diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Thyroid nodules are very common. Most of them are benign non-secerning incidentally found nodules - thyroid incidentalomas. Ultrasound (US) is an essential initial diagnostic tool in thyroid nodules management. Based on the US character, thyroid nodules should be classified to one of the US risk categories (TIRADS - Thyroid Imaging Reporting and Data System). Based on the US risk category and size, some nodules should be referred to fine needle aspiration with cytological evaluation of the sample (FNAC), some should be followed just by US, and some require no follow-up. Further management depends on the FNAC (Bethesda category) and US risk category. In most nodules (Bethesda category II, repeatedly Bethesda category I, some of the nodules of Bethesda category III), just defensive management is recommended (US and/or clinical follow-up, or no follow-up). Usually, only few cases require diagnostic (Bethesda categories III, IV and V) or therapeutic (Bethesda V and VI) surgery. In decision-making of management of nodules Bethesda category III and V, molecular testing for mutations associated with thyroid cancer and serum calcitonin could be useful.
- Klíčová slova
- Bethesda classification, TIRADS, fine needle aspiration biopsy, molecular testing, thyroid cancer, thyroid nodule, ultrasound,
- MeSH
- lidé MeSH
- nádory štítné žlázy * diagnóza terapie MeSH
- retrospektivní studie MeSH
- tenkojehlová biopsie MeSH
- uzle štítné žlázy * diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. OBJECTIVES: The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. METHOD: An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. RESULTS: Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5-5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8-1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9-10.8%) in benign, 29.2% (95% CI: 25.0-33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6-28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1-22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2-8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). CONCLUSIONS: Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.
- Klíčová slova
- Cytomorphology, Meta-analysis, Non-invasive follicular thyroid neoplasm with papillary-like nuclear features, The Bethesda System for Reporting Thyroid Cytology, Thyroid gland,
- MeSH
- cytodiagnostika metody MeSH
- folikulární adenokarcinom * diagnóza patologie MeSH
- lidé MeSH
- nádory štítné žlázy * patologie MeSH
- papilární karcinom štítné žlázy diagnóza patologie MeSH
- tenkojehlová biopsie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- metaanalýza MeSH
- systematický přehled MeSH
We present a case report of a 51-year-old patient who underwent totalization of thyroidectomy - resection of the right thyroid lobe for growth progression of the largest nodule from which a fine needle aspiration biopsy (FNAB) was performed and was cytologically suspected of malignancy. Nodule was a graywhite colored tumor with a solid structure, histologically with an unusual morphology and immunoprofile, called cribriform morular thyroid carcinoma (CMTC). Usually, the tumor behaves indolently with a good prognosis. CMTC can be familial or sporadic, predominantly as a solitary or a multifocal lesion, often associated with autosomal dominant adenomatous polyposis syndrome (FAP), so it is necessary to point this out in the report. The syndrome of familial adenomatous polyposis was ruled out, the APC gene mutation was somatic.
- Klíčová slova
- cribriform-morular thyroid carcinoma, familial adenomatous polyposis, thyroid gland,
- MeSH
- adenokarcinom * MeSH
- familiární adenomatózní polypóza * komplikace patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory štítné žlázy * diagnóza genetika MeSH
- tenkojehlová biopsie škodlivé účinky MeSH
- tyreoidektomie škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: Warthin tumour (WT) management options comprise surgery or follow-up. The purpose of this study was to asses our experience with the follow-up strategy in selected patients with an ultrasound-guided fine-needle aspiration biopsy (FNAB) showing WT. METHODS: We performed a retrospective analysis of patients diagnosed with WT using FNAB between 1.1.2006 and 31.12.2019. Patients were divided into three groups according to the therapeutic approach-immediate surgery, follow-up or surgery and follow-up. RESULTS: 323 patients were diagnosed with WT and met the study's inclusion criteria (154 women, 47.7% and 169 men, 52.3%). 192 patients were operated right after the diagnosis, 109 patients were observed with their first detected tumour and 22 patients had parotid WT surgery and were in the wait-and-scan protocol with a contralateral tumour, recurrence or both. The growth rate (GR) of observed WT was highly variable (mean GR 1.0 mm/year (5%), median GR 0.8 mm (9%), range - 19.7 to +20.0 mm/year). From 131 patients in the follow-up group, 19 patients underwent surgery and definitive histology revealed 17 WTs and 2 adenocarcinomas. However, these 2 patients had changes in sonographic findings at their next control. The mean observation time was 44.7 months (range 12-138 months) in patients followed exclusively at our institution and 50.9 months (range 12-110 months) in patients observed in cooperation with an otorhinolaryngologist at the patients' place of residence. CONCLUSION: Ultrasound-guided FNAB is an accurate and simple method in WT diagnosis and based on its result a follow-up strategy can be chosen for selected patients with WT.
- Klíčová slova
- Cystadenolymphoma, Fine-needle aspiration biopsy, Follow-up strategy, Ultrasound, Warthin tumour,
- MeSH
- adenolymfom * diagnostické zobrazování patologie chirurgie MeSH
- intervenční ultrasonografie MeSH
- lidé MeSH
- následné studie MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- tenkojehlová biopsie metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed outpatient procedure used for the diagnosis, staging of lung cancer, and the evaluation of thoracic lymphadenopathy of unknown origin. With the advent of this minimally invasive technology, mediastinoscopy, once the gold standard, has fallen out of favour. Pneumomediastinum is a rare complication of EBUS-TBNA and can often be managed conservatively. We present a case of a 52-year-old female who developed pneumomediastinum following EBUS-TBNA and improved with expectant management in the emergency department. We discuss the proposed pathophysiology of this rare occurrence that usually follows a benign course. Severe complications, such as mediastinitis and tracheal tear, need to be excluded promptly.
- Klíčová slova
- Complications, EBUS-TBNA, Pneumomediastinum,
- MeSH
- biopsie tenkou jehlou pod endosonografickou kontrolou škodlivé účinky metody MeSH
- endosonografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mediastinální emfyzém * diagnóza etiologie MeSH
- mediastinoskopie MeSH
- nádory plic * diagnóza MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
1: ESGE recommends that, where there is a suspicion of eosinophilic esophagitis, at least six biopsies should be taken, two to four biopsies from the distal esophagus and two to four biopsies from the proximal esophagus, targeting areas with endoscopic mucosal abnormalities. Distal and proximal biopsies should be placed in separate containers.Strong recommendation, low quality of evidence. 2: ESGE recommends obtaining six biopsies, including from the base and edge of the esophageal ulcers, for histologic analysis in patients with suspected viral esophagitis.Strong recommendation, low quality of evidence. 3: ESGE recommends at least six biopsies are taken in cases of suspected advanced esophageal cancer and suspected advanced gastric cancer.Strong recommendation, moderate quality of evidence. 4: ESGE recommends taking only one to two targeted biopsies for lesions in the esophagus or stomach that are potentially amenable to endoscopic resection (Paris classification 0-I, 0-II) in order to confirm the diagnosis and not compromise subsequent endoscopic resection.Strong recommendation, low quality of evidence. 5: ESGE recommends obtaining two biopsies from the antrum and two from the corpus in patients with suspected Helicobacter pylori infection and for gastritis staging.Strong recommendation, low quality of evidence. 6: ESGE recommends biopsies from or, if endoscopically resectable, resection of gastric adenomas.Strong recommendation, moderate quality of evidence. 7: ESGE recommends fine-needle aspiration (FNA) and fine-needle biopsy (FNB) needles equally for sampling of solid pancreatic masses.Strong recommendation, high quality evidence. 8: ESGE suggests performing peroral cholangioscopy (POC) and/or endoscopic ultrasound (EUS)-guided tissue acquisition in indeterminate biliary strictures. For proximal and intrinsic strictures, POC is preferred. For distal and extrinsic strictures, EUS-guided sampling is preferred, with POC where this is not diagnostic.Weak recommendation, low quality evidence. 9: ESGE suggests obtaining possible non-neoplastic biopsies before sampling suspected malignant lesions to prevent intraluminal spread of malignant disease.Weak recommendation, low quality of evidence. 10: ESGE suggests dividing EUS-FNA material into smears (two per pass) and liquid-based cytology (LBC), or the whole of the EUS-FNA material can be processed as LBC, depending on local experience.Weak recommendation, low quality evidence.
