2017 Annual Meeting

SC20-Challenges in Thyroid Cytopathology: How Can Ultrasound Findings and Molecular Tests Help?

March 10 2017, 8:00am to 11:30am


SC20-Challenges in Thyroid Cytopathology: How Can Ultrasound Findings and Molecular Tests Help?

Session Credits: 3 CME and 3 SAMs

Faculty: Helen H. Wang, MD; Pamela Hartzband, MD, and Michiya Nishino, MD, PhD, Beth Israel Deaconess Medical Center, Boston, MA

The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) provides a useful framework for classifying thyroid fine needle aspiration (FNA) specimens in a standardized and clinically meaningful way. However, thyroid FNA continues to be a challenging area of cytopathology because a subset of cases defies definitive classification. On one hand, thyroid FNA may suboptimally represent a nodule due to sampling and preparation factors; in other cases, significant cytologic overlap between benign and malignant nodules may make it impossible to classify a nodule definitively based on cytomorphology alone. These difficulties are commonly encountered in every cytopathology practice. This course will provide a practical, multidisciplinary approach for applying the BSRTC to diagnostically challenging thyroid FNAs.

The first half of the course will consist of lectures covering the following topics:

  • Important clinical and ultrasound features of thyroid nodules
  • Brief overview of the BSRTC diagnostic categories
  • The challenges, controversy, and appropriate use of the indeterminate categories of the BSRTC
  • The role of molecular testing in thyroid FNA.

The second half of the course will consist of interactive case presentations of common, uncommon, and controversial diagnostic entities, highlighting how gross/macroscopic (ultrasound data), microscopic (cytomorphology), and molecular data can be integrated into the final interpretation of diagnostically challenging FNAs. The images used in the case presentations will consist predominantly of liquid-based (ThinPrep) preparations. The TurningPoint Audience Response System will be used to incorporate participants responses into the case discussions. The course is designed for general pathologists, cytopathologists, cytotechnologists, and advanced trainees in pathology and cytopathology. Registrants will be able to view the case studies (clinical data and digital cytopathology images) on the USCAP website prior to the meeting. A comprehensive syllabus consisting of the PowerPoint slides and references will be available online prior to the course.

Upon completion of this educational activity, participants should be able to:

  1. Understand the BSRTC interpretive categories
  2. Apply the indeterminate categories of the BSRTC in a clinically meaningful way, particularly for diagnostically challenging thyroid FNAs
  3. Develop a multidisciplinary approach to evaluating thyroid nodules by integrating cytomorphologic findings with ultrasonographic and clinical information
  4. Recognize the relative strengths, limitations, and appropriate usage of the molecular tests that are available for thyroid FNAs.


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