Short Courses and Special Courses

SC31 - Crossroads of Surgical Pathology and Cytology of Thyroid Tumors: Classification Updates, New Terminologies, and Diagnostic Challenges

Thursday, March 22, 2018 - 8:00 am - 11:30 am
This Short Course session includes up to a half-hour break.

Session Credits:

3 CME and 3 SAMs


Justine A. Barletta, MD, Brigham and Women’s Hospital, Boston, MA
Edmund S. Cibas, MD, Brigham and Women’s Hospital, Boston, MA

Course Description

Thyroid tumors represent some of the most challenging surgical pathology and cytology cases encountered by pathologists today. A variety of diagnostically challenging thyroid lesions will be presented from the daily service and consultation files of the speakers. Indeterminate thyroid lesions account for a significant proportion of thyroid FNA interpretations and represent a source of frustration for pathologists and clinicians. The speakers present a practical approach to diagnosing indeterminate thyroid lesions, including the utilization of well-defined and strict cytologic criteria that help establish a more accurate and reproducible diagnosis. Potential pitfalls and how best to avoid them are emphasized. An update on the 2017 Bethesda System for Reporting Thyroid Cytology (TBSRTC) and the 2015 American Thyroid Association (ATA) guidelines for the management of thyroid nodules are highlighted. The role of molecular testing in thyroid cytology, including its indications, benefits, and limitations is discussed.

Surgical pathology of thyroid tumors, especially follicular-patterned neoplasms, remains a highly challenging diagnostic area for most pathologists and constitutes a major portion of our head and neck consultation volumes. There is well-documented inter-observer variability in the interpretation of these lesions, even amongst experts. Distinction between follicular adenoma, follicular carcinoma, and follicular variant of papillary thyroid carcinoma can at times be very challenging; this is due to poor agreement on the criteria for capsular and vascular space invasion and/or diagnostic nuclear features of FVPTC. The speakers discuss these diagnostic challenges and present the most agreed upon criteria for the diagnosis and classification of such tumors, prognostic implications, and the newly proposed entity of NIFTP.

Few investigators have advocated the routine use of core needle biopsy (CNB) as an alternative to FNA, and some clinicians are requesting routine image-guided CNB of thyroid nodules. Most pathologists, however, have limited experience with such specimens. Indications, benefits, and limitations of CNB and cell blocks are presented, as well as the diagnostic challenges and pitfalls that may be encountered in the evaluation of such specimens.

This course encompasses evidence-based medicine and the speakers' recommendations derived from their experiences with extensive consult services. Emphasis is placed on practical approaches to diagnoses, the impact on patient management, and how the speakers implemented changes in their own practices. A case presentation format is followed. Images from all cases with relevant clinical history are posted as unknowns prior to course. At the time of the course, the final diagnosis and differential diagnoses are discussed, with emphasis on well-defined criteria and potential pitfalls.

Learning Objectives

Upon completion of this educational activity, the learner will be able to:

  • Confidently evaluate indeterminate thyroid cytologic lesions and appropriately triage for molecular testing if needed.
  • Become familiar with new ATA management guidelines, diagnosis of follicular-patterned thyroid tumors, and updates to TBSRTC
  • Recognize challenges and avoid diagnostic pitfalls commonly associated with FNA, surgical resection, and CNB specimens


Continuing Medical Education and Maintenance of Certification

The United States and Canadian Academy of Pathology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The United States and Canadian Academy of Pathology designates this live activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The USCAP is approved by the American Board of Pathology (ABP) to offer Self-Assessment credits (SAMs) for the purpose of meeting the ABP requirements for Maintenance of Certification (MOC). Physicians must take and pass the post-test in order to claim SAMs credit.

Physicians can earn a maximum of 3 SAM credit hours.


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