Translational Aspects of Thyroid Cytology

Armando Filie, M.D. Cytopathology Section

Expertise and Methods

Areas of Expertise
Cytopathology Section
Cytomorphologic evaluation, immunocytochemical evaluation and diagnosis of cervical/vaginal, exfoliative nongynecologic 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

PAP ThinPrep slide

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

Translational Aspects of Thyroid Cytology

Current Reporting System for Thyroid Aspirates
The Bethesda System for Reporting Thyroid Cytopathology

AUS

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

Follicular Neoplasm

Indeterminate Categories
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

Research Implications
Provide additional relevant information for the management of thyroid nodules 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 thyroid cytopathology Reduce the morbidity of patients with thyroid nodules by placing them into a more relevant category

Future Directions
Use existing archival cytology resources as source of diagnostic and predictive molecular markers in thyroid cytology, including novel techniques
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 often used for the initial diagnosis
Lung Pancreas

Challenges and Obstacles

Increase the number of aspirates

Collaborators
Laboratory of Pathology
Mark Roth, M.D. Mark Raffeld, M.D.

Intramural
Francesco Celi, M.D. (NIDDK) Monica Skarulis, M.D. (NIDDK)