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SpringerLink Full view. More options. Find it at other libraries via WorldCat Limited preview. Contributor Ali, Syed Z. Cibas, Edmund S. Bibliography Includes bibliographical references and index.

Contents Overview of Diagnostic Terminology and Reporting. Andrea Abati. Preparations for the conference began 18 months earlier with the designation of a steering committee and the establishment of a dedicated, p- manent web site. The meeting took place on October 22 and 23, in Bethesda, Maryland and was co-moderated by Susan J.

Mandel and Edmund S. The discussions and conclusions regarding terminology and morphologic criteria 1, 2 from the meeting were summarized in publications by Baloch et al. Hidden fields. Top charts. New arrivals. Ali Edmund S. Cibas March 20, Andrea Abati. Preparations for the conference began 18 months earlier with the designation of a steering committee and the establishment of a dedicated, p- manent web site. The meeting took place on October 22 and 23, in Bethesda, Maryland and was co-moderated by Susan J. Mandel and Edmund S. The discussions and conclusions regarding terminology and morphologic criteria 1, 2 from the meeting were summarized in publications by Baloch et al.

It is critical that the cytopathologist communicate thyroid FNA interpretations to the referring physician in terms that are succinct, unambiguous, and helpful clinically. We recognize that the terminology used here is a flexible framework that can be modified by individual laboratories to meet the needs of their providers and the patients they serve. Reviews Review Policy. Published on.

The Bethesda System for Reporting Thyroid Cytopathology Definitions, Criteria and Explanatory Notes

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Cytologic diagnosis by examination of exfoliated cells in serous cavity fluids is one of the most challenging areas in clinical cytopathology. Evaluation of cytologic samples derived from endoscopic or FNA procedures is extremely important for the diagnosis of a set of lesions that are present deep in the abdomen in tissues that are not amenable to histologic biopsy. With increased understanding of the natural history of cystic and solid lesions of the pancreaticobiliary system, it was time for cytopathologists to add uniformity to their interpretations.

The need for useful diagnostic interpretations in this area is especially important because of the high mortality of cancers in this area, such as pancreatic ductal carcinoma or cholangiocarcinoma, and because the early diagnosis that cytopathology can achieve may be essential for survival.

The risks associated with significant surgical interventions such as the Whipple procedure necessitate a high degree of accuracy in malignant diagnoses.


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As above, Drs Pitmann and Layfield were hampered by having to create a system without the help of the structure provided by the government in Bethesda. The offices of the National Cancer Institute that had helped in the previous 2 systems were directed elsewhere, so that the structure of a professional society was used to develop the project.

The Papanicolaou Society PSC created surveys regarding the state of pancreaticobiliary cytologic practice, reviewed the literature and created discussion groups relative to pancreaticobiliary cytology. Five committees were charged with producing guidelines and included:.

The guidelines were published as a set in 3 separate journals in 35 - 37 and led to the monograph, The Papanicolaou Society System for Reporting Pancreaticobiliary Cytology: definitions, criteria and explanatory notes. The categorization scheme for pancreaticobiliary cytology was based on 6 tiers and is shown in Table 4. A number of pancreatic neoplasms may or may not show the propensity for the malignant behavior of local invasion and distant spread and these somehow had to be incorporated in a rational manner. There are variable risks of malignancy for cystic lesions, stromal neoplasms, and neuroendocrine tumors.

The PSC guidelines subdivided their neoplastic lesions in to a number of subsets including: neoplastic benign, neoplastic other, suspicious, and malignant. Lesions that do not clearly indicate their biologic behavior based on cytomorphology are placed in this category and have increased risk.

Definitions, Criteria, and Explanatory Notes

The suspicious for malignancy category was reserved for worrisome samples that are somehow qualitatively or quantitatively deficient without sufficient features to make the call of cancer. With The Paris System TPS , the convention of naming the standardized cytology terminology systems after a notable city became established. For decades it had been well known that urinary cytology was excellent at detecting high grade urothelial lesions, but that it did not fare very well in finding low grade lesions. Urinary cytology has always had a symbiotic relationship with cystoscopy.

Via cystoscopy an urologist could see the low grade papillary lesions that cytology could not reliably detect.

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Alternatively, high grade lesions that are relatively easy to see on cytology tend to be flat and hidden from the cystoscope. As indicated, the history is long, in an article by G. Farrow compared cystoscopy to urinary cytology and found a One, that low grade papillary urothelial lesions rarely invade or metastasize. In fact, after literature review, no one was sure of the quality of rare reports claiming to show progression of low grade lesions into invasive disease. Second, that low grade lesions seem to have genetic disruptions in Fibroblast Growth Factor 3 Receptor FGFR3 pathways 40 as distinct from the more genetically unstable high grade lesions that are characterized by p53 mutation.

If such neoplasms do not invade or metastasize they do not meet the definition of malignancy as a lesion capable of local invasion and distant spread. Fourth, the use of overuse of the atypia category was widespread and impaired the performance characteristics of the test.


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Fifth, and most importantly that the object of urinary cytology should be restricted to what is does best, which is the detection and diagnosis of HGUC. TPS was built around those ideas. The diagnostic categories are listed in Table 5. There was initially some push back from individuals who could not let go of the diagnosis of low grade neoplasia due to papillary groups without fibrovascular cores.

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There are generations of cytologists that have always used the presence of such papillary groups in voided urines to suggest papillary cancers, but the use of those criteria needed to be revised, especially in the face of catheterized or washing specimens that produced benign epithelial papillary type groups secondary to instrumentation effect. In the course of TPS development, the utility and popularity of ancillary methodology was examined. None have proven to be either inexpensive or definitive and provide the superior performance that would enable management decisions. Because of the potential for clear decision making, TPS is being examined in many centers and is the subject of many current research studies, as evidenced by numerous posters and platforms at pathology professional meetings.

The effort is backed by a large body of literature explaining salivary gland FNA utility, but the authors were mindful that the complexity of salivary gland cytology presents unique problems. In Milan, these lesions were termed Salivary gland tumors of Uncertain Malignant Potential or SUMP and includes entities worrisome for malignancy on the basis of indeterminate cytomorphology and when the cytologic pattern is not consistent with the clinical or radiologic findings. The major diagnostic categories are shown in Table 6. Initial surveys to the greater cytology community formed the basis of the initial effort, 12 and the atlas was published in Marked atypia concerning for malignancy but quantitatively or qualitatively insufficient for definitive diagnosis.

A major goal of TMS is to improve cytologic guidance of clinical decision making. Particularly, nonneoplastic lesions do not require surgical excision, while benign neoplasms may benefit from conservative excision. Among malignant neoplasms, the categorization of low grade vs high grade malignancies may dictate whether the facial nerve is sacrificed or spared, or whether lymph node dissection will be pursued.