Thyroid nodule classification: Difference between revisions

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==== Bethesda System for Reporting Thyroid Cytopathology ====
==== Bethesda System for Reporting Thyroid Cytopathology ====
*: 19888858
{| class="wikitable"
{| class="wikitable"
!classification
!classification
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Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 10% that have follicular histology, and 3% that are Hu¨rthle cell or oxyphil tumors
Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 10% that have follicular histology, and 3% that are Hu¨rthle cell or oxyphil tumors


Neoplastic thyroid nodules subclassification:
==== Neoplastic thyroid nodules subclassification: ====
{| class="wikitable"
{| class="wikitable"
!
!Neoplasm
!
!Subclass
!
!Features
!
!
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|Follicular thyroid lesions
| rowspan="5" |Follicular thyroid lesions
|Benign follicular adenoma
|Benign follicular adenoma
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|Minimally invasive follicular carcinoma
|Minimally invasive follicular carcinoma
|only invasion of the capsule of the tumor without vascular invasion
|only invasion of the capsule of the tumor without vascular invasion
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|Widely invasive follicular carcinoma
|Widely invasive follicular carcinoma
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|Encapsulated follicular variant of papillary thyroid cancer
|Encapsulated follicular variant of papillary thyroid cancer
|minor vascular invasion (≤4 foci of angioinvasion within the tumor or capsule of the tumor) with or without capsular invasion
|minor vascular invasion (≤4 foci of angioinvasion within the tumor or capsule of the tumor) with or without capsular invasion
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|Infiltrative variant of papillary thyroid cancer
|Infiltrative variant of papillary thyroid cancer
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| rowspan="2" |papillary thyroid cancer
| rowspan="10" |papillary thyroid cancer
|Classic varient
|Classic varient
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|insular varient
|insular varient
|solid nests of tumor, often separated by fibrous bands, but the tumor cell nuclei have the same characteristics as do the nuclei of classical papillary cancers.
|solid nests of tumor, often separated by fibrous bands, but the tumor cell nuclei have the same characteristics as do the nuclei of classical papillary cancers.
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|columnar variant
|columnar variant
|elongated cells with palisading nuclei.
|elongated cells with palisading nuclei.
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|-
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|Hürthle or oxyphilic variant
|Hürthle or oxyphilic variant
|Cellular features of Hürthle cell carcinomas but cells that are arranged in papillary formations.
|Cellular features of Hürthle cell carcinomas but cells that are arranged in papillary formations.
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|solid or trabecular variant
|solid or trabecular variant
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|clear cell variant
|clear cell variant
|must be distinguished from clear cell carcinomas of other organs such as the kidney or colon that have metastasized to the thyroid.
|must be distinguished from clear cell carcinomas of other organs such as the kidney or colon that have metastasized to the thyroid.
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|-
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|diffuse sclerosing variant
|diffuse sclerosing variant
|diffuse involvement of the thyroid, stromal fibrosis, and prominent lymphocytic infiltration
|diffuse involvement of the thyroid, stromal fibrosis, and prominent lymphocytic infiltration
|
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|-
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|cribriform morular variant
|cribriform morular variant
|Prominent cribriform pattern with solid and spindle cell areas as well as squamous morules. This variant is often associated with familial adenomatous polyposis.
|Prominent cribriform pattern with solid and spindle cell areas as well as squamous morules. This variant is often associated with familial adenomatous polyposis.
|
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|-
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|hobnail variant
|hobnail variant
|harbors ''BRAF'' V600E mutations and appears to be associated with a high risk of distant metastases and an increased disease-specific mortality
|harbors ''BRAF'' V600E mutations and appears to be associated with a high risk of distant metastases and an increased disease-specific mortality
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|}
{| class="wikitable"
!
!
!
|-
|Follicular carcinoma
|Minimally invasive follicular thyroid cancer
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|-
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|Encapsulated angioinvasive follicular thyroid cancer
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|-
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|Widely invasive follicular thyroid cancer
|
*
|}
|}


Thyroid nodule classification based on the sonographhic features:
==== Thyroid nodule classification based on the sonographhic features: ====
 
Classification system has been proposed by Horvath et al 3, with a modified recommendation from Jin Kwak et al 4.
Classification system has been proposed by Horvath et al 3, with a modified recommendation from Jin Kwak et al 4.
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These categories are based on five suspicious sonographic features of malignancy:
*
====== Subclassificaton ======
* '''TIRADS 4a''': 
* '''TIRADS 4b''': 
* '''TIRADS 4c''': 
* '''TIRADS 5''':
TIRADS 4a has , 4b and 4c may have  TIRADS 5 category lesion have  3.


==References==
==References==

Revision as of 11:38, 15 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Bethesda System for Reporting Thyroid Cytopathology

classification FNA cytology Predicted risk of malignancy
Benign
  • Macrofollicular
  • Adenomatoid/hyperplastic nodules
  • Colloid adenomas (most common)
  • Nodular goiter
  • Lymphocytic thyroiditis
  • Granulomatous thyroiditis
0–3 %
Nondiagnostic or Unsatisfactory 1–4 %
Follicular lesion of undetermined significance
  • Mixed macro- and microfollicular nodules
5–15 %
Atypia of undetermined significance
  • Atypical cells
Follicular neoplasm
  • Microfollicular nodules
    • Hurthle cell lesions
15–30 %
Suspicious for a follicular neoplasm
  • Suspicious for Hurthle cell neoplasm
60–75 %
Malignant
  • PTC (most common)
  • MTC
  • Anaplastic carcinoma
  • High-grade metastatic cancers
97–99 %

Classification of neoplastic thyroid nodules based on their origin:

Origin histologic subtypes
Nonmedullary thyroid cancers (NMTCs) 95% of tumors thyroid epithelial cells papillary (85%) 95% are sporadic tumors

5% may be related to inherited genetics due to familial origin

  • Classic varient
  • tall cell variant
  • insular varient
  • columnar variant
  • Hürthle or oxyphilic variant
  • solid or trabecular variant
  • clear cell variant
  • diffuse sclerosing variant
  • cribriform morular variant
  • hobnail variant
follicular (11%)
  • Benign follicular adenoma
  • Minimally invasive follicular carcinoma
  • Widely invasive follicular carcinoma
  • Encapsulated follicular variant of papillary thyroid cancer
  • Infiltrative variant of papillary thyroid cancer
Hürthle cell (3%)
anaplastic (1%)
Medullary thyroid cancers (MTCs) 5% of all thyroid malignancies calcitonin-producing parafollicular cells 20% they are familial and occur as part of the multiple endocrine neoplasia (MEN) syndromes

Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 10% that have follicular histology, and 3% that are Hu¨rthle cell or oxyphil tumors

Neoplastic thyroid nodules subclassification:

Neoplasm Subclass Features
Follicular thyroid lesions Benign follicular adenoma
Minimally invasive follicular carcinoma only invasion of the capsule of the tumor without vascular invasion
Widely invasive follicular carcinoma
  • Extensive invasion of the tumor capsule
  • A multinodular tumor without a well-defined capsule invading the normal thyroid surrounding the tumor
  • Extensive vascular invasion (>4 foci of angioinvasion)
Encapsulated follicular variant of papillary thyroid cancer minor vascular invasion (≤4 foci of angioinvasion within the tumor or capsule of the tumor) with or without capsular invasion
Infiltrative variant of papillary thyroid cancer
papillary thyroid cancer Classic varient
tall cell variant more aggressive tumor than classical papillary cancer

tumor cells with eosinophilic cytoplasm that are twice as tall as they are wide. The primary tumors tend to be large, they are often invasive, and many patients have both local and distant metastases at the time of diagnosis 

insular varient solid nests of tumor, often separated by fibrous bands, but the tumor cell nuclei have the same characteristics as do the nuclei of classical papillary cancers.
columnar variant elongated cells with palisading nuclei.
Hürthle or oxyphilic variant Cellular features of Hürthle cell carcinomas but cells that are arranged in papillary formations.
solid or trabecular variant
clear cell variant must be distinguished from clear cell carcinomas of other organs such as the kidney or colon that have metastasized to the thyroid.
diffuse sclerosing variant diffuse involvement of the thyroid, stromal fibrosis, and prominent lymphocytic infiltration
cribriform morular variant Prominent cribriform pattern with solid and spindle cell areas as well as squamous morules. This variant is often associated with familial adenomatous polyposis.
hobnail variant harbors BRAF V600E mutations and appears to be associated with a high risk of distant metastases and an increased disease-specific mortality

Thyroid nodule classification based on the sonographhic features:

Classification system has been proposed by Horvath et al 3, with a modified recommendation from Jin Kwak et al 4.

TIRADS 1 Normal thyroid gland
TIRADS 2 Benign lesions
  • Avascular anechoic lesion with echogenic specks (colloid type I)
  • vascular heteroechoic non-expansile, non-encapsulated nodules with peripheral halo (colloid type II)
  • isoechoic or heteroechoic, non-encapsulated, expansile vascular nodules (colloid type III)
0% risk of malignancy
TIRADS 3 Probably benign lesions
  • Nodule property:
    • Hyperechoic, iso-echoic or hypoechoic nodules, with partially formed capsule and peripheral vascularity, usually in setting of Hashimoto's thyroiditis (Hashimoto's pseudonodule)
<5% risk of malignancy
TIRADS 4 4a One suspicious feature
  • Suspicious lesions:
    • solid component
      • high stiffness of nodule on elastography if available
    • markedly hypoechoic nodule
    • microlobulations or irregular margins
    • microcalcifications
    • taller-than-wider shape
5-10% risk of malignancy
4b Two suspicious features 10-80% risk of malignancy
4c Three/four suspicious features
TIRADS 5 All five suspicious features Probably malignant lesions (more than 80% risk of malignancy) >80% risk of malignancy
TIRADS 6 Biopsy proven malignancy

References

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