Implementation of Videos Captured by Static Telecytological Applications for Obtaining Expert Opinions

Published studies compare static and dynamic telecytology systems. Still, no study has focused on implementing short videos captured by static telecytology stations for telemedical applications. The chapter aims to evaluate the diagnostic reproducibility of telecytology in thyroid fine-needle aspiration specimens prepared using liquid-based cytology among four cytopathologists using representative short duration videos captured by a static telecytology station. It also examines the agreement between the contributor's and the reviewer's diagnoses.

Thyroid cytology during the COVID-19 pandemic: a single centre experience

Background: In our study, thyroid fine-needle aspiration biopsy (FNAB) data in the same calendar period of 1 year before and after the COVID-19 pandemic were compared.Methods: Thyroid FNAB data for the same calendar period of 1 year before and after the COVID-19 pandemic were included in the study. The patients were grouped according to age, gender and thyroid FNABs according to the Bethesda system for reporting thyroid cytopathology, and the data of both groups were compared considering the diagnoses of the patients who underwent thyroid surgery afterwards.Results: In the post-pandemic period, the number of thyroid FNABs and the number of patients over the age of 40 decreased (all p<0.001). In the post-pandemic period, the rates of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm or suspicious for a follicular neoplasm (FN/SFN), suspicious for malignancy, and malignant cytology increased despite the decrease in the number of patients (p=0.001). Furthermore, the malignant tumour rate was 1.4% before the pandemic in patients who underwent surgical thyroidectomy and/or lobectomy; this rate was 3.5% in the post-pandemic period (p=0.045).Conclusions: We found an increase in the percentage of AUS/FLUS, FN/SFN, suspicious for malignancy, and malignant cases during the period when there were restrictions, such as pandemics, and the sampling was reduced. This finding is valuable in terms of detecting an increased malignancy rate by performing less thyroid FNAB by carefully determining the indications for thyroid aspiration biopsy regarding the latest guidelines.

Comparison of Diagnostic Rates and Concordance with Subsequent Surgical Resections between Conventional Smear and ThinPrep Preparations versus ThinPrep Only in Thyroid Fine Needle Aspiration (T-FNA) Specimens

<b><i>Background:</i></b> Thyroid fine needle aspiration (T-FNA) is a mainstay in management of thyroid nodules. However, the preparation of T-FNA specimens varies across institutions. Prior studies have compared diagnostic rates between different specimen preparations of T-FNA specimens and their associated advantages and disadvantages. However, few have compared the rates of all diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) between liquid-based preparations (LBPs) and a combination of LBP and conventional smear (CS) preparations. Our study compares TBSRTC diagnostic rates between these 2 cohorts and correlates cytologic diagnoses with subsequent thyroid resections to evaluate rates of neoplasia (RON) and malignancy (ROM). <b><i>Methods:</i></b> 584 consecutive thyroid FNA specimens were collected and stratified by preparation type (ThinPrep [TP] vs. CS &amp; TP). Diagnostic rates for each TBSRTC diagnostic category were calculated. The institution’s electronic medical records database was searched for histologic diagnoses of previously sampled thyroid nodules to evaluate the RON and ROM. <b><i>Results:</i></b> Of 584 thyroid FNA specimens, 73 (12.5%) and 511 (87.5%) were evaluated by TP only and CS &amp; TP, respectively, reflecting the predominance of rapid on-site evaluation (ROSE) with CS for T-FNAs at our institution. Of the TP only and CS &amp; TP cohorts, 29 (39.7%) and 98 (19.2%) had subsequent resections, respectively. The frequency of non-diagnostic cases was lower in the CS &amp; TP cohort (12.7% vs. 26%). While the diagnostic rate of follicular lesion of undetermined significance was similar for both cohorts, SFN categorization was only utilized in the CS &amp; TP cohort (1.5% vs. 0%). Although RON and ROM were similar between cohorts in many of the TBSRTC categories, there was a higher RON associated with non-diagnostic specimens in the TP only cohort when the denominator included all non-diagnostic cases. <b><i>Conclusion:</i></b> The combination of CS and LBP may potentially decrease the non-diagnostic rate of T-FNA specimens as well as the number of passes required for diagnosis, particularly with ROSE. Evaluation of morphologic features highlighted in conventional smears may facilitate diagnostic categorization in the “suspicious for follicular neoplasm” category.

Diagnostic value of thyroid imaging reporting and data system in thyroid nodules

Background: The improved detection of TNs (TNs) with US has resulted in an increase in the number of thyroid fine needle aspiration biopsy (FNAB). Appropriate criteria are necessary to avoid an increase of rather unnecessary benign cytologic results in TNs. Thyroid imaging reporting and data system (TIRADS) was first used by Horvath et al in 2009. This was to standardize the reporting of results of thyroid (ultrasonography) US that can be understood by clinicians and also stratify the risk of malignancy of a lesion based on the US features of the lesion.Methods: Cases with uninodular or multinodular goiter had been included. Evaluation of cases had been done using ultrasound of the neck. TNs were classified into categories according to thyroid imaging reporting and data system of the American colleague of radiologists (ACR-TIRADS).Cases were ordered for fine needle aspiration cytology (FNAC). Operable cases were only included in the study and postoperative histopathology was revised.Results: The study included 46 patients. The different TIRADS categories were confronted with the results of cytology and histopathology. Combining TIRADS 2 and 3 as probably benign categories and TIRADS 4 and 5 as probably malignant categories, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were respectively 100%, 84.38%, 73.68% and 100%. The accuracy of ACR-TIRADS was 89.13%.Conclusions: ACR-TIRADS helps in stratifying nodular thyroid disease based on the risk of malignancy. It could lead to a significant decrease of the number of unnecessary FNABs.