hrvatski

Štitnjača – hrvatske smjernice u usporedbi s Bethesda kategorijama

Thyroid nodules always raise the question of cancer. FNA is the most important tool in the evaluation of thyroid nodules because it is fast, inexpensive, and highly accurate. The rate of thyroid FNAs is increasing rapidly, most probably due to increased use of more sensitive neck imaging tools. Nowadays, the thyroid FNA is the most common type of FNA specimens in a cytology laboratory. In the recent years, a variety of 4- to 6-tiered classification schemes for thyroid FNA have been proposed by different societies and institutions. With the aim to standardize the diagnostic terminology in thyroid FNA, in 2007 in United States National Cancer Institute has proposed a 6- tiered reporting Bethesda system for thyroid cytology based on the NCI Thyroid FNA State-Of- Science Consensus Conference. In Italy and UK, national 5-tiered classifications are proposed. In Croatia, in 2012, on the basis of data reported in literature and our own experience we implemented the following 4-tiered diagnostic scheme: The non-diagnostic category is usually consisted of those specimens that contain virtually no or very few follicular cells. This category also includes lesions when the specimen shows material without any suspicious cellular features but the lack or paucity of follicular cells makes it insufficient to comfortably make a diagnosis of a benign lesion. The most common lesion from this category is pseudocystic lesions. Cytological diagnosis of these lesions indicate close follow- up or repeat FNA. The benign lesions category includes lesions that could be cytologically diagnosed as benign with confidence and accuracy. More common diagnoses in this category are nodular goiter, Hashimoto thyroiditis and adenomatoid nodule. Lesions in this group can be managed conservatively, and if the nodules continue to enlarge, then the repetition of FNA is indicated. The indeterminate lesions category comprises a large spectrum of lesions with cytological features more or less suggestive of, but not diagnostic for, malignancy. More common diagnoses in this category are cellular follicular lesion, atypia of undeterminated significance, follicular neoplasm, Hürthle cell neoplasm and suspicious of papillary carcinoma. Individual approach is recommended and, in most cases, clinical data and ancillary methods determine further treatment. The malignant neoplasms category includes all specimens in which an unequivocal diagnosis of malignancy can be made. The overwhelming majority in this category are papillary carcinomas, followed by medullary carcinomas and anaplastic carcinomas. The main difference between Bethesda system and Croatian guidelines lies in a different number of categories. In Bethesda 6-tiered system indeterminate lesions are divided in 3 separate categories according to the different risk of malignancy and therefore somewhat different treatment. In Croatian thyroid FNA guidelines all indeterminate lesions are in the same category to stress the importance of individual approach, diagnostically and therapeutically, to these patients. Clinical data, age, patient's preferences, and ancillary methods, such as immunocytochemistry and molecular methods, are the clue for further treatment. The most important to all newly proposed classification schemes is unique terminology. Implementation of terms atypia of undeterminated significance and follicular lesion of undeterminated significance (or its synonym cellular follicular lesion) is widely accepted.

štitnjača; citologija; smjernice; Bethesda

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