Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

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2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. Methods: Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, a...

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Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

/pdf/sexually-transmitted-diseases-treatment-guidelines-4zaqk3joit.pdf

Sexually transmitted diseases treatment guidelines.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673607614160.pdf

Human papillomavirus and cervical cancer

Of the many types of human papillomavirus (HPV), more than 30 infect the genital tract. The association between certain oncogenic (high-risk) strains of HPV and cervical cancer is well established. Although HPV is essential to the transformation of cervical epithelial cells, it is not sufficient, and a variety of cofactors and molecular events influence whether cervical cancer will develop. Early detection and treatment of precancerous lesions can prevent progression to cervical cancer. Identification of precancerous lesions has been primarily by cytologic screening of cervical cells. Cellular abnormalities, however, may be missed or may not be sufficiently distinct, and a portion of patients with borderline or mildly dyskaryotic cytomorphology will have higher-grade disease identified by subsequent colposcopy and biopsy. Sensitive and specific molecular techniques that detect HPV DNA and distinguish high-risk HPV types from low-risk HPV types have been introduced as an adjunct to cytology. Earlier detection of high-risk HPV types may improve triage, treatment, and follow-up in infected patients. Currently, the clearest role for HPV DNA testing is to improve diagnostic accuracy and limit unnecessary colposcopy in patients with borderline or mildly abnormal cytologic test results.

Human Papillomavirus and Cervical Cancer

ObjectivesThe Bethesda 2001 Workshop was convened to evaluate and update the 1991
Bethesda System terminology for reporting the results of cervical cytology.
A primary objective was to develop a new approach to broaden participation
in the consensus process.ParticipantsForum groups composed of 6 to 10 individuals were responsible for developing
recommendations for discussion at the workshop. Each forum group included
at least 1 cytopathologist, cytotechnologist, clinician, and international
representative to ensure a broad range of views and interests. More than 400
cytopathologists, cytotechnologists, histopathologists, family practitioners,
gynecologists, public health physicians, epidemiologists, patient advocates,
and attorneys participated in the workshop, which was convened by the National
Cancer Institute and cosponsored by 44 professional societies. More than 20
countries were represented.EvidenceLiterature review, expert opinion, and input from an Internet bulletin
board were all considered in developing recommendations. The strength of evidence
of the scientific data was considered of paramount importance.Consensus ProcessBethesda 2001 was a year-long iterative review process. An Internet
bulletin board was used for discussion of issues and drafts of recommendations.
More than 1000 comments were posted to the bulletin board over the course
of 6 months. The Bethesda Workshop, held April 30-May 2, 2001, was open to
the public. Postworkshop recommendations were posted on the bulletin board
for a last round of critical review prior to finalizing the terminology.ConclusionsBethesda 2001 was developed with broad participation in the consensus
process. The 2001 Bethesda System terminology reflects important advances
in biological understanding of cervical neoplasia and cervical screening technology.

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The 2001 Bethesda System: terminology for reporting results of cervical cytology.

The Bethesda System for reporting the results of cervical cytology was introduced in 1988 and revised in 1991 using the actual laboratory and clinical experience with the system. After 10 years of widespread use and advances in biologic understanding of cervical neoplasia, it was felt important to reexamine this terminology. After extensive internet web-based discussion groups on various aspects of the System, a workshop was held at the National Cancer Institute in Bethesda, Maryland, with participation from a broad range of constituents including cytologists, pathologist, clinicians, epidemiologists, patient advocates, and attorneys. This consensus statement is the report of this workshop. The following table (Table 1) is an abstract of the consensus statement.

The 2001 Bethesda system: Terminology for reporting results of cervical cytology

Objective. The prevalence of thyroid nodularity in children has been estimated to be 1.8%. The reported prevalence of specific diseases which comprise these nodules is conflicting as evidenced by a reported range of malignancy of 2 to 50% in solitary nodules. In order to better classify pediatric (<18 years old) thyroid disease and evaluate the utility of fine needle aspiration biopsy (FNAB) in this patient population, we retrospectively reviewed 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes from 57 patients. Methodology. Patients: The study was composed of 8 males and 49 females who ranged in age from 1 to 18 years old (mean=13.1). Design: Surgical and/or clinical follow-up was obtained in all patients. The 66 FNAB diagnoses were initially classified into specific diseases. However, for the purpose of this review, the cases were classified as: 3 insufficient, 51 benign, 8 suspicious, and 4 malignant. Results. There were no «false positives» and one «false negative» (a papillary carcinoma was misdiagnosed as a benign nodule). Overall, 10 patients (18%) had malignant thyroid lesions, including 8 papillary carcinomas and 2 follicular carcinomas. Benign diagnoses included benign nodule, cyst, lymphocytic thyroiditis, granulomatous thyroiditis, hyperplasia, and abscess. Conclusions. The prevalence of malignancy in pediatric patients with thyroid nodules was 18%. We conclude that, because of its high diagnostic accuracy and minimal invasiveness, FNAB is useful in the management of pediatric thyroid nodules

Pediatric Thyroid Nodules: Disease Demographics and Clinical Management as Determined by Fine Needle Aspiration Biopsy

Background. Bladder cytology is being used increasingly to detect and monitor early stage bladder cancer. Because of the lack of significant cytomorphologic atypia in low grade transitional cell carcinomas (TCCs), there often is great difficulty in separating these neoplastic cells from benign urothelial cells.



Methods. In an attempt to increase diagnostic sensitivity, 82 bladder wash specimens, which included 33 low grade TCCs and 49 nonneoplastic lesions, were reviewed retrospectively. With a stepwise logistic regression analysis, three key cytomorphologic criteria useful in the separation of low grade TCC from benign urothelium were identified.



Results. The key cytologic criteria were increased nuclear/cytoplasmic ratios, irregular nuclear borders, and cytoplasmic homogeneity. By using contingency tables, these three criteria combined had a sensitivity of 45% and a specificity of 98% in the diagnosis of low grade transitional cell carcinoma. If any two of the criteria were present, there was a sensitivity of 85% and a specificity of 96%.



Conclusions. By using these three criteria, the diagnosis of TCC can be made with a high degree of accuracy in bladder wash specimens.

Low Grade Transitional Cell Carcinoma of the Bladder Cytologic Diagnosis by Key Features as Identified by Logistic Regression Analysis

Although cervical-vaginal telecytology is a promising tool, diagnostic accuracy has not been extensively evaluated. The authors examined the accuracy of five cytotechnologists who retrospectively reviewed 50 cervical-vaginal smears using the video monitor, and 2 months later, using the light microscope. Accuracy was expressed in terms of crude agreement with the original diagnosis and number of false positives (FPs) and false negatives (FNs). With a greater than one step difference as discrepant, the group crude agreement using the video monitor and the light microscope was 85.6% and 95.6%, respectively. The group number of FNs and FPs for the light microscope was 8 and 7, respectively, and for the video monitor was 34 and 7, respectively. There was a wide range of individual performance. We conclude that accuracy of telecytology is high, but less than that of light microscopy. The major reason for lower telecytologic accuracy was undercalling dysplasia.

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Stephen S. Raab

Papers

The 2001 Bethesda System: terminology for reporting results of cervical cytology.

The 2001 Bethesda system: Terminology for reporting results of cervical cytology

Pediatric Thyroid Nodules: Disease Demographics and Clinical Management as Determined by Fine Needle Aspiration Biopsy

Low Grade Transitional Cell Carcinoma of the Bladder Cytologic Diagnosis by Key Features as Identified by Logistic Regression Analysis

Telecytology: diagnostic accuracy in cervical-vaginal smears.