J Pathol Transl Med.  2017 Nov;51(6):548-554. 10.4132/jptm.2017.09.29.

Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital

• Satoh S
• Yamashita
• Kakudo K

• KMID: 2396536
• DOI: http://doi.org/10.4132/jptm.2017.09.29

Abstract

In Japan, fine-needle aspiration (FNA) cytology is the most important diagnostic modality for triaging patients with thyroid nodules. A clinician (endocrinologist, endocrine surgeon, or head and neck surgeon) generally performs FNA cytology at the outpatient clinic, and ultrasound (US)-guided FNA is widespread because US is extremely common and most clinicians are familiar with it. Although almost all FNA thyroid samples are examined by certified cytopathologists and pathologists, some clinicians assess cytological specimens themselves. In Japan, there are two clinical guidelines regarding the management of thyroid nodules. One is the General Rules for the Description of Thyroid Cancer (GRDTC) published by the Japanese Society of Thyroid Surgery (JSTS) in 2005, and the other is the national reporting system for thyroid FNA cytology published by the Japan Thyroid Association in 2013 (Japanese system). Although the Bethesda System for Reporting Thyroid Cytopathology (Bethesda system) is rarely used in Japan, both the GRDTC and Japanese system tried to incorporate the Bethesda system so that the cytological diagnoses would be compatible with each other. The essential point of the Japanese system is stratification of follicular neoplasm (FN) into three subgroups based on cytological features in order to reduce unnecessary diagnostic thyroidectomy, and this system has been successful in stratifying the risk of malignancy in FN patients at several high-volume thyroid surgery centers. In Japan, the measurement of thyroglobulin and/or calcitonin in FNA needle washings is often used as an adjunct for diagnosis of possible cervical lymph node metastasis when FNA cytology is performed.

Keyword

Thyroid; Fine needle aspiration cytology; Indeterminate; The Bethesda System for Reporting Thyroid Cytopathology; Japan; Risk stratification; Risk of malignancy

MeSH Terms

Ambulatory Care Facilities
Asian Continental Ancestry Group*
Biopsy, Fine-Needle
Calcitonin
Diagnosis
Head
Humans
Japan
Lymph Nodes
Neck
Needles
Neoplasm Metastasis
Thyroglobulin
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule
Thyroidectomy
Ultrasonography
Calcitonin
Thyroglobulin

Figure

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  Fig. 1. Correlation between the Japan Thyroid Association reporting system (the Japanese system) and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). FN, follicular neoplasm.

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  Fig. 2. Cytological findings of indeterminate A3. Cellular atypia, loss of cellular polarity, nuclear enlargement, and nuclear over-lapping are noted. The specimen was aspirated from a minimally invasive follicular carcinoma.

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  Fig. 3. Cytological findings of indeterminate A1. Microfollicular clusters are seen. The nuclei are round and slightly small. The specimen was aspirated from a follicular adenoma.

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