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JPTM > Ahead-of Print

doi: https://doi.org/10.4132/jptm.2017.09.29    [Epub ahead of print]
Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital
Shinya Satoh1, Hiroyuki Yamashita1, Kennichi Kakudo2
1Department of Endocrine Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
2Department of Pathology, Kindai University Faculty of Medicine, Nara Hospital, Ikoma, Japan
Corresponding Author: Shinya Satoh ,Tel: +81-92-281-1300, Fax: +81-92-281-1301, Email: shinya.s.48128@kojosen.com
Received: August 25, 2017;  Revised: September 23, 2017  Accepted: September 29, 2017.  Published online: October 11, 2017.
ABSTRACT
In Japan, fine needle aspiration (FNA) cytology is the most important diagnostic modalities 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 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, the GRDTC and Japanese system both tried to incorporate the Bethesda system so that cytological diagnoses would be comparable among the different systems. 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 used successfully to stratify the risk of malignancy in FN patients at several high-volume thyroid surgery centers. In Japan, 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.
Key Words: thyroid, fine needle aspiration cytology, indeterminate, The Bethesda System for Reporting Thyroid Cytopathology, Japan, risk stratification, risk of malignancy
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