Objectives: We have previously shown that specimens diagnosed as containing Hürthle cells have a 12% chance of being malignant if they are classified as atypia of undetermined significance (AUS-HC). The identification of Hürthle cells by cytotechnologists (CTs) during screening can improve cytopathologist efficiency and may prevent diagnostic errors due to the oversights of focal findings. Here, we examine the performance of our institutional CTs when screening for Hürthle cell atypia in thyroid fine-needle aspiration (FNA) specimens. Study Design: Information on 8,814 thyroid cytopathology specimens was retrieved for a 10-year period. Specimens were screened by 1 of 11 CTs. A subsample of cases was categorized either as AUS-HC or suspicious for Hürthle cell neoplasm. Results: AUS-HC screening diagnoses were more likely to be downgraded to benign but less likely to be upgraded compared to AUS diagnoses with nuclear or microfollicular atypia. AUS-HC represents almost all papillary thyroid carcinoma (PTC) screening diagnoses downgraded to the AUS category, which suggests that even low levels of Hürthle cell atypia can result in PTC being included in the differential diagnosis. Conclusion: Overall, there are few major discrepancies between CT and pathologist diagnoses for specimens containing Hürthle cell atypia.

Olson MT, Ali SZ: Cytotechnologist on-site evaluation of pancreas fine needle aspiration adequacy: comparison with cytopathologists and correlation with the final interpretation. Acta Cytol 2012;56:340-346.
Olson MT, Novak A, Kirby J, Shahid H, Boonyaarunnate T, Ali SZ: Cytotechnologist-attended on-site evaluation of adequacy for metastatic disease involving bone and soft tissue. Acta Cytol 2013;57:550-556.
Olson MT, Tatsas AD, Ali SZ: Cytotechnologist-attended on-site adequacy evaluation of thyroid fine-needle aspiration: comparison with cytopathologists and correlation with the final interpretation. Am J Clin Pathol 2012;138:90-95.
Collins JA, Novak A, Ali SZ, Olson MT: Cytotechnologists and on-site evaluation of adequacy. Korean J Pathol 2013;47:405-410.
Marotti JD, Rao KP, Brister KJ, Gutmann EJ, Tsapakos MJ, Sheiman R, Wang HH, VanderLaan PA: Cytologic rapid on-site evaluation of transthoracic computed tomography-guided lung needle biopsies: who should perform ROSE? A cross-institutional analysis of procedural and diagnostic outcomes. J Am Soc Cytopathol 2015;4:160-169.
Goulart RA: Cytotechnologists today: much more than ‘Pap-ologists' with schools in need of our support. Am J Clin Pathol 2008;129:523-524.
Olson MT, Trotter J, Sterling F, Kelly D, Sachs S, Cornish TC, Boonyaarunnate T, Toll A, Tatsas AT, Maleki Z, Erozan YS, Rosenthal DL: Reproducibility of the Johns Hopkins Hospital template for urologic cytology samples. J Am Soc Cytopathol 2014;3:156-164.
Cibas ES, Dean B, Maffeo N, Allred EN: Quality assurance in gynecologic cytology. The value of cytotechnologist-cytopathologist discrepancy logs. Am J Clin Pathol 2001;115:512-516.
Clary KM, Davey DD, Naryshkin S, Austin RM, Thomas N, Chmara BA, Sugrue C, Tworek J: The role of monitoring interpretive rates, concordance between cytotechnologist and pathologist interpretations before sign-out, and turnaround time in gynecologic cytology quality assurance: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference Working Group 1. Arch Pathol Lab Med 2013;137:164-174.
Medicare, Medicaid and CLIA Programs: Regulations implementing the clinical laboratory improvement amendments of 1988 (CLIA)-HCFA. Final rule. Fed Regist 1992;57:7002-7186.
Cibas ES, Ali SZ: The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658-665.
Solomon D, Nayar R: The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes, ed 2. New York, Springer, 2006.
Fazeli R, Schneider EB, Ali SZ, Zeiger MA, Olson MT: Diagnostic frequency ratios are insufficient to measure laboratory precision with the Bethesda system for reporting thyroid cytopathology. Acta Cytol 2015;59:225-232.
Olson MT, Boonyaarunnate T, Aragon Han P, Umbricht CB, Ali SZ, Zeiger MA: A tertiary center's experience with second review of 3885 thyroid cytopathology specimens. J Clin Endocrinol Metabol 2013;98:1450-1457.
Sherman ME, Dasgupta A, Schiffman M, Nayar R, Solomon D: The Bethesda Interobserver Reproducibility Study (BIRST): a web-based assessment of the Bethesda 2001 system for classifying cervical cytology. Cancer 2007;111:15-25.
Nagarajan N, Schneider EB, Ali SZ, Zeiger MA, Olson MT: How do liquid-based preparations of thyroid fine-needle aspiration compare with conventional smears? An analysis of 5,475 specimens. Thyroid 2015;25:308-313.
Nagarajan N, Najafian A, Schneider EB, Zeiger MA, Olson MT: Conventional smears versus liquid-based preparations for thyroid fine-needle aspirates: a systematic review and meta-analysis. J Am Soc Cytopathol 2015, in press.
Olson MT, Clark DP, Erozan YS, Ali SZ: Spectrum of risk of malignancy in subcategories of ‘atypia of undetermined significance'. Acta Cytol 2011;55:518-525.
Boonyaarunnate T, Olson MT, Ali SZ: ‘Suspicious for a follicular neoplasm' before and after the Bethesda system for reporting thyroid cytopathology: impact of standardized terminology. Acta Cytol 2013;57:455-463.
Fisher RA: The logic of inductive interference. J R Stat Soc 1935;98:39-82.
Student: The probable error of a mean. Biometrika 1908;6:1-25.
VandenBussche CJ, Olson MT, Adams C, Ali SZ: Cytotechnologist performance for screening microfollicular atypia in indeterminate thyroid fine-needle aspirates. Acta Cytol 2014;58:432-438.
VandenBussche CJ, Adams C, Ali SZ, Olson MT: Cytotechnologist performance for detecting nuclear atypia in indeterminate thyroid fine needle aspirates. Acta Cytol 2014;58:239-247.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.