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Hazard JB, Hawk WA, Crile G. Medullary (solid) carcinoma of the thyroid; a clinicopathologic entity. Describing methods to: i. Three of the 28 specimens (11%) were sparsely cellular, and the rest (89%) were at least moderately cellular. Kocjan G, Cochand-Priollet B, de Agustin PP, Bourgain C, Chandra A, Daneshbod Y, Deery A, Duskova J, Ersoz C, Fadda G, et al. Ramzy . Horn RC. These cells constitute more than 50% of tumor volume[44]. Schnadig Neither of these patterns fits comfortably into the benign category, but the changes are insufficient for any of the more . The management of cases with papillary microcarcinomas, i.e., tumors less than 1.0 cm in diameter, is still controversial. Jo VY, Stelow EB, Dustin SM, Hanley KZ. Hematoxylin-eosinstained sections of the clot particle. Herein lies everything you were afraid to ask. The individual tumor cells are enlarged, oval in shape with eosinophilic cytoplasm; the nuclei show elongation, oval shape, membrane thickening, chromatin clearing, grooves, and inclusions. Since it is a two-dimensional specimen and reveals cells in cut section, it is not ideal for assessment of dysplasia (a marrow aspirate is preferred), but it is extremely useful in identifying possible reasons for a dry tap (a term for when liquid marrow cannot be aspirated during the bone marrow procedure), since the architecture can show fibrosis, sheets of cohesive plasma cells, or metastatic tumor which could result in a dry tap. Retrieved from https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer. Q: Can the core biopsy determine the blast count? These can be highly useful when a core biopsy is suboptimal, demonstrates marked myelofibrosis, is a dry tap, or otherwise fails to provide adequate visual data for morphology, architecture, cellularity, and hematopoietic lineage assessments. There are three main methods of sample preparation; smears, liquid-based preparations, and cell block--these preparation methods may be used singly or in . )TEgX>T|*Q0%K5P- HVe t It usually behaves as an indolent malignant tumor; however, an aggressive clinical course with decreased survival has been reported in some histologic variants of PTC[41]. The significance and clinical value of a CFO result depend in large part on sonographic correlation. The nuclei are hyperchromatic, uniform in size and shape, and with indinstinct nucleoli. The atypical thyroid fine-needle aspiration: past, present, and future. First Time Setup Tested phones Android App Settings Estimated Band FAQ Translate . {t+[O-]:KtJE]+ZhoZo$ZfqemI,W69l]g]EuGnWMGow" elP~G>6?{LsTY?R+-jW:E#x( xtT} . It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Phenotyping hematopoietic cells. Descriptive comments that follow are used to subclassify the benign interpretation. The general category malignant is used whenever the cytomorphologic features are conclusive for malignancy. The NCI conference participants acknowledged the importance of developing a uniform terminology for reporting thyroid FNA results. Bethesda, MD 20894, Web Policies The most common scenarios can be described as follows: There is a prominent population of microfollicles in an aspirate that does not otherwise fulfill the criteria for follicular neoplasm/suspicious for follicular neoplasm. This situation may arise when a predominance of microfollicles is seen in a sparsely cellular aspirate with scant colloid. official website and that any information you provide is encrypted Ohori NP, Nikiforova MN, Schoedel KE, LeBeau SO, Hodak SP, Seethala RR, Carty SE, Ogilvie JB, Yip L, Nikiforov YE. Redman R, Yoder BJ, Massoll NA. A syringe with applied negative pressure gently removes approximately 5 mL of deep red, semi-liquid marrow content. van Hoeven How do the different parts of a bone marrow workup relate to more in-depth analyses of morphology, markers, lineages, and overall diagnostic information? and transmitted securely. Each diagnostic category is associated with a specific risk of malignancy and a recommendation for management. This website is intended for pathologists and laboratory personnel but not for patients. This category also includes cases with a predominant population of Hurthle cells; these cases are labelled Hurthle cell neoplasm (Figure (Figure3).3). The TBSRTC classifies thyroid follicular lesions with microfollicle predominance and lack of colloid into the suspicious for follicular neoplasm category. For clarity of communication, TBSRTC recommends that each report begin with 1 of 6 general diagnostic categories. Some categories have 2 alternative names; a consensus was not reached at the NCI conference on a single name for these categories. J To collect as many cells as possible from sparsely cellular urine, the specimen should have which of the following techniques applied? Map ; Apps; Tools . WC Psammoma bodies are occasionally seen in some aspirates, most possibly arising from calcification of epithelial tips. As a result, 3 to 15 glass slides from each patient are taken and examined, which can be either Giemsa- or Papanikolaou-stained slides[14]. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Any specimen that contains abundant colloid is adequate (and benign), even if 6 groups of follicular cells are not identified; a sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and therefore almost certainly benign. In the World Health Organization classification, Hrthle cell adenoma and Hrthle cell carcinoma are considered oncocytic variants of FA and FC, respectively.24 Studies suggest, however, that follicular and Hrthle cell tumors have different underlying genetics.4,25 For this reason, and because they have such distinctive morphologic features, it is helpful to specify that a sample raises the possibility of a Hrthle cell rather than a follicular neoplasm. Fine-needle aspiration in the work-up of thyroid nodules. A serum protein electrophoresis might have even shown a monotypic expansion. That said, this specimen (if involved by a disease process) can be sent for genetic testing such as polymerase chain reaction and does not present the issue of being postdecalcification (which may hinder some genetic tests). Some cases may present with diagnostic difficulty if the specimen consists mainly of necrotic debris or if the tumor is extremely sclerotic (the paucicellular variant)[40,53]. Such cases represent a minority of thyroid FNAs and in the Bethesda System are reported as atypia of undetermined significance (AUS) or follicular lesion of undetermined significance. The necessity for this category was debated at the NCI conference, after which a vote (limited to the clinicians in attendance) was taken, and the majority voted in favor of this category. Lymphadenopathy is also present in one quarter to half of patients, whereas the lungs is the most common site of metastases[49,50]. This distinction cannot be made by FNA and is of no consequence to the patient. hbbd``b`$Ks ^ Until recently there were no uniform criteria for the various diagnostic categories in thyroid cytopathology. Since there is a considerable proportion of patients with a thyroid nodule who remain undiagnosed with FNA, molecular biology could be very helpful at that point. The thyroid nodules are aspirated 3 to 5 times with a 22-gauge or 25-gauge needle. Figure 1. Use freshly squeaky-cleaned slides. 36.3-50 mL); all 3 scantly cellular specimens had volumes below this median value. et al. After this therapy the patients serum thyroglobulin levels should fall to undetectable levels. Furthermore, various other thyroid FNA reporting systems have been created, in which the experiences of the pathologists and/or associated risks of malignancy have been taken into account. For most cases surgical resection is not an effective treatment and only palliative therapies are used. CS JA Liquid-based preparation can also be made after a FNA pass, with the needle been rinsed in normal saline or ThinPrep solutions. (iii) Cytologic and architectural atypia: The above panel correctly identified cancer in 78.2%, whereas cytology identified 58.9% of the thyroid cancers. Papaparaskeva K, Nagel H, Droese M. Cytologic diagnosis of medullary carcinoma of the thyroid gland. The Paris System for Reporting Urinary Cytology tried lately to address adequacy. Regardless the staining method used, all slides with diagnostic material are used for the evaluation and clarification of each case. In addition, Ohori et al[61] investigated the utility of the above panel in specimens classified as FLUS. The sensitivity of thyroid FNA for medullary thyroid carcinoma (MTC) is considered high, actually it is higher than the sensitivity of FNA for PTC[36]. V 2021 L Street NW, Suite 900,Washington, DC 20036, Phone 202-776-0544Toll Free 866-828-1231Fax 202-776-0545, Copyright 2023 by American Society of Hematology, Support Opportunities|Privacy Policy|Terms of Service|Contact Us, Helping hematologists conquer blood diseases worldwide, Demystifying the Bone Marrow Biopsy: A Hematopathology Primer, https://www.hematology.org/education/trainees/fellows/trainee-news/2021/demystifying-the-bone-marrow-biopsy-a-hematopathology-primer, Relative quantity of different cell types, Provides material for flow and molecular studies. Without individual cells to analyze through flow cytometric methods, the clot section is limited to only tissue-type immunostaining. Megakaryocytes (yellow circles) can be seen at low power. T Reduce red blood cells in smears iii. A complete bone marrow biopsy examination usually involves the review of these four specimens noted here in a slide tray: A) marrow aspirate smear, B) marrow core biopsy, C) clot section, and D) touch imprint preparation. Additionally an immunohistochemical panel, including thyroglobulin, TTF1, and CDX2 may help in the differential diagnosis of such difficult cases. Any specimen that contains abundant colloid is considered adequate (and benign), even if 6 groups of follicular cells are not identified: A sparsely cellular specimen with abundant colloid is, by implication, a predominantly macrofollicular nodule and, therefore, almost certainly benign. 2nd ed. Proposal of the SIAPEC-IAP Italian Consensus Working Group. If the nodule is almost entirely cystic, with no worrisome sonographic features, an endocrinologist might proceed as if the CFO were a benign result. J JR Sparsely cellular specimens: Sample w/ not many cells in suspension can be made more conc'd by Cytospin or centrifugation preparation: 1mL properly prepared cell suspension in funnel of cytospin, centrifuge, cells will be deposited on slide & fluid absorbed by filter paper: Problem: bloody specimens: They are then stained and processed much like the original core biopsy. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). VA The remaining 10% of cases represent a significant subset of thyroid specimens with some form of AUS/FLUS. Architectural atypia may present in smears with paucity of cells, which contain a few microfollicles, trabeculae, or crowded groups. Inadequate cellularity is defined as the presence of less than 6 groups of well-preserved follicular cells on each of at least two slides; (2) DC II Benign (Figure (Figure1).1). However, the percentage of the cases classified into the TIR 3/DC IV (follicular proliferation/neoplasm) category was substantially smaller (4.6%) in the 5-tiered system compared with the 6-tiered system (23.8%). Like the marrow aspirate smear, touch imprint preparations provide a quick turnaround time (i.e., do not need decalcification) and great morphologic detail (if the aspirate smears are paucispicular or hemodiluted). The diagnosis of MTC can be confirmed by simply measuring serum calcitonin levels, which are markedly elevated in the majority of cases (> 10 pg/mL)[48]. The most widely known is the SIAPEC-IAP thyroid reporting system, which is also consists of 5 diagnostic classes[12]. However, in almost 25%-30% of cases, MTC is inherited, and is associated with one of three familial syndromes: Multiple endocrine neoplasia (MEN) syndrome type 2A (Sipples syndrome), MEN type 2B (mucosa neuroma syndrome or Gorlins syndrome), and familial MTC[35]. The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. The cytotechnologist is specially trained and certified to examine cellular samples under a microscope, evaluating the slides for specific abnormalities in the cell's shape, color, or size which could signal a cancerous process or other disease. Johnson For that reason these findings are best interpreted as SFM. The positive predictive value of a malignant FNA interpretation is 97% to 99%. endstream endobj startxref et al. A moderately or markedly cellular sample is composed of a virtually exclusive population of Hrthle cells, yet the clinical setting suggests a benign Hrthle cell nodule, eg. A review of the English literature was conducted, and data were analyzed and summarized and integrated from the authors perspective. A benign result is obtained in 60% to 70% of thyroid FNAs. et al. DP Therefore this tumor may mimic other thyroid tumors, such as Hurthle cell neoplasms, PTCs, anaplastic carcinomas, and metastatic tumors. 4';KiRQ5S&. Baloch Kelman One nucleus has an apparent intranuclear pseudoinclusion (arrow). Theoharis CG, Schofield KM, Hammers L, Udelsman R, Chhieng DC. Maybe a routine peripheral smear caught some circulating blasts. Should atypical follicular cells in thyroid fine-needle aspirates be subclassified? It generally affects elderly patients presenting as a firm mass rapidly growing in the neck infiltrating extrathyroidal tissues, such as muscle, trachea, esophagus, skin, bone and cartilage[49]. Deshpande AH, Munshi MM, Bobhate SK. Effect of the Bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions. Clark DP, Faquin WC. Gough hWkO+t{9! x,{d^O*D Walfish Many of the HCLUS cases did not show any of the above features and were proved to be benign adenomas. In adult mammalian testes, spermatids, most notably step 17-19 spermatids in stage IV-VIII tubules, are aligned with their heads pointing toward the basement membrane and their tails toward the tubule lumen. Carcinoma of the thyroid. The cellular sample is typically monomorphic, although some specimens may appear pleomorphic; the cells are usually small or medium-sized, noncohesive, and contain an eccentrically located nuclei[35]. IB Research is directed to the identification of molecular markers that, in conjunction with FNA, can identify patients with a malignant nodule. Since this is a liquid sample, it does not need to undergo decalcification, can be smeared onto a slide and stained relatively quickly, used for flow cytometry (which needs unfixed, liquid cells), and sent fresh for molecular analysis. The main purpose of thyroid FNA is to identify patients with higher risk for malignancy, and to prevent unnecessary surgeries for benign conditions. This conference established the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), a 6-tiered diagnostic classification system based on a probabilistic approach[8,9]. Williams ED. In some cases psammoma bodies may be present[35,44]. However cases with indeterminate cytological findings still remain a matter of debate. VanderLaan PA, Marqusee E, Krane JF. et al. Of those that prove to be malignant, many are FCs, but a significant proportion are follicular variants of papillary carcinoma.2,8,11,19. et al. Consequently it is essential to distinguish this form of atypical calcification from true psammomatous calcifications with their concentrically laminated microscopic appearance[35]. These indeterminate aspirates may present with architectural atypia or nuclear atypia[21]. Fleisher The prognosis of this tumor is good; death due to PTC is rare. . Extensive research is going on in this field; an important step for the introduction of new molecular markers in the diagnosis of molecular tumors could be the clinical testing of FNA samples in large multicenter trials. We thank Diane Solomon, MD, for review of the manuscript and helpful comments. The reason is that in approximately 10%-30% of cases, cytology is indeterminate and nondiagnostic[4]. In a large study with 1382 cases in a community practice setting, in the United States, Wu et al[32] diagnosed AUS in 27% of cases, ranging from 10% to 47% among pathologists participating in the study. ES Two-dimensional fixed tissue specimens from the biopsy and clot are easily stained with immunohistochemical methods while three-dimensional, liquid cellular content can be assessed with flow cytometry. However, we cannot answer medical or research questions or give advice. The specimen is fixed in paraffin and cut for slide preparation. Ghossein As with the Bethesda System for cervical cytology, it is expected that subsequent workshops will lead to further refinements to this framework. Federal government websites often end in .gov or .mil. Baloch et al. Logani Conflict-of-interest statement: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. In general, patients diagnosed with FNA test as having PTC, are usually managed operatively, but the final decision of the type of resection (lobectomy vs total thyroidectomy) depends on numerous coexisting factors. Figure 3. FOIA Guidelines for management of thyroid cancer. An AUS result is obtained in 3% to 6% of thyroid FNAs.2,10 Higher rates likely represent overuse of this category when other interpretations are more appropriate. Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. Comparative findings of lymphocytic thyroiditis and thyroid lymphoma. Warthin's tumor : the presence of oncocytic epithelium. Cellularity may in part be due to the LBC technique in comparison with smears made after sedimentation, . L Hahn SY, Shin JH, Han BK, Ko EY, Ko ES. . Distant metastases seldom occur, but may develop in 20% of cases in late stage. Hrthle cell carcinoma is a better gold standard than Hrthle cell neoplasm for fine-needle aspiration of the thyroid: defining more consistent and specific cytologic criteria. Inclusion in an NLM database does not imply endorsement of, or agreement with, The disc is then wrapped in tissue paper and paraffin processed as for a biopsy specimen. Theoharis C, Roman S, Sosa JA. The malignancy rate of the AUS/FLUS category is estimated to be between 5% and 15%[10], which is intermediate between that of the benign category (0%-3%) and that of the SFN category (15%-30%). et al. The accuracy of fine-needle aspiration biopsy and frozen section in patients with thyroid cancer. The diagnosis of this variant as a PTC is relatively easy, due to the numerous papillae and the coexisting intranuclear inclusions. ED et al. BRAF is not usually found in the follicular variant of papillary thyroid carcinoma, but is increasingly detectable in each step of dedifferentiation, including tall cell tumors and anaplastic cancer. KH LiVolsi The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation. government site. Issue: Non-Gyn specimen slide is sparsely cellular when ample specimen collected and centrifuged cell pellet is visibly adequate. Logrono Tyrosine-derived polymeric surfactant nanospheres insert cholesterol in cell membranes. "Demystifying the Bone Marrow Biopsy: A Hematopathology Primer, 01 May. The aspirates from anaplastic carcinoma do not pose any diagnostic difficulties. The bone marrow aspirate is arguably the most straightforward aspect of the bone marrow workup. Baloch On the other hand a definitive diagnosis of a low-grade lymphoma (usually a MALT lymphoma) is even more difficult. The risk of malignancy for an AUS nodule is difficult to ascertain because only a minority of cases in this category have surgical follow-up. A: Ideally, no. Benson Thyroid, Cytopathology, Nodule, Papillary cancer, Fine needle, Biopsy. Lin M A specimen is considered as suspicious for malignancy (SFM), when some features of malignancy (usually PTC features) exist, but the findings are not sufficient for a definitive diagnosis[9]. et al. Therefore, it is not prudent to remove every thyroid nodule we encounter in our medical practice. Neutrophils are the same as WBCs, and as you know, it is normal to gave some WBCs in the urine. Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid. %PDF-1.6 % However in doubtful cases definitive diagnosis can be made if sufficient material is available for immunocytochemical stains, or if it is known that the patient has an elevated serum calcitonin level. In conclusion, patients who require repeated FNAs for indeterminate diagnoses will be resolved by repeat FNA in a percentage of 72%-80%. Renshaw MS Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA. A malignant thyroid FNA diagnosis accounts for 4%-8% of all thyroid FNAs, the majority of which are PTCs, and these patients will require thyroidectomy[53]. R Additional benign findings (eg, black thyroid, reactive changes, radiation changes, cyst lining cells) can be mentioned as descriptive diagnoses at the discretion of the cytopathologist. The preparation of a "cell block" (a formalin-fixed, paraffin-embedded sediment of the urine sample) can be particularly useful because small pieces of tumor are often easier to evaluate with this preparation method. The authors of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) recommended that the DC III (AUS/FLUS) category should not exceed 7% of the thyroid FNA diagnoses, and the risk of malignancy in this category should be in the range of 5% to 15%[23]. Cyst lining cells are usually elongated, containing pale chromatin, with sparsely found intranuclear grooves, large nucleoli, and always associated with hemosiderin-laden macrophages and benign-appearing macrofollicle fragments. PG the contents by NLM or the National Institutes of Health. For example, increased serum calcitonin levels and/or strong immunoresponce of chromogranin which is disclosed after multiple FNA tests can indicate the diagnosis of a medullary carcinoma. In: Ali SZ, Cibas ES, editors. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. Goellner It is expected that the many benefits, clinical and investigational, of the Bethesda cervical terminology will also apply to the Bethesda thyroid terminology. The many faces and mimics of papillary thyroid carcinoma. ZW The method could also be applicable to other sparsely cellular samples such as cerebrospinal fluid (CSF) samples, or eye vitreous fluid samples. Such atypia may result from a variety of benign cellular changes, but in some cases may reflect an underline malignancy which has been suboptimally sampled or has intermediate diagnostic features[20-22]. The cancer cells are also elongated, with a height-to-weight ratio of at least 3:1. RT et al. Sparsely definition, in a thinly distributed way; not thickly or densely: Michigan's Upper Peninsula is very sparsely populated, as more than 90% of it is forested. Pan-keratin is the most reliable positive immunostain in UTCs, acquiring an expression ranging from 50% to 100%. The interpretation of follicular cell atypia is hindered by sample preparation artifact, eg, Air-drying artifact with slight nuclear and cytoplasmic enlargement, pale and slightly smudgy chromatin, and/or mildly irregular nuclear contours. These include hypocellular smears with extensive cystic degeneration with rare follicular cells with nuclear atypia indicative of PTC. Once obtained, the core biopsy is used to make touch preps (discussed below) and then is transferred into a container with appropriate fixative (usually formalin) and sent to the laboratory for processing. Prepares and stains all specimen types (gyn, medical cytology, fna) for cytologic examination. Filie AC, Asa SL, Geisinger KR, Logani S, Merino M, Nikiforov YE, Clark DP. Amyloid can be observed in close association with tumor cells, and can be distinguished from the thick colloid of PTC by performing a Congo-red stain. lobectomy). Cantara S, Capezzone M, Marchisotta S, Capuano S, Busonero G, Toti P, Di Santo A, Caruso G, Carli AF, Brilli L, et al. The discussions and conclusions regarding terminology and morphologic criteria from the NCI meeting, summarized in the publications by Baloch et al,4,5 form the framework for the terminology presented here and in atlas form.3 It is intended as a flexible framework that can be modified to suit the needs of the particular laboratory and the patients it serves. Bongiovanni M, Krane JF, Cibas ES, Faquin WC. Does the fine-needle aspiration diagnosis of Hrthle-cell neoplasm/follicular neoplasm with oncocytic features denote increased risk of malignancy? Papillary structures are not as common as it was believed, because intact papillae are often too large to enter the fine needle or are disrupted during the preparation of the smears. It usually affects the elderly population, and often presents as a large and bulky tumor with extrathyroidal extension and metastases. In other cases it is sparsely cellular and contains atypical lymphoid cells. One nucleus has an apparent intranuclear pseudoinclusion ( arrow ). I Note granulocytic precursors (arrows) and erythroid cells (arrow heads). Quick tip: Flow cytometry cannot be performed on the clot section after the clot has set and after fixation in formalin. Layfield It is critical that cytopathologists communicate thyroid FNA interpretations to referring physicians in terms that are succinct, unambiguous, and clinically helpful. This system also contains guidelines for the diagnosis and treatment of indeterminate or suspicious for malignancy cases. Its clinical utilization is significant, as it can define whether a recently emerged thyroid nodule should be managed expectantly or surgically, and can assist in selecting the appropriate surgical procedure when necessary[3]. The difficulties in securing diagnosis of a diffuse large B-cell lymphoma derive from the inadequate sampling technique and/or insufficient preservation of the specimen. The interpretation should provide clinically relevant information that will assist referring physicians in the management of patients. Q: Can flow cytometry be used for assessment of morphologic dysplasia? FNA is diagnostic of many thyroid conditions (eg, papillary carcinoma, lymphocytic thyroiditis), but, with regard to follicular carcinoma, it is better considered a screening test. If these constitute the minority of the follicular cells, they have little significance and the FNA can be interpreted as benign. This resulted in diagnostic inconsistencies among different laboratories and difficulty in communicating the implications of thyroid fine-needle aspiration (FNA) results both to clinicians (endocrinologists and endocrine surgeons) and laboratory doctors (pathologists and radiologists)[6]. Description of a distinctive morphological variant and report of 7 cases. Vimentin immunoexpression is also a common finding[52]. Rossi Deveci The molecular testing proved to have a high specificity, although the sensitivity was quite low (60%). Dottorini This is an aggressive variant of PTC characterized by the presence of crowded, stratified clusters of elongated cells resembling cells from a colonic adenoma. Every thyroid FNA must be evaluated for adequacy. Nikiforov YE, Ohori NP, Hodak SP, Carty SE, LeBeau SO, Ferris RL, Yip L, Seethala RR, Tublin ME, Stang MT, et al. Broome JT, Solorzano CC. There are focal features suggestive of papillary carcinoma, including nuclear grooves, enlarged nuclei with pale chromatin, and alterations in nuclear contour and shape in an otherwise predominantly benign-appearing sample (especially in patients with Hashimoto thyroiditis or with abundant colloid and other benign-appearing follicular cells). The false-negative rate of a benign interpretation is low (0%3%),2,12 but patients are nevertheless followed up with repeated assessment by palpation or ultrasound at 6- to 18-month intervals.15 If the nodule shows significant growth or suspicious sonographic changes, a repeated FNA is considered. Characteristically, distinct granules (calcitonin granules) are spotted in the cytoplasm of the cancer cells, as well as eccentric nuclei, indicating a plasmacytoid appearance to the tumor cells.
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Information and Communication Technology (ICT) is one of the Models used by Bank of Baroda for implementation of Financial Inclusion. ICT based models are (i) POS, (ii) Kiosk. POS is based on Application Service Provider (ASP) model with smart cards based technology for financial inclusion under the model, BCs are appointed by banks and CBCs These BCs are provided with point-of-service(POS) devices, using which they carry out transaction for the smart card holders at their doorsteps. The customers can operate their account using their smart cards through biometric authentication. In this system all transactions processed by the BC are online real time basis in core banking of bank. PoS devices deployed in the field are capable to process the transaction on the basis of Smart Card, Account number (card less), Aadhar number (AEPS) transactions.