Fransiska Dale

Intern/Mentor G/T
Pd. 6

Annotated Source List

Ali, Syed, and Edmund Cibas. "The Bethesda System for Reporting Thyroid Cytopathology."
American Journal for Clinical Pathology, vol. 19, no. 11, Nov. 2009.

This article was created to address the terminology that is used for thyroid FNAs. It goes
through in detail how to report the thyroid cytopathology in accordance with the Bethesda
System, which is the current system used to report diagnoses. It begins by discussing the format
that the report should follow, and stipulates that every report should begin with a general
diagnostic category, of which there are six. The first category is Nondiagnostic or
Unsatisfactory, which is used whenever there are inadequate samples. This should be used
whenever the thyroid sample is not sufficient, perhaps because there is too much blood which
obscures the cells, or if there are not enough follicular cells required to make a diagnosis. The
next category is Benign, which is used to indicate that there are no malignancies and thus does
not require surgery. In fact, 60 to 70 percent of thyroid FNA results fall in this category. The
following category is Atypia of Undetermined Significance or Follicular Lesion of
Undetermined Significance. This category is used when it is difficult to classify the sample in
any of the other categories. It then outlines all of the scenarios for which an atypia of
undetermined significance could be used. The fourth category is Follicular Neoplasm or
Suspicious for a Follicular Neoplasm. This specific category is used when the nodule may be
follicular carcinoma. The FNA in regards to follicular carcinoma for thyroids is better as a
screening test, and may be different follicular variants. This diagnostic category is often used if
there is disturbed cytoarchitecture, meaning that the cells often are crowded and overlapping, and
the cells are larger than normal. However, nuclear atypia or pleomorphism is not common for
this diagnosis. The proceeded category is Suspicious for Malignancy, which is used with the
nuclear and architectural changes of the cancer, often papillary thyroid cancer, may be subtle or
focal. In other cases, there may be incomplete sampling where the number of abnormal cells is
small and not enough to outright diagnose it as malignant. When there are only one to two
features of the papillary thyroid cancer, the sample does not contain enough cells, or the sample
is very focal and not widespread enough throughout the cell population, this diagnosis is used.
The last category is Malignant, and this is used whenever the cytomorphologic features can
conclusively mark the sample as malignant. When this diagnosis is given, the malignant nodules
are almost always removed by surgery. The statistic that is given for malignant cases is that they
are correctly predictive for a malignant FNA 97 to 99 percent of the time, which is very high.
This article is very useful to me by providing me with the specifics for diagnosing a
thyroid nodule. It goes through in detail the different categories that can be used, and then
explains when and why that specific category would work. In my time in the cytopathology
department, there have been many thyroid cases where this terminology has been used, and
previously I did not understand the distinctions between the different categories and why the
specific diagnoses were made. This source very explicitly defines the terms for diagnosing
thyroid cancer, which will help me better understand when the doctors are discussing and
diagnosing the different slides. In addition, there are many similarities between the diagnoses for
thyroid cancer and other cancers, and thus this information will also help me to understand the
final diagnoses that are made for cancers in other parts of the bodies. In general, this was a very
helpful and informative article that helped me to better understand the minutiae that goes along
with diagnosing the patients in cytopathology.

American Society of Cytopathology, www.cytopathology.org/.

This is the website for the American Society for Clinical Pathology. The ASCP is the
largest professional membership of pathologists in the world, and the purpose of the association
is to increase the excellence in education, certification, and advocacy of patients for these
pathologists. On the home screen of the association website, there are tabs for pathologists,
laboratory professionals and students, each with information on how to join the society and
providing various resources. It also has icons at the bottom that lead to tabs for laboratory
science students, medical students, and a career center.
This website is helpful for finding out more information about pathology and the jobs that
are out there. It describes how to become a pathologist, what it entails, how much it pays, and
also includes career tools to help people on their way to becoming a pathologist. For me, this
website is useful in giving me a broad scope of knowledge in the field of clinical pathology,
informing me of new information in the field, and connecting me with the work of pathologists
around the world.

American Society for Clinical Pathology, www.ascp.org/content/.

This is the website for the American Society of Cytopathology. On the home screen there
is a section for latest news, which scrolls through conferences, articles, journals, and just general
information about the foundation and any events it is holding. The purpose of the ASC
foundation is to provide services and programs to promote research and education in the field of
cytopathology. In the about the foundation section, it talks about the importance of the cell to
control health, giving credence to the importance of cytopathology for detecting cancer and
helping the patient.
This website is useful for learning more about cytopathology and why it is such an
important field, even if not as widely known. I can also learn about the possibility of grants and
scholarships given to help cytotechnologist and cytopathologists to attend meetings, conferences,
and travel the world to meet with other people in the field. With the slogan Saving Lives One
Cell at a Time, the website does a good job of advocating for education in the field of
cytopathology. In addition, the website gives me tools for finding more information and articles
specific to this field.
DeMay, Richard M. Practical Principles of Cytopathology Revised Edition. Rev. ed., American
Society for Clinical Pathology, 2007.

This textbook gives a very detailed overview of cytopathology and its principles.
Consisting of twenty-one chapters, it goes into depth about the major organs in the body and
different methods for obtaining and diagnosing cells. Each chapter focuses on a specific type of
test or organ, and goes into detail about the different types of diagnoses, all the way from benign
to malignant, that can be made regarding those cells, and what they mean. There are also colored
pictures of cells taken through microscopes that illustrate and correspond to different parts of the
text where those specific cells are discussed. The first chapter is entitled The Pap Test, and
begins by discussing normal cytology. The normal human vaginal mucosa cell begins as a basal
cell and then becomes parabasal to intermediate to superficial. Basal cells are undifferentiated
and as the cells proceed through the stages, they eventually become superficial cells, which are
the most mature, but are almost identical in appearance to the most mature intermediate cells.
The chapter then goes into benign proliferative reactions, and starts by describing squamous
metaplasia. Metaplasia occurs when the cell differentiates into a glandular or a squamous cell
and then the cells acquire squamous features. The next section describes dysplasia and carcinoma
in situ, which describe the cervical carcinoma precursor lesions. In the Bethesda System, this is
further divided into low and high grade squamous intraepithelial lesions (LSIL and HSIL), which
refer to the level of dysplasia with high being severe dysplasia. Dysplasia refers to abnormal
reactions where squamous differentiation occurs towards the surface. Carcinoma in situ occurs as
a noninvasive normal reaction where throughout the epithelium, no squamous differentiation
occurs. When trying to diagnose dysplasia, it is very important to examine the nucleus. In
general, if the nucleus is dark and big, then it will be dysplasia. The next step is to determine the
grade and severity of dysplasia, and the nuclear to cytoplasm ratio is a key feature to evaluating
dysplasia. This is because the ratio is also a measure of cell maturity, and as the severity of the
dysplasia increases, so does the n/c ratio.
This source is a very useful reference tool for entering the field of cytopathology,
especially with little to no pathological background. It clearly explains and clarifies many
different tools, approaches, and diagnoses that are used/occur in cytopathology. In addition, on
the sides it includes colored images of cells that match the text, giving a visual aid to help
understand the context of what is being described. One of the downfalls of this textbook is that it
was written for someone who had already gone through medical school and uses very technical
language that would be familiar to a medical student, but not necessarily to a high school
student. It takes me a very long time to read a few sections at a time as I have to research and
decipher the different terms used in order to understand what the paragraph is talking about.
Even then, it often requires several readings in order to digest and understand the information
and apply it to what I have learned in my internship. However, as I become more adept at
understanding the medical terminology, I think this textbook will become even more useful to
understand cytopathology. Already, I have begun to recognize words and phrases that are used by
the cytopathologists commonly, and I begin to make more connections between what I have read
on how to analyze the cell, and how I actually analyze the cells when looking through the
microscope.
Elaraj, D., et al. "Utility of Molecular Testin in the Management of Thyroid Nodules."
Cytopathology, vol. 26, no. 5, Oct. 2015.

This article was discussing discussing thyroid cancer and how it has become increasingly
popular in the population. Currently, fine needle aspiration cytology is being used to determine if
the thyroid nodules are benign or cancerous, and it has a very high success rate. However, in
about 20 to 30 percent of the FNA cytology specimens, the cytological material is ruled to be
indeterminate, and is classified as atypia of undetermined significance, follicular lesion of
undetermined significance, follicular neoplasm/suspicious for follicular neoplasm or suspicious
for malignant cells. Thus this article suggests the sequencing of DNA, RNA, and proteins of the
cells to help determine if the specimen is cancerous. This technology has been growing recently,
and the genomic analysis of thyroid FNA specimens has now become more widely available for
use in the field of pathology. With this technology, the clinical pathologists would have another
method to determine if the sample was cancerous, if the initial diagnosis was indeterminate, and
this would help the doctors know if surgery for the thyroid nodule is necessary if it is indeed
cancerous.
This article has been very informative in learning more specifically about the use of
molecular testing for thyroid nodules. This was written specifically for clinical use, so the article
has a specific purpose of informing about the current state of testing for thyroid nodules and how
it would be improved through the use of molecular testing. While the entire article is not entirely
relevant to my internship, as we solely examine the FNA slides and make a diagnosis on that,
rather than using molecular testing, it is still a helpful article to understand the technology that is
out there, and how it can make a difference in the field of pathology. I personally have witnessed
many cases where the final diagnosis was indeterminate, and thus I know that it is something that
needs to be improved upon, so this article helps give an answer to that. In addition, there is an
entire section just on fine needle aspiration cytology, which is used commonly at Hopkins, so
that section is particularly helpful to the work I am doing at Hopkins.

Guresci, S., et al. "Utility of On-Site Cytological Examination and Cell Block Preparation in
Thyroid Fine Needle Aspiration Biopsy of Metastatic Carcinoma: Report of Two Cases."
Cytopathology, vol. 26, no. 1, Feb. 2015.

This article discussed two cases of metastatic lung adenocarcinoma to the thyroid, where
the original source of cancer was found in the lung, but then the cancer cells moved to the
thyroid, leading to cancer in the thyroid as well. Both cases used fine needle aspiration biopsy
(FNAB) and immunocytochemistry applied on cell blocks to make the diagnosis. The authors
first discussed a 47-year-old man with a swelling of the right lobe of the thyroid without any
previous history of substantial diseases. The second case was a 68-year-old man who began by
presenting dyspnea, meaning he had trouble breathing, and F-Flourodeoxyglucose uptake was
observed in various parts including both lobes of the thyroid gland. Both patients were diagnosed
with stage four cancer and then received chemotherapy as treatment. The reason these cases are
significant is because metastases to the thyroid are very rare occurrences, and in both of these
cases, the men had metastases from lung to the thyroid. Because metastases to the thyroid are
rare, it is important to make sure that there were indeed markers from the lung to indicate that the
origin of cancer was not the thyroid, seeing as the treatment may differ. In addition to the FNAB
for the patients, a cell block preparation with immunocytochemical analysis was conducted to
help find markers from the lungs, indicating that the cancer metastasized from the lung to the
thyroid, and was not just a cancer that originated in the thyroid. Thus, the on-site
cytopathological evaluation of the thyroid FNAB used in conjunction with the cell block
preparation strongly increased the accuracy of the diagnosis for the men to ensure that the correct
treatment was used. In this particular case, some of the features that helped distinguish the cancer
from a primary thyroid carcinoma, which starts in the thyroid, were cohesive clusters and
papillae that were fairly large, acinar structures, a high nucleus to cytoplasm ration, nucleoli that
were prominent, and mucin production, common in adenocarcinoma from glandular cells such as
those in the lungs. In addition, the article includes two images of cell slides from the two
separate patients, detailing certain aspects that can be found in the cell to indicate the malignancy
of the cells. In the first figure, the cluster of cells has irregular nuclei and coarse, ropy chromatic,
both strong indicators of cancer. In the second figure, the cells that are malignant are forming
acinar structures, which, as mentioned earlier, were one of the reasons detailed in the article itself
for the malignant diagnosis.
I included this article in my sources because, while it was simply an article discussing
two cases of men who had a rare metastasis to the thyroid, it was written in a format that was
very similar to the way the sign-out sessions are conducted at Hopkins. In these sessions, a
resident will first read the biographical information of the patient and underline any history of
diseases that the patient may have, to help inform the cytopathologists. If there was a previous
history of cancer, and the sample is taken from another location, then it could be the result of a
metastasis. If this is the case, then the original location of the cancer that was treated must be
looked at again to see if malignant cells came back. Once the histories have been reviewed, the
doctors proceed to view the cell slides and make a diagnosis for the patient. In this article, the
authors outlined a very similar process, and much of the vocabulary used to describe the cells
and the patient was very similar to the vocabulary used to describe the cells and the patient at
Hopkins. Thus, while the information in the article does not directly pertain to what I am doing,
it just continued to familiarize me with the process and vocabulary of diagnosing a patient with
cancer.

Hipp, Jason D., et al. "Spatially Invariant Vector Quantization: A Pattern Matching Algorithm for
Multiple Classes of Image Subject Matter including Pathology." Journal of Pathology
Informatics, 26 Feb. 2011.

This article is about the development of a new technology, SIVQ, to help current
pathologists with their work. SIVQ stands for Spatially Invariant Vector Quantization, and would
be able to recognize patterns in the cases presented to it. Unlike previous technology, the model
uses ring vectors, which allows continuous symmetry that the previous square and rectangular
vectors did not have. With this, the ability to match and recognize patterns increases greatly. As
this technology continues to be developed, it may soon be implemented readily by pathologists
everywhere, assisting them in their workload without the pathologists themselves having to bring
in an image analysis expert to examine the patterns.
This article was very interesting because it gives backgrounds into the technology that is
forming in the field of pathology. In fields everywhere technology is becoming a greater
component, allowing things to be done faster and better, and the field of pathology is no
different. However, while informative, the article itself does not help me much in my research as
this type of technology is not used at Johns Hopkins. As such, I will not come into contact with
the SIVQ and therefore the information doesn't directly pertain to what I am doing in my
internship.

Illei, Peter B. Interview. 14 Sept. 2016.

Dr. Peter Illei is the Director of Immunopathology Laboratory and the Assistant Director
of Pathology at Johns Hopkins. In 1988, he obtained his medical degree from the University of
Pecs Medical School. He then proceeded to complete a residency in 1998 at the New York
University Medical Center, in Anatomic and Clinical Pathology. Then, in 2000 Dr. Illei
performed a fellowship at the Memorial Sloan-Kettering Cancer Center in the field of Oncologic
Pathology. Now working at Johns Hopkins, he focuses his research on the immunohistochemical
and molecular characterization of lung cancers. He is also very interested in the pathology of
lung transplantation and the role that antibody-mediated rejection plays in these transplants.

PubMed, www.ncbi.nlm.nih.gov/pubmed/.

PubMed is a website that is part of the US National Library of Medicine and the National
Institute of Health. On the website, there are options to find journals, articles - abstracts and full
ones, and books. Spanning a wide variety of medical topics, PubMed has more than 26 million
citations for biomedical literature. There are different options to search the website for sources,
including just a simple search as well as an advanced search based on author, date, title, location
and more. On the homepage, there is a section dedicated to the latest literature as well as
trending articles.
PubMed is a very helpful source for finding articles related to my topic of pathology. It
has a very wide-range of sources, almost guaranteeing that you will be able to find something
useful that relates to a specific part of your topic. In addition, as there are only scholarly works
that are published as a part of PubMed, it is guaranteed that the sources are reliable and can be
depended on for accurate and up-to-date information regarding the medical topic of your
choosing. I personally have been able to find many scholarly research papers through PubMed
that deal with specific areas of pathology and cytopathology, and it has been a very useful
source.

Johns Hopkins Medicine Pathology, pathology.jhu.edu/.

This is the website of Johns Hopkins Hospital Pathology, which is the department I am
interning in at JHH. On the page, there are tabs for the training programs, how to learn about the
disease for the patients, research, services, and laboratory information. In addition, there is a
directory of staff to find contact information for specific doctors in the field. Dr. Ralph Aruban is
the director of the pathology department, and in a letter from him, he describes the Johns
Hopkins Pathology department, giving details about the scope the program, with outreaches in
many countries around the world.
This website has been very helpful to me, and incidentally, it is through this website that I
was able to first contact Dr. VandenBussche to obtain my internship. Through the pathology
directory, I found a page on Dr. VandenBussche, which not only included his contact details, but
also information about his work and research that he has completed at Hopkins. This website is
also helpful because it provides me with ways to find different research opportunities and
information about research labs.

Seo, J.W., et al. "Atypia of Undetermined Significance on Thyroid Fine Needle Aspiration - Risk
Factors for Malignancy." Clinical Otolaryngology, 19 July 2016.

This was another article that dealt with fine needle aspirations of thyroids. In this specific
research, the scientists were trying to find out what the clinical predictors are that would indicate
there is malignancy in the atypia of undetermined significance (AUS) category. To complete this
research, 62 patients were studied, who had a thyroid surgery from January of 2010 to December
of 2013. All of these patients underwent the surgery because they had previously had an AUS
diagnosis as a result of the thyroid FNA that was completed prior to the operation. Some of the
things that were measured in the patients included age, gender, size of the nodules,
ultrasonographic findings and cytologic features. The results were that of the 62 patients, 41
were malignant and 21 were benign diseases. The research was concluded, and it was determined
that in patients with nodules less than 1.5 centimeters and with two or more malignant ultrasound
features/AUS findings, there should be close observations to determine if it is in fact malignant.
This particular source, while important to the field of pathology and in particular, cases
that deal with AUS diagnoses after thyroid FNAs, it is not particularly helpful to me. There were
very few facts involved that would directly influence my knowledge of my internship, and that
would help me better understand thyroid FNAs. Even though the topic did include the FNAs.
which I have observed in my mentorship, it was more closely focused on specific diagnoses in
the AUS category, which I have not come across yet. In addition, unfortunately for this source, I
was unable to access the entire text, and could only see the abstract for free. In the abstract, while
it was helping for understanding a general theme of the research, there were few facts or pieces
of information that were particularly relevant to me, and perhaps there would be more useful
details in the actual article itself.

Taylor, Tim. "Brain." Inner Body, www.innerbody.com/image/nerv02.html#full-description.

This source gives an overview of the purpose and function of the brain, as well as going
into detail about the specific parts and their functions. It begins by splitting the brain up into the
three large portions - the forebrain, the midbrain, and the hindbrain, and then describes which
parts of the brain are found in those portions. It then goes into the histology and describes the
two main groups of brain cells, which are neurons and neuroglia. The neurons are responsible for
all of the communication and processing that occurs in the brain, while the neuroglia, or glial
cells, are responsible for supporting and protecting the neurons. The article then focuses on the
specific parts and functions of the brain, and goes into detail about the brainstem, cerebellum,
mesencephalon, diencephalon, cerebrum, meninges and cerebrospinal fluid (CSF). In addition,
there is a section about the physiology of the brain, describing its role in metabolism, sensory
details, motor control, processing, learning and memory, homeostasis, sleep, and reflexes.
This article has been very helpful to give me a general idea of the brain and the parts and
functions that it has. Soon I will be going to the Medical Examiners Office with Dr. Troncoso
and Dr. Pletnikova, two neuropathologists at Johns Hopkins. I will be able to observe brain
cutting and the conference at the end of the day that is help with the medical examiners to give
an overview of what was found that day in the brain cutting. Besides some cursory knowledge
from biology and psychology, I know very little about the components of the brain and their
functions. The brain is a very complex part of the body, part of the reason why there is an entire
field of pathology dedicated it, so this source was very helpful to begin to give me an
understanding of the brain. The knowledge and terminology that I have gained through this
article will help me understand the proceedings when I go to the Medical Examiners Office so
that I am not completely lost about what they are discussing.

"Types of Cancer." Cancer Research UK, www.cancerresearchuk.org/about-cancer/what-is-

cancer/how-cancer-starts/types-of-cancer.

The purpose of this website is to inform the reader of the different types of cancers. They
start by discussing the five main categories: carcinoma, sarcoma, leukaemia, lymphoma and
myeloma, and brain and spinal cord cancers. Carcinomas are cancer that begins in the epithelial
tissues. Epithelial tissues can be found surrounding the outside of the body as skin as well lining
the organs in the body and the body cavities. Squamous cell carcinoma is a specific type of
carcinoma that begins in squamous cells, which are flat cells that cover the surface.
Adenocarcinomas are another type of carcinoma that begins in glandular cells, which produce
fluid to keep tissues moist. Basal cell carcinoma is a carcinoma of basal cells, which are the cells
that are found in the deepest layer of skin cells. Sarcomas are cancer that begin in connective
tissues, including bones, cartilage, tendons and fibrous tissue that supports the organs.
Lymphomas are cancer that begin in cells of the lymphatic system which is comprised of tubes
and glands in the body, including lymph glands. Lymphoma can start basically anywhere in the
body since the lymphatic system is found throughout the body. The article includes diagrams and
pictures of the cells with labels that help identify the cell.
This source is extremely helpful for giving me an overview of the different types of
cancers, where they come from and more facts about them. I spend the majority of my internship
looking at slides, with the cells of the patients. The purpose of doing this is to find out if there
are any malignancies that would threaten the life of the patient so that action can be taken to get
rid of the cancer. Thus, having knowledge of the different types of cancer is very important to
understanding the diagnoses that are given by the doctors. Initially I was extremely confused, as
the diagnosis would be a sarcoma or a carcinoma and I would not understand what that meant.
After reading this source, I have a much better understanding and grasp on the different types of
cancer and where they come from. All of the cancers that I described previously are cancers that
I have heard mentioned in the diagnoses of the doctors. Thus, in the future, when the doctors
make a diagnosis of a certain type of cancer for the patient, I will be able to know what that
cancer is, and have more information about it, which will in turn broaden my understanding of
that slide and of the topic in general.
VandenBussche, Christopher. Interview. 7 Sept. 2016.
Dr. Christopher VandenBussche is the Associate Director of the Cytopathology Division
at Johns Hopkins University. In 2009, he received his medical degree from Georgetown
University, and then proceeded to Johns Hopkins to perform his residency in the Anatomic and
Clinical Pathology Department. Also at Johns Hopkins, he performed a fellowship in
Cytopathology. In his work and research, he focuses on his clinical expertise in bladder cancer
and pathology, areas in which he has had many publications. Also, in addition to the research he
has completed on bladder cancer, he also is working on genetic, molecular and immunological
ancillary assays in order to help better the ability to diagnose patients.

VandenBussche, C. J., et al. "Cytotechnologist Performance for Detecting Nuclear Atypia in

Indeterminate Thyroid Fine Needle Aspirates." Acta Cytologica, vol. 58, no. 3, 3 Nov.
2014.

The thyroid gland is one of the fastest growing anatomic sites that is used for fine needle
aspirations. The purpose of this research was to determine and reevaluate the screening metrics
that the cytotechnologists use to define the thyroid cases. These cytotechnologists are screening
for nuclear atypia to determine the diagnosis for the thyroid using specific screening metrics, so
these metrics were analyzed to determine if they were still well qualified to accurately diagnose.
In the research, they used 8,814 thyroid cytopathology cases that were collected over a 10-year
period, which were then categorized by the cytopathologists. They then compared the
cytotechnologists diagnoses with those of the cytopathologists to determine the discrepancies
between them. The results were that there were discrepancies in less than 10 percent of the cases,
and most commonly they discrepancies were only one-category difference. The final conclusion
was that the quality of screening for nuclear atypia in thyroid FNAs was very high, and any
outliers could be used to track specific cytotechnologists work.
This was an interesting article to gain insight into the quality of work of the
cytotechnologists, and if their diagnosing was accurate enough. Recently, I went with a
cytotechnologist to view a thyroid FNA, and while they did not create a diagnosis for the patient
right there, as first they would take the duplicate slides and treat them and stain them more
thoroughly, they did have slides that they could view right away with a Diff-Quick stain and they
theorized to me what the final diagnosis would probably be. At the time I had been curious as to
why the cytotechnologists were in charge of those slides rather than the cytopathologist, however
after reading this article it is clear that there were very few discrepancies between the diagnoses
of the two. Thus, while this article will probably not be very helpful for my research, it was
interesting and informative.

Vinayak, Sudhir, and Joyce Sande. "Avoiding Unnecessary Fine-Needle Aspiration Cytology by
Accuractely Predicting the Benign Nature of Thyroid Nodules Using Ultrasound."
Journal of Clinical Imaging Science, vol. 2, no. 23, 28 Apr. 2012.

The purpose of the study that was demonstrated in this article was to determine if
ultrasounds would be reliable to determine if a thyroid nodule was benign based on a specific
index scoring system. A total of 284 patients and their thyroid nodules were studied from
November 2005 to November 2011, and any solid or even partly solid focal nodule in the thyroid
gland was also included in the study. There were four characteristics that were evaluated from
the ultrasounds: nodule margins, echo texture, vascularity, and calcification. Then the results -
whether benign or not - were compared with the diagnoses that were concluded from the
cytology of the FNA. The results determined that when the ultrasound labeled a thyroid nodule
as benign, it was correct 100 percent of the time. This is very significant research, as it will help
prevent unnecessary FNAs for patients where the thyroid nodule is benign.
The research in this article is very interesting and can be applied to the work I am doing
in my internship. According to this, if an ultrasound determines that a thyroid nodule is benign,
then it will be benign and no more FNA is required. This would imply that if this method is
implemented at the hospital, then any fine needle aspirations that are completed would be of
thyroid nodules that are probably not benign, and have some malignant features to them. This
would allow the cytopathologists to focus more on cases that are more likely to be malignant,
and allow them to spend more time on a diagnosis, as they would have to spend less time
analyzing the benign thyroid nodules.

Wu, Maoxin, and David Burnstein. "Fine Needle Aspiration." Cancer Investigation, vol. 22, no.
4, 24 Sept. 2004.

The purpose of this article is to give detail about the fine needle aspiration procedure and
its uses. Fine needle aspirations (FNAs), have been widely used by doctors as a diagnostic tool.
The procedure uses 22 to 27 gauge needles which are then aspirated from a lesion on the body
that needs to be tested, a common example is one of a thyroid. The samples are then smeared on
a slide so that they can be stained and then evaluated immediately under the microscope. This
preliminary report can usually all occur in 15 minutes, and the final diagnosis and report usually
takes only 24 hours with this technique.
This article is very helpful in giving me a thorough overview of the FNA procedure. Dr.
VandenBussche has mentioned this procedure many times in my internship, and many of the cell
slides that we view in the microscope have been obtained through an FNA procedure. In
addition, the next time that I will go to my internship, I will be able to shadow a doctor to view
an FNA. Thus, this is very helpful for me to understand the logistics of what I will observe so
that I can spend all of my time viewing the process and procedure to get the most out of the
experience. Also, it will help give me a background for viewing FNA slides in the future so that I
can understand how the cells were obtained.

Yang, Chi-Shun, et al. "High Apoptotic Index in Urine Cytology Is Associated with High-Grade
Urothelial Carcinoma." Cancer Cytopathology, vol. 124, no. 8, Aug. 2016.

This article begins by discussing the significance of apoptosis and its connection with
high-grade urothelial carcinoma (HGUC) in urine cytology. While there is often evidence of
apoptosis in conjunction with HGUC, the actual association between the two has not been
determined and that is the purpose of this study. To complete this research, a total of 228 cases of
which 105 were benign, 79 were diagnosed with HGUC and 44 were cases of low-grade
urothelial carcinoma. These were then scored on a numerical system based on the amount of
apoptotic cells discovered, as seen through cells experiencing pyknosis. The scale was as
follows: 0 indicated none, 1 indicated less than 10, 2 indicated 10 to 30 cells, and 3 indicated
more than 30. The research concluded that specimens with a high apoptotic index, with scores
greater than 2, appeared to be strongly associated with HGUC.
This article was very interesting and taught me a lot about the correlation between
apoptosis and high-grade urothelial carcinoma. During my internship, I have witnessed several
cases that have received this diagnosis, and oftentimes have not understood exactly why this
diagnosis was made. Through this article and its discussion of pyknosis, which I looked up to
find was the irreversible condensation of chromatin in the nucleus of a cell that is undergoing
apoptosis, I now have more information of what cell-markers to look for when trying to diagnose
urothelial carcinomas, since this study proved that there was a strong link between the number of
cells exhibiting pyknosis and the diagnosis of HGUC.

Yoon, J.H., et al. "The Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration

Biopsy and the Sonographic Differences between Benign and Malignant Thyroid
Nodules 3cm or Larger." Thyroid, vol. 21, no. 9, 30 Aug. 2011.

This article was written about the accuracy of ultrasound-guided fine needle aspiration
biopsies (FNAB) for thyroid nodules that were 3 centimeters or larger. These operations are the
standard used for evaluation of the thyroid nodules without surgery, and have been very useful,
however the value of the diagnostic ability has been questioned for thyroid nodules of larger
size. To conduct the research, 661 thyroid masses were studied, each greater than or equal to 3
cm in size. The diagnoses of the cytology and surgical pathology readings were reviewed and
then histopathology was used to determine the accuracy parameters for these readings. The final
conclusion of the experiment was that the method was accurate, even when evaluating the larger
thyroid nodules. There was only a 2 percent rate for false-negative readings for the research.
I actually found this article after looking up a question about fine needle aspirations. I had
been wondering if the samples were accurate if the nodule was larger, as the sample of cells
would be from a smaller area. I thought that maybe if the nodule was larger, the radiologists who
obtained the FNA sample might accidentally sample a benign section and may never obtain
malignant cells even if the nodule was indeed malignant. Thus, this article was very helpful in
answering my question, and helped broaden my knowledge of FNABs. However, besides my
specific question, this article is not inherently very helpful for my research.