The evaluation of thyroid nodules by fine needle aspiration (FNA) is one
of the most challenging tasks in all of cytopathology. A cytologist must
understand the clinical presentation of thyroid diseases, their defining
histopathologic and cytopathologic features, and even the intricacies of
patient management. Drs. Clark and Faquin have provided a valuable
framework for cytologists learning (and continuing to learn) this
exacting discipline. Org- ized around a practical algorithm, the authors
lay out a rational and concise approach toward acquiring the necessary
skills for the cytologic diagnosis of thyroid nodules. The first
edition, published in 2005, was a very welcome addition to the cytology
literature. This new edition, with updated terminology for reporting
thyroid FNA results, builds on the success of their approach. Why are we
examining such challenging specimens? Clearly, the clinical need is
there. Over 50% of adults have one or more thyroid nodules. Surgical
excision of all nodules is certainly neither practical nor desirable.
Enter FNA, a minimally invasive cellular sampling method that has proven
to be a highly useful screening test for thyroid cancer. Because of it,
thousands of patients with a benign diagnosis are spared unnecessary
surgery every year, and those with cancer are reliably triaged for
appropriate therapy.