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Dr M TASSART Dr A FAJAC
Radiologie Cytologie
Tenon AP HP Paris
FRANCE
Cyto-ponction Thyroiumlde -Comment se lancer-
Cyto-ponction Thyroiumlde -Comment se lancer-
nodule et ADP
Ectopie TTG
Suivi Cancer
Echographie
TIRADS
Cytoponction
Cytologie
BETHESDA
Evaluation
risque maligniteacute
Conduite
agrave
Tenir
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan35(1)
Cytoponction Thyroiumlde Nodule
Freacutequent
Malin inf 5
Bon pronostic
The National Cancer Institute Thyroid fine needle aspiration state of the science conference a summation Baloch Z
Cytojournal 200856 httpwwwcytojournalcomcontent516
The Bethesda System for Reporting Thyroid Cytopathology Definitions Criteria and Explanatory Notes ALI and CIBAS
SPRINGER 2010
Confeacuterence de Beacutethesda 2008 2010
Echographie == Cytoponction
Diagnostic
TIRADS
Cytoponction Thyroiumlde Bilan preacutealable
FICHE INFORMATION PATIENT ++++
Prise de RDV
Salle drsquoattente
CONSENTEMENT ECLAIRE
Cytoponction Thyroiumlde Scintigraphie
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cyto-ponction Thyroiumlde -Comment se lancer-
nodule et ADP
Ectopie TTG
Suivi Cancer
Echographie
TIRADS
Cytoponction
Cytologie
BETHESDA
Evaluation
risque maligniteacute
Conduite
agrave
Tenir
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan35(1)
Cytoponction Thyroiumlde Nodule
Freacutequent
Malin inf 5
Bon pronostic
The National Cancer Institute Thyroid fine needle aspiration state of the science conference a summation Baloch Z
Cytojournal 200856 httpwwwcytojournalcomcontent516
The Bethesda System for Reporting Thyroid Cytopathology Definitions Criteria and Explanatory Notes ALI and CIBAS
SPRINGER 2010
Confeacuterence de Beacutethesda 2008 2010
Echographie == Cytoponction
Diagnostic
TIRADS
Cytoponction Thyroiumlde Bilan preacutealable
FICHE INFORMATION PATIENT ++++
Prise de RDV
Salle drsquoattente
CONSENTEMENT ECLAIRE
Cytoponction Thyroiumlde Scintigraphie
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Echographie
TIRADS
Cytoponction
Cytologie
BETHESDA
Evaluation
risque maligniteacute
Conduite
agrave
Tenir
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan35(1)
Cytoponction Thyroiumlde Nodule
Freacutequent
Malin inf 5
Bon pronostic
The National Cancer Institute Thyroid fine needle aspiration state of the science conference a summation Baloch Z
Cytojournal 200856 httpwwwcytojournalcomcontent516
The Bethesda System for Reporting Thyroid Cytopathology Definitions Criteria and Explanatory Notes ALI and CIBAS
SPRINGER 2010
Confeacuterence de Beacutethesda 2008 2010
Echographie == Cytoponction
Diagnostic
TIRADS
Cytoponction Thyroiumlde Bilan preacutealable
FICHE INFORMATION PATIENT ++++
Prise de RDV
Salle drsquoattente
CONSENTEMENT ECLAIRE
Cytoponction Thyroiumlde Scintigraphie
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
The National Cancer Institute Thyroid fine needle aspiration state of the science conference a summation Baloch Z
Cytojournal 200856 httpwwwcytojournalcomcontent516
The Bethesda System for Reporting Thyroid Cytopathology Definitions Criteria and Explanatory Notes ALI and CIBAS
SPRINGER 2010
Confeacuterence de Beacutethesda 2008 2010
Echographie == Cytoponction
Diagnostic
TIRADS
Cytoponction Thyroiumlde Bilan preacutealable
FICHE INFORMATION PATIENT ++++
Prise de RDV
Salle drsquoattente
CONSENTEMENT ECLAIRE
Cytoponction Thyroiumlde Scintigraphie
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Echographie == Cytoponction
Diagnostic
TIRADS
Cytoponction Thyroiumlde Bilan preacutealable
FICHE INFORMATION PATIENT ++++
Prise de RDV
Salle drsquoattente
CONSENTEMENT ECLAIRE
Cytoponction Thyroiumlde Scintigraphie
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Scintigraphie
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Scintigraphie
bull NON ++++
MAIS TSH ++++
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
8
Si
TSH basse
Scintigraphie
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Contre indications Heacutemostase
bull NON
bull Aspirine Plavix
bull Anticoagulants
MAIS
Aiguille Fine 27 G
Sous eacutechographie
Limiter les passages et compression
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Quel Nodule ponctionner
(Quel nodule ne pas
ponctionner )
TIRADS Taille Contexte
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
bull Taille chir si sup 3 cm
McHenry CR Is nodule size an independent predictor of thyroid malignancy
Surgery 2008
Shrestha M The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-
needle aspiration a 10-year study from a single institution Thyroid 2012 Dec
MINEURS
Calcification Centrale
Vascularisation arteacuterielle
centrale
MAJEURS (de KIM)
Fortement hypoeacutechogegravene
Microcalcifications
Contours anguleux
Epaisseurgtgt largeur
ELASTOGRAPHIE
CRITERES de MALIGNITE
Cytoponction Thyroiumlde Nodule
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
NODULE THYROIumlDIEN -TI RADS-
THYROID IMAGING REPORTING and DATASYSTEMS
laquo eacuteviter de ponctionner tous les nodules raquo
bull TI-RADS 1 normal pas de surveillance
bull TI-RADS 2 beacutenin (Maligniteacute proche 0) surveillance
bull Kyste simple +- colloiumlde sans VG (Kyste Colloiumlde 1)
bull Nodule spongiforme (Kyste Colloiumlde 2)
bull Plage non nodulaire hypo de thyroiumldite focale (+- vascul centrale) contexte clinico-biologique
bull Nodule hyper de reacutegeacuteneacuteration sur TCAI white Knight
bull Macrocalcification isoleacutee
bull Amas nodulaires isohyper
Russ G TIRADS en eacutechographie Jal de radiologie 2011 92 701-13
Horvath E An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for
clinical management
J Clin Endocrinol Metab 2009941748-51
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
13
Cytoponction Thyroiumlde Anticorps
INFOS pour le CYTOLOGISTE +++ HASHIMOTO
Ac Anti Thyropeacuteroxydase
Ac Anti Thyroglobuline
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Risk stratification of thyroid nodules on ultrasonography with the French TI-RADS description and reflections
Russ G Ultrasonography 2016 Jan
TIRADS Description K Taille
I Pas ponction
II kyste pur 0 Pas ponction
autres gt 3 cm
III Isohyper 025 gt 15 ou 2cm
IV A aucun critegravere5 6 gt 1 cm
B 1 ou 2 critegraveres 69 lt 1 cm
V gt ou = 3 critegraveres 97 lt 1 cm
ADP 99 avec ponction ADP
Overdiagnosis N Engl J Med 2016 Aug 18375(7)614-7
Worldwide Thyroid-Cancer Epidemic The Increasing Impact of Overdiagnosis Vaccarella S1 Franceschi S1 Bray F1 Wild CP1 Plummer M1 Dal Maso L1
Thyroid 2015 Oct25(10)1127-36
The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence A Population-Based Study in Selected HighVaccarella S1 Dal Maso L2 Laversanne M1 Bray F1 Plummer M1 Franceschi S1
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
15
NODULE THYROIumlDIEN -TIRADS 3-
bull TI-RADS 3 tregraves probablement beacutenin
Sup
08
bull TI-RADS 3 Tregraves probablement beacutenin
Maligniteacute 025 agrave 2
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
ATCD papillaire chez soeur
Contours mal limiteacutes
Ep gtgt Largeur
MicroCa
TIRADS V
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
28 de leacutesions malignes
(Carc Papillairegtgt Meacuteta )
49 leacutesions malignes
Aspect Beacutenin 132 de leacutesions malignes
Aspect suspect 755 de leacutesions malignes
JA Eloy AJNR 2009 301431ndash34
G RUSS Eur Thyroid J 2014
Kwak JY Thyroid incidentalomas identified by 18F-FDG PET sonographic correlation
AJR 2008
NODULE THYROIumlDIEN -Fixation PET TDM
(idem en scinti MIBI )-
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Technique
bull Anestheacutesie locale Non
bull (EMLA +++ Dreacutepanocytaires)
bull Nettoyage des mains Gants steacuteriles
bull Protection Steacuterile
bull Deacutesinfection cutaneacutee + Conducteur transsonique
Biseptine gtgtgtgtBeacutetadine (Gel steacuterile)
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
h = 2γ Cos θ rρg
h hauteur du liquide
γ tension superficielle du liquide
θ angle raccordement contact avec paroi
ρ masse volumique
r rayon du tube
g acceacuteleacuteration de la pesanteur
Loi de Jurin Forces de Capillariteacute
Plus les moleacutecules ont une coheacutesion forte + susceptibles decirctre transporteacute par capillariteacute
25 G 25 mm
27 G 20 mm
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
2 mains 1 cerveau
2 mains 2 cerveaux
Preacuteleacutevements radiaires
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Etalement
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
22
Description Risque CAT
Non Diagnostique Refaire ponction sauf Kyste
BENIN 0 agrave 3 Suivi 18 mois 5 ans
Atypie ou folliculaire 5 agrave Reacutepeacuteter ponction (3 agrave 6 mois )
indeacutetermineacutee 15
Neacuteoplasie folliculaire 15 agrave Chirurgie Loboisthmectomie
ou agrave Cell Oxyphiles 30 et extemporaneacute
Suspect maligniteacute 60 agrave 75 Thyroiumldectomie totale extempo
Malin 97 agrave 99 Thyroiumldectomie et curage
Bethesda 2010
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Diagn Cytopathol 2016 Janv Use of fine-needle aspirate calcitonin to detect medullary
thyroid carcinoma A systematic review Trimboli P
PTH
Cytoponction Thyroiumlde Dosages compleacutementaires
Thyrocalcitonine
Dosage Sanguin in situ
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction Thyroiumlde Techniques compleacutementaires
Immunocytochimie Anticorps (aucun complegravetement speacutecifique)
Testing moleacuteculaire (ADN) Mutation BRAF tregraves speacutecifique
PAX8PPARY
Pheacutenotypage Lymphocytaire (lymphome)
Eur J Endocrinol Fev 2016 Diagnosis of endocrine disease High-yield thyroid FNA
cytology an update focused on ancillary techniques improving its accuracy M Bongiovanni
Future Oncol 2015 The utility of molecular markers in pre-operative assessment of
thyroid nodules Bhatia P
BRAF V600E detection in cytological thyroid samples A key component of the decision tree for surgical
treatment of papillary thyroid carcinoma Collet JF Lacave R Hugonin S Poulot V Tassart M Fajac A
Head Neck 2016 Jul38(7)1017-21
Galectin-3 immunodetection in follicular thyroid neoplasms a prospective study on fine-needle aspiration samplesBr J Cancer 2005 Nov 1493(10)1175-81
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
25
Cytoponction Thyroiumlde et la THYROGLOBULINE
( = THYROCALCITONINE)
Marqueur tissu thyroiumldien
Normal position ectopique
Carcinome diffeacuterencieacute
(papillaire et Veacutesiculaire)
Marqueur reacutecidive apregraves
ThyroiumldectomieIratheacuterapie
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Adeacutenopathie IV Gche Mixte laquo Thyroid Like raquo THYROIumlDE NORMALE
Thyroglobuline +++++++
Suffit pour Affirmer Dg
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Adeacutenopathie IV Gche Thyroglobuline +++++++
Suffit pour Affirmer Dg
Cyto papillaire
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
SUS Isthmique
Ligne meacutediane
28
Thyroiumlde ectopique lateacuteraliseacutee
Devant la carotide
sous le lobe thyroiumlde THYROGLOBULINE AUCUN INTERET pour Dg K diffeacuterencieacute
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
29
ADP IV
TIRADS V= ADP + TIRADS IVB
Thyroglobuline + suffit pour faire le Diagnostic Cyto PAPILLAIRE
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
30
TABC
Thyroglobuline ++ Tissu thyroiumldien Beacutenin
TIRADS V= ADP + TIRADS IIIIVA
Cyto Beacutenin Bethesda
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
laquo Cytoponction raquo Thyroiumlde BIOPSIE
Beacutethesda Atypies ou folliculaire de nature indeacutetermineacute agrave 2 reprises
Lymphome eacutevoqueacute
1egravere intention
Calcifieacute
Anestheacutesie locale
Heacutemostase
Complications seacutevegraveres
Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules review of current literature
Suh CH THE ROLE OF CORE-NEEDLE BIOPSY FOR THYROID NODULES WITH INITIALLY NONDIAGNOSTIC FINE
Na DG Thyroid nodules with isolated macrocalcification malignancy risk and diagnostic efficacy of fine
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
32
bull DISSEacuteMINATION trajet de ponction (2 cas)
bull MINIMES 11 HEacuteMATOME VAGAL
bull HISTOLOGIQUES (surtout si aiguilles grosses) compromettre le Dg
- WHAFFT (Whorrisome Histologic Alteration Following FNA of the Thyroid)
- Vanishing tumors
Cytoponction Thyroiumlde COMPLICATIONS
Ultrasound-guided fine needle aspiration of thyroid nodules factors affecting diagnostic outcomes and confounding variables
Worrisome histologic alterations following fine needle aspiration of the thyroid Pandit AA Acta Cytol 2001
Vanishing tumors of thyroid histological variations after fine needle aspiration Bhatia P Gland Surg
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
33
Cytoponction Suivi Cancer
Marqueurs (seacuteriques liquide rinccedilage)
Thyrocalcitonine Carc Meacutedullaire Thyroide
Thyroglobuline K bien diffeacuterentieacutes souche folliculaire
Papillaire
Veacutesiculaire
Cytoponction cytologie
dosage (TG Thyrocalcitonine) suffit
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
laquo Kystiques raquo
Wunderbaldinger P Cystic Lymph Node Metastases in Papillary Thyroid Carcinoma AJR 2002
Kessler A Cystic appearance of cervical lymph is characteristic of metastatic papillary thyroid carcinoma J Clinical Utrasound 2003
Nakagawa T Differential diagnosis of a lateral cervical cyst and solitary cystic lymph node metastasis of occult thyroid
papillary carcinoma J Laryngol Otol 2001
ADP THYROIDE laquo Kyste +
Thyroid like raquo
laquo Kyste + microcalcif raquo
THYROGLOBULINE
+++++
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
35
Fixation post iratheacuterapie iode 131 Thyroiumldectomie + curage rec X 2
SAUF helliphelliphelliphellip
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
- Minimaliste - Contexte TSH (Calceacutemie PTH Thyrocalcitonine) - Signes de thyropathie auto immune (Ac)
- Description seacutemio TIRADS +++++ - Mensurations du Nodule Volume ++++ - Preciser site de ponction nodule ADP
CONCLUSION CR eacutechographie pour cytologiste
Cytoponction thyroiumlde beacutenin
Cytoponction thyroiumlde beacutenin