title: The nightmare of indeterminate follicular proliferations: when liquid-based cytology and ancillary techniques are not a moon landing but a realistic plan.
abstract: OBJECTIVE
  Thyroid nodules are a common finding in the general population, including both nonneoplastic and neoplastic entities. Fine-needle aspiration cytology (FNAC) is the first tool for evaluating thyroid nodules. In spite of its high diagnostic accuracy, 25% of nodules result in the category of follicular neoplasms (FN), with varying risk of malignancy and different management strategies.
  
  
  METHODS
  The use of ancillary techniques is reshaping the practice of FNAC. These tools can significantly empower the morphological diagnosis and prognosis of thyroid nodules, allowing a more accurate prediction of the nature of the lesion. Several studies have underlined the role of single or multiple testing for the category of FN as strong indicators of cancer. Every cytological preparation can be used for the application of ancillary techniques but the introduction of liquid-based cytology (LBC) might facilitate the application.
  
  
  RESULTS
  Our experience involving an immunocytochemical panel made up of HBME-1 and galectin-3 pointed to an 81% overall diagnostic accuracy in discriminating between low and high risk of malignancy in FN.
  
  
  CONCLUSIONS
  The application of these techniques on LBC represents an adjunct to the morphological evaluation of FN. They represent a critical and challenging, but also a feasible, tool in the preoperative diagnoses, allowing specific prognostic and predictive details regardless of the cytological preparation. © 2014 S. Karger AG, Basel.
authors.affiliation: Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Esther Diana
authors.initials: ED
authors.lastname: Rossi
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
authors.forename: Fernando
authors.initials: F
authors.lastname: Schmitt
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology; D014408:Biomarkers, Tumor / Q000032:analysis; D044963:Biopsy, Fine-Needle; D001798:Blood Proteins; D049109:Cell Proliferation; D003581:Cytodiagnosis / Q000379:methods*; D003937:Diagnosis, Differential; D037502:Galectin 3 / Q000032:analysis; D037161:Galectins; D006801:Humans; D007150:Immunohistochemistry; D025202:Molecular Diagnostic Techniques; D011237:Predictive Value of Tests; D013048:Specimen Handling / Q000379:methods*; D013961:Thyroid Gland / Q000737:chemistry / Q000473:pathology*; D016606:Thyroid Nodule / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology; D000951:Antigens, Neoplasm
chemical_list: D014408:Biomarkers, Tumor; D001798:Blood Proteins; D037502:Galectin 3; D037161:Galectins; C432845:HBME-1 antigen; D000951:Antigens, Neoplasm; C428445:LGALS3 protein, human