title: Cytotechnologist Performance for Screening Hürthle Cell Atypia in Indeterminate Thyroid Fine-Needle Aspirates.
abstract: OBJECTIVE
  We have previously shown that specimens diagnosed as containing Hürthle cells have a 12% chance of being malignant if they are classified as atypia of undetermined significance (AUS-HC). The identification of Hürthle cells by cytotechnologists (CTs) during screening can improve cytopathologist efficiency and may prevent diagnostic errors due to the oversights of focal findings. Here, we examine the performance of our institutional CTs when screening for Hürthle cell atypia in thyroid fine-needle aspiration (FNA) specimens.
  
  
  METHODS
  Information on 8,814 thyroid cytopathology specimens was retrieved for a 10-year period. Specimens were screened by 1 of 11 CTs. A subsample of cases was categorized either as AUS-HC or suspicious for Hürthle cell neoplasm.
  
  
  RESULTS
  AUS-HC screening diagnoses were more likely to be downgraded to benign but less likely to be upgraded compared to AUS diagnoses with nuclear or microfollicular atypia. AUS-HC represents almost all papillary thyroid carcinoma (PTC) screening diagnoses downgraded to the AUS category, which suggests that even low levels of Hürthle cell atypia can result in PTC being included in the differential diagnosis.
  
  
  CONCLUSIONS
  Overall, there are few major discrepancies between CT and pathologist diagnoses for specimens containing Hürthle cell atypia.
authors.affiliation: Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Md., USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: VandenBussche
authors.forename: Christina
authors.initials: C
authors.lastname: Adams
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Olson
mesh_terms: D018249:Adenoma, Oxyphilic; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000473:pathology*; D002291:Carcinoma, Papillary; D002983:Clinical Competence; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D024862:Oxyphil Cells / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology*