Atypia of undetermined significance and follicular lesions of undetermined significance: sonographic assessment for prediction of the final diagnosis.

OBJECTIVES: To determine whether radiologic assessment of thyroid nodules can potentially help guide clinical management after a cytologic diagnosis of atypia of undetermined significance or a follicular lesion of undetermined significance. METHODS: We identified 41 patients with 41 thyroid nodules initially diagnosed as atypia or follicular lesions of undetermined significance on fine-needle aspiration that were subsequently definitively diagnosed by either surgical resection or repeated fine-needle aspiration. All sonograms of nodules were reviewed by 2 blinded board-certifiedradiologists. Lesions were assessed in 3 ways: (1) Mayo pattern classification as benign, indeterminate, or worrisome for malignancy (Ultrasound Q 2005; 21:157-165); (2) thyroid imaging reporting and data system scores (scale of 1-5) based on 2 different previously published scoring criteria (Park et al [Thyroid 2009; 19:1257-1264] and Kwak et al [Radiology 2011; 260:892-899]); and (3) binary classification as benign or malignant. RESULTS: Of the 41 nodules, 25 had benign histologic findings, and 16 were malignant. Mayo pattern classification was 100% accurate for the benign score. Lesions with a Mayo score of indeterminate were malignant in 21% of cases (6 of 28) and benign in 79% (22 of 28). Lesions with a Mayo score of malignant were malignant in 91% of cases (10 of 11) and benign in 9% (1 of 11). Thyroid imaging reporting and data system scores had area under the receiver operating characteristic curve values of 0.827 for Park scores and 0.822 for Kwak scores. Radiologist binary classification of thyroid nodules showed 88% overall accuracy. CONCLUSIONS: Radiologist assessment of thyroid nodules in cases of atypia of undetermined significance or follicular lesions of undetermined significance is highly predictive of the final diagnosis and can help guide management of thyroid nodules of these pathologic types.

Mock gynecologic cytology proficiency testing as a milestone assessment tool for anatomic pathology residents.

INTRODUCTION: One of the major aims of the Next Accreditation System is to move toward an outcomes-based evaluation system where each accredited medical residency program must demonstrate that its residents are competent in performing the essential tasks necessary for clinical practice. Because all pathologists who sign-out or screen Papanicolaou (Pap) tests are required to pass an annual 10-slide gynecologic cytology proficiency test (PT), we developed mock PT modules as a tool for assessing competency. MATERIALS AND METHODS: In 2007, we introduced mock proficiency testing with 3 distinct modules, each consisting of 3 10-slide test sets (10 ThinPrep, 10 SurePath, and 10 conventional Pap slides). Each module was administered at 3 different time points. We evaluated the following parameters: (1) performance differences between Pap preparations; (2) performance over time; (3) performance before and after initiation of one-on-one teaching sessions with cytotechnologists in 2009; and (4) quality of test slides. RESULTS: Residents showed improvement over time, and overall scores did not differ significantly among ThinPrep, SurePath, and conventional slide sets. The average score for the first test set was significantly higher for residents who received formal training by a cytotechnologist than for those who did not. Overall, 16 of 90 slides were misclassified by 40% or more of residents, half of which exhibited glandular abnormalities. CONCLUSIONS: The objective assessment provided by mock PT is a useful tool for both faculty and residents.

Radiologic assessment of retropharyngeal node involvement in oropharyngeal carcinomas stratified by HPV status.

Radiation of retropharyngeal nodes (RPN) results in increased toxicities. This study assessed characteristics associated with RPN involvement in 165 oropharynx cancer patients. Factors associated with involvement were stage N2c-3 disease and stage N2b disease with either advanced T-stage, ⩾3 involved cervical LN, and ⩾1 involved contralateral LN, or lateral/posterior subsites.