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Suspicious for Malignancy

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The Bethesda System for Reporting Thyroid Cytopathology

Abstract

The term “suspicious for malignancy” (SFM) is applied when the cytologic features of a thyroid fine needle aspiration (FNA) are worrisome for papillary thyroid carcinoma, medullary thyroid carcinoma, lymphoma, or other malignant neoplasm but are quantitatively and/or qualitatively insufficient for a definitive diagnosis. Reasons for diagnostic uncertainty include suboptimal sampling or cellular preservation, an unusual tumor variant, or overlap** cytomorphologic features with other thyroid lesions. Although the proportion varies among laboratories, approximately 3% of thyroid fine needle aspirations are reported as SFM. SFM is a heterogeneous category because it includes a variety of different malignancies, but most cases are suspicious for papillary thyroid carcinoma. As with any indeterminate diagnosis, this category should be used judiciously so that patients are managed as appropriately as possible. The usual management is either lobectomy or near-total thyroidectomy.

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Author information

Authors and Affiliations

  1. Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Paul A. VanderLaan

  2. Department of Cellular Pathology, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK

    Ashish Chandra

  3. Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA

    Armando C. Filie

  4. The Claire and John Bertucci Endowed Chair in Thyroid Surgery Oncology, Harvard Medical School, Boston, MA, USA

    Gregory W. Randolph

  5. Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Gregory W. Randolph

  6. Department of Surgery, Endocrine Surgery Service, Massachusetts General Hospital, Boston, MA, USA

    Gregory W. Randolph

  7. Department of Pathology, VCUHealth, Richmond, VA, USA

    Celeste N. Powers

Authors
  1. Paul A. VanderLaan
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  2. Ashish Chandra
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  3. Armando C. Filie
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  4. Gregory W. Randolph
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  5. Celeste N. Powers
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Corresponding author

Correspondence to Paul A. VanderLaan .

Editor information

Editors and Affiliations

  1. Department of Pathology, The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Syed Z. Ali

  2. Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA

    Edmund S. Cibas

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VanderLaan, P.A., Chandra, A., Filie, A.C., Randolph, G.W., Powers, C.N. (2018). Suspicious for Malignancy. In: Ali, S., Cibas, E. (eds) The Bethesda System for Reporting Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-60570-8_7

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  • DOI: https://doi.org/10.1007/978-3-319-60570-8_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60569-2

  • Online ISBN: 978-3-319-60570-8

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