Thyroid: Practice Question

Which thyroid FNA specimen may be considered adequate (satisfactory for evaluation) under Bethesda adequacy criteria?
  1. Absent follicles with abundant granulomatous inflammation
  2. Three groups of follicles with 6 cells each.
  3. 5 groups of follicles with at least 8 cells each.
  4. Absent colloid material.
  5. Rare, isolated follicular cells without atypia
Show Answer and Explanations

Absent follicles with abundant granulomatous inflammation — Correct answer

Correct. The usual Bethesda adequacy benchmark is at least 6 well-visualized groups of follicular epithelial cells, with at least 10 cells per group. However, a specimen that does not meet this numeric threshold may still be adequate when it contains abundant colloid, significant inflammation (including lymphocytic or granulomatous thyroiditis), or significant cytologic atypia. Therefore, abundant granulomatous inflammation qualifies as an adequacy exception.

Three groups of follicles with 6 cells each.

Incorrect. Rare, isolated follicular cells without atypia do not meet the usual adequacy benchmark of at least 6 well-visualized follicular epithelial cell groups with at least 10 cells per group. The absence of atypia does not itself make a quantitatively scant specimen adequate.

5 groups of follicles with at least 8 cells each.

Incorrect. At least 6 groups of follicles with at least 10 cells each qualifies as adequate.

Absent colloid material.

Incorrect. If at least 6 groups of follicles with at least 10 cells each isn't present, the specimen can still be adequate with abundant colloid material, or inflammation, or atypia.

Rare, isolated follicular cells without atypia

Incorrect. At least 6 groups of follicles with at least 10 cells each qualifies as adequate.

Summary

Summary: Under Bethesda thyroid FNA adequacy criteria, the usual benchmark is at least 6 well-visualized groups of follicular epithelial cells with at least 10 cells per group. Specimens below this threshold may still be adequate when they show abundant colloid, significant inflammation (including granulomatous or lymphocytic thyroiditis), or significant cytologic atypia. Rare isolated follicular cells without atypia are insufficient.
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