Thyroid Cytopathology

If you have been told to have surgery because of a suspicious result on a needle biopsy, you are a candidate for cytopathology and genetic testing.

Dr. Richard Guttler is a CLIA-certified thyroid cytopathologist and a member of American Society of Cytopathologists. He is an expert on the molecular markers used to detect thyroid cancer at the genetic level.

The test (Afirma by Veracyte) looks at 143 genes that are expressed in benign nodules, meaning that this test will tell you if a nodule is benign; it does not detect cancer.

Using molecular markers, this type of genetic test will prevent tens of thousands of unnecessary thyroid surgeries. The test is 96% effective at accurately identifying a benign nodule using fine needle aspiration (FNA) cytopathology.

Another marker test done on needle washouts of nodules is specific for thyroid cancer. It measures BRAF, RET/PTC/, and other thyroid cancer markers. The name is ThyGenX by Interpace lab.RAS mutations may be seen in low grade follicular type lesions that may need only a lobectomy.

Dr. Guttler uses eROSE to assess the quality of the biopsy specimen for cellular adequacy. This includes a rapid staining of the first pass and review under the microscope. The eROSE process decreases inadequacy rates and allows for the addition of molecular markers during the biopsy if the cells look worrisome for cancer.

Dr. Guttler can perform an ultrasound-guided thyroid nodule biopsy at the Thyroid Center of Santa Monica, and all cytopathology interpretations of the biopsy are performed on-site by Dr. Guttler in our cytopathology lab. Rapid turnaround means less stress and worry while you wait for the report to come back from the lab. It also means you can receive treatment sooner.

We provide cytopathology services for patients who need:

Fine needle biopsy
Fine needle aspiration
Cyst therapy
Cytopathology interpretation

Second opinion on a prior biopsy or surgery

1Papillary 60-80%
Sheet of papillary thyroid cancer cells with a cloudy giant cell.
2Follicular / Hurthle cell 15-25%
At surgery there is capsule invasion. Cytology can not DD adenoma from cancer. Single Hurthle cells >20% in a biopsy suggests a neoplasm. Just like follicular carcinoma surgery is needed for diagnosis.
3Medullary 5-10%
The first FNA that has cells with extreme eccentric nuclei with a distinct salt and pepper look and all shapes from spindle to small cell groups and can be confused with the more common Hurthle cell neoplasm needs calcitonin studies.
4Undifferented 1-10%

Meet Richard Guttler of Santa Monica Thyroid Ablation Center

Meet Richard Guttler of Santa Monica Thyroid Ablation Center

September 25, 2017 Meet Richard Guttler of Santa Monica Thyroid Ablation Center VoyageLA Staff...

More info

Thyroid Awareness Month

Thyroid Awareness Month

Thyroid Awareness Month   January is thyroid awareness month, so get ready to be made...

More info

Thyroid Nodules and Cancer 101: Does Size Matter?

Thyroid Nodules and Cancer 101: Does Size Matter?

Thyroid Nodules and Cancer 101: Does Size Matter? Yes, except when it does’t...

More info

Thyroid Cancer 101: Third World Thyroid Cancer Congress II : What did We learn about cytology??

Thyroid Cancer 101: Third World Thyroid Cancer Congress II : What did We learn about cytology??

Thyroid Cancer 101: Third World Thyroid Cancer Congress II : What did We learn about cytology ?...

More info

Thyroid Nodular Goiter 101: What to Know if You have one

Thyroid Nodular Goiter 101: What to Know if You have one

Thyroid Nodular Goiter 101: What to Know if You have one. A swelling in the neck due to an...

More info

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery. Rules: Never...

More info

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery. Rules: Never go...

More info

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Thyroid No Surgery 101: Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Thyroid No Surgery 101: Dr. Guttler’s Rules to Avoid Unnecessary Thyroid Surgery. When...

More info

Thyroid Cancer 101: The Scarlet Letter Big C Tattoo to the Blue Letter b tattoo. Looks like Papillary Thyroid Cancer but it is Not Cancer.

Thyroid Cancer 101: The Scarlet Letter Big C Tattoo to the Blue Letter b tattoo. Looks like Papillary Thyroid Cancer but it is Not Cancer.

Thyroid Cancer 101: Looks like Papillary thyroid Cancer but it is Not Cancer. The Scarlet Letter...

More info

Thyroid Cancer101: A Bout with ‘The Big C

Thyroid Cancer101: A Bout with ‘The Big C

Thyroid Cancer101: A Bout with ‘The Big C Dr.Guttler’s comments on this article...

More info

Thyroid Cancer Diagnosis 101: Bad Ultrasound Reports= Too Many Thyroid Biopsies

Thyroid Cancer Diagnosis 101: Bad Ultrasound Reports= Too Many Thyroid Biopsies

Thyroid Cancer Diagnosis 101: Bad Ultrasound Reports= Too Many Thyroid Biopsies...

More info

Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery.

Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery.

Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery...

More info

Thyroid Nodules 101: Dr. Guttler’s 84 Rules on Thyroid Nodules

Thyroid Nodules 101: Dr. Guttler’s 84 Rules on Thyroid Nodules

Thyroid Nodules 101: Dr.Guttler’s  84 Rules on thyroid nodules The term thyroid nodule...

More info

Thyroid Cancer No Longer: What is a NIFTP, non-invasive follicular tumor with look alike papillary thyroid cells?

Thyroid Cancer No Longer: What is a NIFTP, non-invasive follicular tumor with look alike papillary thyroid cells?

Thyroid Cancer No Longer: What is a NIFTP, non-invasive follicular tumor with look alike...

More info

Thyroid Cancer in Teenage Basketball Star

Thyroid Cancer in Teenage Basketball Star

Thyroid Cancer in Teenage Basketball Star Dr.Guttler’s Comments The fact he needed more...

More info

Thyroid Cancer 101: Scare Tactics By Endocrinologist and Surgeon Who Tells Patient He has less than a year to live!

Thyroid Cancer 101: Scare Tactics By Endocrinologist and Surgeon Who Tells Patient He has less than a year to live!

Thyroid Cancer 101: Scare Tactics By Surgeon Who Tells Patient He had less than a year to live!...

More info

Thyroid Nodules No Surgery 101: Why a Simple Needle Washout for Molecular Markers for Thyroid Cancer Can Save You a Surgery.

Thyroid Nodules No Surgery 101: Why a Simple Needle Washout for Molecular Markers for Thyroid Cancer Can Save You a Surgery.

Thyroid Nodules No Surgery 101: Why a Simple FNA Needle Washout for Molecular Markers for...

More info

Thyroid Cancer 101: Why with thyroid cancer awareness week you should not get thyroid cancer screening.

Thyroid Cancer 101: Why with thyroid cancer awareness week you should not get thyroid cancer screening.

Thyroid Cancer 101: Why with thyroid cancer awareness week you should not get thyroid cancer...

More info

Thyroid Nodules 101: Why you should not go to surgery without molecular marker studies if you have a Indeterminate biopsy result.

Thyroid Nodules 101: Why you should not go to surgery without molecular marker studies if you have a Indeterminate biopsy result.

           Thyroid Nodules 101: Why you should not go to surgery without molecular marker...

More info

Thyroid Cancer 101: Branchial Cleft Cyst is Really Thyroid Cancer.

Thyroid Cancer 101: Branchial Cleft Cyst is Really Thyroid Cancer.

Patient has a large mass in the lateral neck with normal thyroid examination and ultrasound...

More info

Massive Benign Goiter Nodule: Endocrinologists Fail to Offer Alternative Therapy to Serious Thyroid Surgery.

Massive Benign Goiter Nodule: Endocrinologists Fail to Offer Alternative Therapy to Serious Thyroid Surgery.

Massive Benign Goiter Nodule: Endocrinologists Fail to Offer Alternative Therapy to Serious...

More info
Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860