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%

PET/CT Thyroid Incidentaloma During Treatment for Kidney Cancer

PET/CT Thyroid Incidentaloma During Treatment for Kidney Cancer

PET/CT Thyroid Incidentaloma Found During Treatment for Kidney Cancer Metastasis of Renal Clear...

More info

Flow Chart for Evaluation of Nodular Goiter

Flow Chart for Evaluation of Nodular Goiter

Flow Chart for Evaluation of Nodular Goiter

More info

Hashimoto’s thyroiditis and papillary thyroid carcinoma

Hashimoto’s thyroiditis and papillary thyroid carcinoma

Hashimoto’s thyroiditis and papillary thyroid carcinoma There has long been a controversy in the...

More info

Why You usually don’t need radioiodine after surgery in most thyroid cancers.

Why You usually don’t need radioiodine after surgery in most thyroid cancers.

Why You usually don’t need radioiodine after surgery in most thyroid cancers. Radioiodine...

More info

Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under Active Surveillance?

Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under Active Surveillance?

Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under...

More info

Needle biopsy of Parathyroid adenoma: The cells can look like follicular neoplasm or papillary thyroid cancer.

Needle biopsy of Parathyroid adenoma: The cells can look like follicular neoplasm or papillary thyroid cancer.

Needle biopsy of Parathyroid adenoma: The cells can look like follicular neoplasm or papillary...

More info

The ABC’s of Diagnosing Metastatic Lymph Node Disease in Papillary Thyroid Cancer

The ABC’s of Diagnosing Metastatic Lymph Node Disease in Papillary Thyroid Cancer

The ABC’s of Diagnosing Metastatic Lymph Node Disease in Papillary Thyroid Cancer...

More info

Non-functioning Parathyroid Cysts: Diagnosis made by Needle Washout for PTH not Cytology.

Non-functioning Parathyroid Cysts: Diagnosis made by Needle Washout for PTH not Cytology.

Non-functioning Parathyroid Cysts: Diagnosis made by Needle Washout for PTH not Cytology. Rossi...

More info

Team Work Needed When Hurthle Cells Are Seen on thyroid Fine Needle biopsy

Team Work Needed When Hurthle Cells Are Seen on thyroid Fine Needle biopsy

Team Work Needed When Hurthle Cells Are Seen on thyroid Fine Needle biopsy Hurthle cells in FNA...

More info

Why Hurthle Cells HC Drive Cytopathologists Mad

Why Hurthle Cells HC Drive Cytopathologists Mad

Why Hurthle Cells Drive Cytopathologists Mad Because HCs are found in all benign conditions such...

More info

What are Cystic Thyroid Nodules?

What are Cystic Thyroid Nodules?

What are Cystic Thyroid Nodules? Thyroid nodules are common, and a large proportion has mixed...

More info

What to do with <1 cm nodules that are candidates for Active Surveillence? To biopsy or not that is the question.

What to do with <1 cm nodules that are candidates for Active Surveillence? To biopsy or not that is the question.

What to do with <1 cm nodules PMT papillary microcarcinomas that are candidates for Active...

More info

Eggshell calcification: Any Calcifications in the thyroid nodule should be carefully evaluated

Eggshell calcification: Any Calcifications in the thyroid nodule should be carefully evaluated

Eggshell calcification: Any Calcifications in the thyroid nodule should be carefully evaluated...

More info

How Good is a Suspicious Afirma test result in detecting thyroid cancer? Not too good compared to thyroid cytology

How Good is a Suspicious Afirma test result in detecting thyroid cancer? Not too good compared to thyroid cytology

How Good is a Suspicious Afirma test result in detecting thyroid cancer? Not too good compared...

More info

Thyroid Surgery is not the only treatment option in 2017

Thyroid Surgery is not the only treatment option in 2017

Thyroid Surgery is not the only treatment option in 2017: Genetic test could spare cancer...

More info

Maltoma Lymphoma of the Thyroid in a Man with Hashimoto’s Thyroiditis

Maltoma Lymphoma of the Thyroid in a Man with Hashimoto’s Thyroiditis

Maltoma ( lymphoma) of the Thyroid in a Man with Hashimoto’s Thyroiditis Robert Wozniak (1999)...

More info

Thyroid Lymphoma in Little Old Ladies with long standing Hashimoto’s thyroiditis

Thyroid Lymphoma in Little Old Ladies with long standing Hashimoto’s thyroiditis

Thyroid Lymphoma in Little Old Ladies with long standing Hashimoto’s thyroiditis Clinical...

More info

RAS Mutation in “benign”( NIFT-P)Non invasive follicular tumor with papillary cell features

RAS Mutation in “benign”( NIFT-P)Non invasive follicular tumor with papillary cell features

RAS Mutation in “benign”( NIFT-P)Non invasive follicular tumor with papillary cell...

More info

Thyroid Center of Santa Monica Named Top 40 Thyroid Blog

Thyroid Center of Santa Monica Named Top 40 Thyroid Blog

Thyroid Center of Santa Monica Named Top 40 Thyroid Blog Hi Dr.Guttler, My name is Anuj Agarwal...

More info

Parathyroid Cyst Masquerading as a Thyroid Nodule

Parathyroid Cyst Masquerading as a Thyroid Nodule

Parathyroid Cyst Masquerading as a Thyroid Nodule in 63 year old female failed prior drainage...

More info

Bravo: An Endocrinologist Refers a Patient for ( PEI ) Ethanol Thyroid Cyst Ablation

Bravo: An Endocrinologist Refers a Patient for ( PEI ) Ethanol Thyroid Cyst Ablation

Bravo: An Endocrinologist Refers a Patient for ( PEI ) Ethanol Thyroid Cyst Ablation Finally the...

More info

Why Neck Lymph Nodes Need to be looked at BEFORE the first thyroid cancer surgery

Why Neck Lymph Nodes Need to be looked at BEFORE the first thyroid cancer surgery

Why Neck Lymph Nodes Need to be looked at BEFORE the first thyroid cancer surgery. There are 300...

More info

Afirma GEC

Afirma GEC

Afirma GEC Beware of small numbers in studies so far. Afirma has a strong negative predictive...

More info

Rosetta GX Reveal and ThyGen X ThyraMIR

Rosetta GX Reveal and ThyGen X ThyraMIR

Rosetta GX Reveal New approach doing testing on stained cytology slides instead of needle...

More info

What are the Various Molecular Marker Tests For Thyroid Cancers?

What are the Various Molecular Marker Tests For Thyroid Cancers?

What are the Various Molecular Marker Tests For Thyroid Cancers? The law of small numbers...

More info

Clinical Thyroidology 2017: The Year of No Thyroid Surgery

Clinical Thyroidology 2017: The Year of No Thyroid Surgery

Clinical Thyroidology 2017: The Year of No Thyroid Surgery The key word is less. Less thyroid...

More info

Thyroid Diseases Fact Sheet #1

Thyroid Diseases Fact Sheet #1

Thyroid Diseases Fact Sheet #1 The important gland that controls the human bodies metabolism...

More info

Main Paper on Molecular Marker Testing for Thyroid Nodules and Cancer

Main Paper on Molecular Marker Testing for Thyroid Nodules and Cancer

Main Paper on Molecular Marker Testing for Thyroid Nodules and Cancer DR Guttler was a...

More info

What Does A Renal Ca Thyroid Metastasis Look Like on Ultrasound?

What Does A Renal Ca Thyroid Metastasis Look Like on Ultrasound?

What Does A Renal or other Cancer Metastasis to the thyroid Look Like on Ultrasound? A rare...

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