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%

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