{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T15:28:53Z","timestamp":1779377333556,"version":"3.53.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The transition from conventional smear (\n                      <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n                      ) cytology to liquid\u2010based cytology (\n                      <jats:styled-content style=\"fixed-case\">LBC<\/jats:styled-content>\n                      ) in thyroid fine\u2010needle aspiration (\n                      <jats:styled-content style=\"fixed-case\">FNA<\/jats:styled-content>\n                      ) has been a subject of debate, with varying reports on diagnostic performance. This retrospective observational study evaluates this institution's 5\u2010year experience with\n                      <jats:styled-content style=\"fixed-case\">LBC<\/jats:styled-content>\n                      in thyroid cytology from 2020 to 2024, comparing its advantages and results with past experience using\n                      <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\n                      combined with rapid on\u2010site assessment (\n                      <jats:styled-content style=\"fixed-case\">ROSE<\/jats:styled-content>\n                      ) from 2016 to 2018, and correlating cytological diagnoses with histopathological outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of all thyroid FNAs processed and reported at the cytopathology department of Cleveland Clinic Abu Dhabi\u2014National Reference Laboratory (CCAD\/NRL) using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). A total of 741 nodules were aspirated from January 2016 to May 2018 using primarily conventional smears with the routine practice of ROSE (pre\u2010LBC), while 4993 nodules were aspirated via LBC (ThinPrep) between July 2020 and September 2024 without ROSE (post\u2010LBC). Cases with subsequent surgical resection were reviewed and correlated with the pre\u2010operative cytology diagnosis to assess diagnostic accuracy. Data analysis before and after transitioning to LBC was performed to compare diagnostic performance, Bethesda category distribution, and surgical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LBC was associated with improved pre\u2010analytical standardization, with nondiagnostic rates stabilizing at 10.8% compared with 4%\u20137% during the pre\u2010LBC period when ROSE was routinely used. The atypia of undetermined significance (AUS; Bethesda III) rate significantly decreased from 16% pre\u2010LBC to 7% post\u2010LBC, with architectural atypia alone comprising 3% post\u2010LBC. Histologic correlation was available for 199 pre\u2010LBC and 258 post\u2010LBC nodules. Pre\u2010LBC cytology demonstrated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 80.8%, 95.1%, 93.3%, and 85.3%, respectively. Post\u2010LBC metrics improved to 92.3% sensitivity and PPV, and 98.8% specificity and NPV. Among Bethesda II nodules, the false\u2010negative rate decreased from 14.3% pre\u2010LBC to 2.3% post\u2010LBC. AUS nodules with nuclear atypia demonstrated a 92.3% malignancy rate post\u2010LBC, compared to 40.4% in unstratified AUS cases pre\u2010LBC. Oncocytic cell\u2010rich indeterminate nodules were predominantly benign in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LBC is associated with several practical advantages over CS in thyroid cytology. In addition to streamlining and standardizing diagnostic workflows, it significantly helped to improve diagnostic accuracy. We observed a significant decrease in AUS rate, reducing interpretive uncertainty, and enhanced detection of malignancy with nuclear atypia. These findings validate Bethesda's recommendations for more granular classification of indeterminate cytology. The nondiagnostic rate increased slightly in the post\u2010LBC period, a predictable effect of ROSE withdrawal. However, this modest rise was offset by the substantial gains in workflow efficiency and overall diagnostic accuracy achieved with LBC. This long\u2010term experience reinforces LBC as a reliable and efficient method for thyroid FNA evaluation and better risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dc.70072","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T07:18:16Z","timestamp":1766560696000},"page":"219-229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fine Needle Aspiration of Thyroid Nodules: From Conventional Smears to Liquid\u2010Based Cytology\u2014The 8\u2010Year Cleveland Clinic Abu Dhabi Experience"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2883-6841","authenticated-orcid":false,"given":"Ayoub","family":"Nahal","sequence":"first","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-2712(18)30434-7"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/104.2.150"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mpdhp.2008.08.001"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000325407"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000329029"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.16.97"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.10391"},{"key":"e_1_2_11_9_1","first-page":"35","volume-title":"The Bethesda System for Reporting Thyroid Cytopathology","author":"Cibas E. 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