{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:50:09Z","timestamp":1785451809806,"version":"3.56.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"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":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      An international grading system for medullary thyroid carcinoma (IMTCGS) was established in 2022. High\u2010grade MTC is defined by the presence of one or more of the following features: mitotic index \u2265\u20095 per 2\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      , Ki\u201067 proliferative index \u2265\u20095%, or tumor necrosis. Fine\u2010needle aspiration (FNA) is the primary diagnostic tool for MTC; however, tumor grading in cell blocks remains underexplored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A total of 60 FNA cases diagnosed as MTC or metastatic MTC between 2000 and 2025 were identified. Of these, 15 met the inclusion criteria: cell blocks with &gt;\u2009500 tumor cells and corresponding surgical specimens available. The Ki\u201067 proliferation index was assessed in hotspot regions using an online platform.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 11 adults and 4 pediatric\/adolescents with a median age of 50\u2009years (range: 8\u201376). Based on the IMTCGS grading criteria, six cases were classified as high\u2010grade and nine as low\u2010grade. In low\u2010grade tumors, the Ki\u201067 proliferation index on surgical resections ranged from &lt;\u20091% to 4%, and all corresponding cell blocks showed Ki\u201067 rates of \u2264\u20091%. High\u2010grade tumors exhibited Ki\u201067 indices ranging from 7% to 24%, with mitotic figures ranging from 1 to 14 per 2\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      . Among these, two cell blocks showed Ki\u201067 rates of 5%, while the remaining four had rates between &lt;\u20091% and 2%. Four of six patients with high\u2010grade MTC developed distant metastases to the liver, lung, or bone, and one died of disease 35\u2009months after diagnosis. None of the low\u2010grade tumors developed distant metastasis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Grading MTC using the Ki\u201067 proliferation index on cell blocks is challenging because of low cellularity and intratumoral heterogeneity in Ki\u201067 expression. In our study, this approach tended to undergrade high\u2010grade MTC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dc.70102","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:25:15Z","timestamp":1771244715000},"page":"380-387","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Utility of Ki\u201067 Index on Cell Block Material for Grading Medullary Thyroid Carcinoma"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5930-4365","authenticated-orcid":false,"given":"Tieying","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1833-4642","authenticated-orcid":false,"given":"Hector","family":"Mesa","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Puello","sequence":"additional","affiliation":[{"name":"AmeriPath Inc.  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Molden","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379\u2010020\u20100532\u20101"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001505"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01329"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2023.0482"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.15195"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010023\u201008341\u2010x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22778"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.modpat.2023.100235"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2024.0444"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12022\u2010022\u201009719\u2010z"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.modpat.2023.100244"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2014.0335"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqz110"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010022\u201009923\u20101"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13172756"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2008.177"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1159\/000439434"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPQ55SKOCYFZHN"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31821a0696"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.22170"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.10219"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010017\u20105899\u2010y"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/pin.12108"}],"container-title":["Diagnostic Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/dc.70102","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:27:15Z","timestamp":1777408035000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dc.70102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/dc.70102"],"URL":"https:\/\/doi.org\/10.1002\/dc.70102","archive":["Portico"],"relation":{},"ISSN":["8755-1039","1097-0339"],"issn-type":[{"value":"8755-1039","type":"print"},{"value":"1097-0339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]},"assertion":[{"value":"2025-12-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}