1
|
Sinna EA, Ezzat N. Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions. J Egypt Natl Canc Inst 2012; 24:63-70. [PMID: 23582597 DOI: 10.1016/j.jnci.2012.01.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 01/13/2012] [Accepted: 01/23/2012] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Evaluation of accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of different thyroid lesions. PATIENTS AND METHODS This is a retrospective study of 296 diagnosed cases of thyroid nodules referred to cytology unit, pathology department, NCI, who underwent FNAC for diagnosis. The results were categorized according to the recent Bethesda classification into: insufficient for diagnosis, benign, atypical follicular lesion of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant sampling. The final histologic diagnosis and/or clinico-radiologic follow-up assessment for non-neoplastic lesions were considered the gold standard. RESULTS The study included 296 cases presented with thyroid nodules who underwent diagnostic thyroid FNAC. Female to male ratio was 5.2:1, and the median age was 44years. Ninety-eight cases (33.1%) were diagnosed as benign, 40 cases (13.5%) as follicular lesion of undetermined significance, 49 cases (16.5%) as follicular neoplasm, 30 cases (10.1%) as suspicious for malignancy, 58 cases (19.5%) as malignant, and 21 cases (7.1%) as unsatisfactory. Nodular hyperplasia represented the majority of benign cases (89.8%), while papillary carcinoma was the most frequent malignant lesion (72.4%). Cytologic diagnoses were compared with their corresponding final histologic ones. FNAC achieved a sensitivity of 92.8, a specificity of 94.2%, a positive predictive value of 94.9%, a negative predictive value of 91.8%, a false positive rate of 7.2%, a false negative rate of 5.8%, and a total accuracy of 93.6%. CONCLUSION FNA cytology is a sensitive, specific, and accurate initial diagnostic test for the evaluation of patients with thyroid swellings.
Collapse
Affiliation(s)
- E A Sinna
- The Department of Pathology, Cytopathology Unit, NCI, Cairo University, Egypt
| | | |
Collapse
|
2
|
MuddeGowda PH, Lingegowda J, Natesan R, Kurpad R. Divide and rule: cytodiagnosis of thyroid lesions using pattern analysis: a study of 233 cases. Diagn Cytopathol 2010; 39:888-95. [PMID: 22081525 DOI: 10.1002/dc.21486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 06/07/2010] [Indexed: 01/21/2023]
Abstract
Fine needle aspiration cytology (FNAC) of the thyroid is a simple, accurate, fast, economical and safe method for the diagnosis of thyroid lesions on FNA. The objective of this study was application of pattern analysis in the interpretation of thyroid lesions. Two hundred and thirty three cases of thyroid lesion were reviewed, which had histopathological correlation. Smears were classified based on primary (predominant) and secondary (next dominant) pattern and categorized. The variation between combined and final cytological diagnosis was correlated with the histopathological diagnosis. The sensitivity, specificity and diagnostic accuracy for the diagnosis of malignancy were 90.47, 100 and 99.14%. Our study demonstrates the feasibility and applicability of pattern analysis in diagnosing thyroid lesions, which could be easily reproducible.
Collapse
|
3
|
Sahoo M, Sekhri T, Tripathi M, Rautela N, Solanki Y. Absence of microfollicular basement membrane: a new indicator in the diagnosis of follicular carcinoma thyroid. Diagn Cytopathol 2008; 36:519-22. [PMID: 18528882 DOI: 10.1002/dc.20833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The thyroid follicles represent a biological continuum. Each follicle is closely related to the follicle that is next to it. The important feature of a follicular carcinoma is a microfollicular pattern. We report a case of follicular carcinoma in a 48-year-old female that demonstrates microfollicles which are larger in size and contain more number of follicular cells in cytologic smears (20-29 cells) in contrary to the literature definition of microfollicles containing approximately 6-12 cells. We also demonstrate absence of basement membranes in these microfollicles in histologic sections by Silver Methanamine Stain, which may be an indicator to search for vascular and capsular invasion. This case report also describes postoperative positron emission tomography scan findings.
Collapse
Affiliation(s)
- Maheswar Sahoo
- Department of Cytology, Institute of Nuclear Medicine & Allied Sciences, Delhi, India.
| | | | | | | | | | | |
Collapse
|
4
|
Fukunari N, Nagahama M, Sugino K, Mimura T, Ito K, Ito K. Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. World J Surg 2004; 28:1261-5. [PMID: 15517496 DOI: 10.1007/s00268-004-7597-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ultrasonography (US) of the thyroid gland has recently proved to be a useful clinical diagnostic method, and the newly developed high-resolution US with a color Doppler flow mapping function can reveal fine details of the thyroid gland and the hemodynamic features of a thyroid neoplasm. US can yield a diagnostic accuracy of more than 90% for thyroid carcinoma, especially papillary carcinoma. However, neither conventional B-mode US imaging nor aspiration biopsy cytology has delivered satisfactory results for follicular carcinoma. The aim of this study was to evaluate the clinical usefulness of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. A color Doppler scan was performed in 310 patients with a solitary cold nodule, and a combination of B-mode US and color Doppler findings, including tumor vascularity and results of a fast Fourier transform (FFT) analysis were used to create the following diagnostic grading system for differential diagnosis of follicular lesions: grade 1, benign follicular lesion [no color flow mapping (CFM) inside the nodule]; grade 2, benign peripheral type [CFM only in peripheral area, pulsatility index (PI) < 1.0]; grade 3, suspected follicular carcinoma (penetrating CFM, vascularity moderate); grade 4, follicular carcinoma (high-velocity penetrating CFM, PI = 1.0). All patients were subjected to surgical resection, and histologic examination was used to confirm the diagnosis. The grades of the 177 adenomatous nodules were as follows: grade 1, 46.9%; grade 2, 48.0%; grade 3, 5.1%; grade 4, 0%. The corresponding percentages for the 89 follicular adenomas were 16.9%, 49.4%, 30.3%, and 3.4%; and for the 44 follicular carcinomas they were 0%, 13.6%, 45.5%, and 40.9%. On the assumption that grade 1 and 2 lesions are benign and grade 3 and 4 lesions are malignant, 38 of the 44 follicular carcinomas and 227 of the 266 benign tumors had been accurately diagnosed, yielding a sensitivity of 88.9%, a specificity of 74.2%, and an accuracy of 81.0% for the grading system. Color Doppler imaging of 310 follicular tumors has revealed that high-velocity pulsatile blood flow penetrating the tumor is a characteristic finding of follicular carcinoma and is a new diagnostic criterion for performing color Doppler imaging. The differential diagnostic grading scores for color Doppler examinations and the results of FFT analysis demonstrate that US with the color Doppler function can play an important role in the differential diagnosis of thyroid tumors.
Collapse
Affiliation(s)
- Nobuhiro Fukunari
- Department of Surgery and Diagnostic Imaging, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
5
|
Bezabih M. Superficial malignant neoplasms in southwestern Ethiopia: a cytopathological approach. Diagn Cytopathol 2004; 31:347-51. [PMID: 15468117 DOI: 10.1002/dc.20129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to describe the distributions of superficial malignant neoplasms diagnosed by fine-needle aspiration cytology (FNAC). A prospective cross-sectional study was conducted within the Jimma Teaching Hospital, Pathology Department, Jimma University during the years between September 1998 and August 2002. Cases fulfilling cytopathological evidences of superficial malignancies were included whereas deep-seated malignancies were excluded from the study. An air-dried smear stained with the Wright staining procedure was utilized for the FNAC diagnostic technique. A total of 3,200 cases were investigated during the study period where 267 (8.3%) cases were of primary superficial malignant neoplasms, with 98 cases in the peak age group of 40-59 yr (36.7%) and a median age of 38.0 yr (range, 0.2-88 yr). The most frequent superficial cytodiagnosis was breast carcinoma, 79 (29.6%) cases; followed by non-Hodgkin's lymphomas, 37 (13.9%) cases; and soft tissue sarcomas, 26 (9.7%) cases. The overall male-to-female ratio showed preponderance to female patients (1:1.3). Carcinomas were identified more frequently in those >40 yr of age whereas sarcomas were identified in those <40 yr of age (P > 0.05). The most common malignant neoplasm in women was breast carcinomas found in 74 (27.7%) cases, whereas in men non-Hodgkin's lymphomas were found in 29 (10.9%) cases. Large proportions of carcinomas (88 cases, 33.0%), lymphomas (33 cases, 12.4%), and sarcomas (20 cases, 7.5%) were detected on the trunk, head, and neck, as well as on the lower limb regions, respectively. This study uncovered different types of superficial malignant neoplasms that are prevalent in the southwestern part of Ethiopia. The most common types of cytodiagnoses such as breast carcinomas, etc. may suggest that attention be given to future high-caliber prospective studies in trying to identify some of the associated strong risk factors for the disease under study. This study may be helpful to local health planners in prioritizing some of the commonest malignancies. Some of the diagnostic challenges of lymphomas and thyroid follicular lesions were shown also. This investigation is the first in Ethiopia and therefore may act as baseline data for similar studies in the future.
Collapse
Affiliation(s)
- Mesele Bezabih
- Department of Pathology, Jimma University, Jimma, Ethiopia.
| |
Collapse
|
6
|
Abstract
Recently, ultrasonography of the thyroid gland has proved to be a useful clinical diagnostic method. The newly developed high-resolution ultrasonography with color-Doppler flow mapping function can reveal fine details of the thyroid gland and the hemodynamic features of thyroid neoplasmas. Ultrasonography can deliver a diagnostic accuracy of over 90% in thyroid carcinoma, especially papillary carcinoma. However, in the case of follicular carcinoma, neither conventional B-mode ultrasound imaging nor aspiration biopsy cytology can deliver satisfactory results. Color-Doppler imaging examination of 212 follicular tumors has been carried out, resulting in the characteristic finding that a high-velocity pulsative blood flow penetrates the tumor in the case of follicular carcinoma, which led to new diagnostic criteria with color-Doppler examination. The differential diagnostic grading score using color-Doppler examination and FFT analysis can show a dramatic diagnostic accuracy of 81.0%, a sensitivity of 88.9% and a specificity of 74.2%. Ultrasound with the color-Doppler function can play a more important role in the differential diagnosis of thyroid tumors.
Collapse
Affiliation(s)
- Nobuhiro Fukunari
- Surgical branch of ITO Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo 150-8308, Japan.
| |
Collapse
|
7
|
Ng WK, Collins RJ, Shek WH, Ng IO. Cytologic Diagnosis of "CASTLE" of thyroid gland: report of a case with histologic correlation. Diagn Cytopathol 1996; 15:224-7. [PMID: 8955605 DOI: 10.1002/(sici)1097-0339(199609)15:3<224::aid-dc9>3.0.co;2-g] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report on the cytologic and histologic features of a rare form of lymphoepithelioma-like carcinoma of the thyroid i.e., carcinoma showing thymus-like element (CASTLE). Sixteen cases of cervical lymph node aspirates with metastatic nasopharyngeal carcinoma are also reviewed. While it is important to recognize CASTLE of the thyroid because of its distinctly good prognosis, its cytologic features closely resemble those in metastatic nasopharyngeal carcinoma.
Collapse
Affiliation(s)
- W K Ng
- Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | | |
Collapse
|
8
|
Ostrowski ML, Brown RW, Wheeler TM, Green LK, Schaffner DL. Leu-7 immunoreactivity in cytologic specimens of thyroid lesions, with emphasis on follicular neoplasms. Diagn Cytopathol 1995; 12:297-302. [PMID: 7544717 DOI: 10.1002/dc.2840120403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Anti-Leu-7 (HNK-1, CD 57) antibody, a marker for natural killer lymphocytes, was employed by Ghali et al. (Hum Pathol 1992;23: 21-25) to study surgically resected formalin-fixed, paraffin-embedded thyroid lesions. They demonstrated strong immunoreactivity of this antibody with thyroid carcinomas, both follicular and papillary, and only occasional weak immunoreactivity with colloid goiters and follicular adenomas. We studied cytologic specimens (primarily fine-needle aspiration biopsy specimens) from 44 thyroid lesions, including 10 follicular carcinomas, 14 follicular adenomas, seven adenomatous nodules, six papillary carcinomas, and seven cases of Hashimoto's thyroiditis. All follicular carcinomas exhibited immunoreactivity to anti-Leu-7 antibody, usually of a moderate to strong degree (9/10); however, six of 14 follicular adenomas yielded similar results. The patterns of immunoreactivity in the other lesions were similar to those previously described (Ghali et al., Hum Pathol 1992;23:21-25). It does not appear that anti-Leu-7 antibody can be used as a specific marker of malignancy in the cytologic assessment of follicular neoplasms of the thyroid.
Collapse
Affiliation(s)
- M L Ostrowski
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | |
Collapse
|
9
|
Busseniers AE, Oertel YC. "Cellular adenomatoid nodules" of the thyroid: review of 219 fine-needle aspirates. Diagn Cytopathol 1993; 9:581-9. [PMID: 8287772 DOI: 10.1002/dc.2840090523] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We reviewed 219 consecutive thyroid aspirates previously diagnosed as "cellular adenomatoid nodule," applying the criteria presented in this paper and reclassifying them as 146 adenomatoid nodules (AN), 31 cellular adenomatoid nodules (CELL-AN), 29 cellular adenomatoid nodules vs. follicular neoplasms (CELL-AN vs. FN), 5 follicular neoplasms (FN), 2 FN of oxyphilic cell type, 4 papillary carcinomas, and 2 chronic lymphocytic (Hashimoto's) thyroiditis. Of the 146 adenomatoid nodules, 14 occurred in multinodular goiters on histologic examination. Of the 31 CELL-AN, five had surgery: two were follicular adenomas, one was papillary carcinoma, and two were multinodular goiters. Of the 29 CELL-AN vs. FN, 11 had surgery: six were follicular adenomas, two were follicular carcinomas, two were multinodular goiters, and one was Hashimoto's thyroiditis. Surgery on four FN showed follicular adenomas (a fifth patient was lost to follow-up). Of the two FN of oxyphilic cell type, one was a multinodular goiter and the other a follicular adenoma with oxyphilic cells. Three of the four papillary carcinomas were confirmed histologically (one patient was lost to follow-up). Of the two cases showing Hashimoto's thyroiditis, one was diagnosed as FN on repeat aspiration and follicular carcinoma at surgery. After review, we identified 40 patients at higher risk of harboring a neoplasm and 31 with cellular adenomatoid nodules. Twenty-five underwent surgery with the above results. In the classification of follicular lesions of the thyroid by FNA, adherence to strict cytologic criteria helps identify those patients who will benefit most from surgery.
Collapse
Affiliation(s)
- A E Busseniers
- Department of Pathology, George Washington University Medical Center, Washington, DC 20037
| | | |
Collapse
|
10
|
Harach HR, Zusman SB, Saravia Day E. Nodular goiter: a histo-cytological study with some emphasis on pitfalls of fine-needle aspiration cytology. Diagn Cytopathol 1992; 8:409-19. [PMID: 1638942 DOI: 10.1002/dc.2840080421] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A comprehensive comparative histo-cytological study of 48 nodular goiters from an endemic goiter region was undertaken. Practically all features observed on the biopsies were identified, although with less frequency, on the smears. In agreement with previous observations, characteristic components of nodular goiter (NG) in aspirates included small to medium size epithelial cells with regular round nuclei, honeycomb pattern, large follicles, papillae showing the previously mentioned epithelial features, oxyphilic cells, and moderate to abundant background colloid material and thyroid phagocytes (macrophages). All eight features occurred together in only 2% of the studied cases, seven in 6 (12.5%), six in 4 (8%), five in 6 (12.5%), four in 12 (25%), three in 6 (12.5%), two in 11 (23%), and one in 2 (4%) cases, respectively. Regardless of the number and combination of features present, specific identification of NG on the smears may not always be possible and diagnostic pitfalls include thyroid cyst, Hashimoto's thyroiditis, granulomatous lesions, and, more frequently, follicular neoplasia. Our findings suggest that thyroid aspirates should be analysed with critical clinico-pathological approach and surgery considered only for nodules that are clinically suspicious or unresponsive to hormonotherapy when a diagnosis of follicular neoplasia is made.
Collapse
Affiliation(s)
- H R Harach
- Service of Pathology, Dr. A. Oñativia Endocrinology and Metabolism Hospital, Salta, Argentina
| | | | | |
Collapse
|
11
|
Abstract
A stepwise logistic regression analysis was performed in 27 cases of papillary carcinoma thyroid (PC), 20 follicular neoplasms (FN), 30 cases of Grave's disease (GD), and 40 cases of colloid adenomatous goitre (CAG). The three most important variables in predicting PC were papillary clusters, dense cytoplasm, and intranuclear cytoplasmic inclusions, whereas the predictors of FN were high cellularity combined with a prominent acinar pattern. A few cases of GD and CAG showed a cytologic overlap with PC and FN, respectively. Regression analysis established high cellularity, fire flare appearance, and epitheloid granulomas as reliable predictors of GD, whereas abundant colloid with or without foam cells and follicles associated with colloid (FAC) were important variables in CAG.
Collapse
Affiliation(s)
- D Basu
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | | |
Collapse
|
12
|
Chen KT. Fine-needle aspiration cytology of papillary Hürthle-cell tumors of thyroid: a report of three cases. Diagn Cytopathol 1991; 7:53-6. [PMID: 1709087 DOI: 10.1002/dc.2840070114] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Papillary Hürthle-cell tumors of the thyroid are composed of oxyphilic cells with a prominent papillary component. Their biologic behavior appears to be comparable with that of conventional papillary thyroid carcinomas. The literature on the fine-needle aspiration cytology of these tumors is scanty. The cytologic findings of three such cases are reported here. The findings suggest that most papillary Hürthle-cell tumors cannot be differentiated from other types of Hürthle-cell tumors cytologically.
Collapse
Affiliation(s)
- K T Chen
- Department of Pathology, Saint Agnes Medical Center, Fresno, CA 93710
| |
Collapse
|
13
|
Suen KC. How does one separate cellular follicular lesions of the thyroid by fine-needle aspiration biopsy? Diagn Cytopathol 1988; 4:78-81. [PMID: 3378490 DOI: 10.1002/dc.2840040119] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- K C Suen
- Department of Pathology, Vancouver General Hospital, University of British Columbia, Canada
| |
Collapse
|