Cytological Features That Differentiate Follicular Neoplasm from Mimicking Lesions

Han, Kanghee; Ha, Hwa-Jeong; Kong, Joon Seog; Kim, Jungsoon; Myung, Jae Kyung; Koh, Jae Soo; Park, Sunhoo; Shin, Myung-Soon; Song, Woo-Tack; Seol, Hye Sil; Lee, Seung-Sook

doi:10.4132/jptm.2018.01.17

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…The compatibility rate with histopathology of Han K et al in the FN/SFN series of 116 cases were only 44%. Incompatible lesions were 40% TPC and 15% NG in this FN / FNK series (21). The compatibility rate in this study was 36% in the FN/SFN series while incompatible lesions were 30% PTC+PTMC and 33% NG in the our FN/SFN group.…”

Section: Discussionsupporting

confidence: 41%

Tiroid Nodüllerinin Değerlendirilmesinde Bethesda Sistemi ve İnce İğne Aspirasyon Biopsisinin Yeri

Akgün

Aslan

2021

Anadolu Kliniği Tıp Bilimleri Dergisi

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In this study, the role of fine needle aspiration biopsy (FNAB) evaluated with the Bethesda System in the diagnosis of thyroid nodules was investigated. Materials and Methods: Total 2284 FNAB materials of 1846 patients were performed in the Pathology Department of Kutahya Health Sciences University, Evliya Celebi Traning and Research Hospital between 2016 and 2019 and reported according to the Bethesda category. Among these cases, diagnostic sensitivity, specificity, accuracy, positive and negative predictive values of FNAB were calculated by making cytohistopathological comparison in 328 cases who underwent total thyroidectomy. Results: In the study, 1538 of the 1846 patients included were female (83.31%) and 308 (16.68%) were male. The average age was 49.92 years (Age range 19-87). The final cytological diagnoses of 2284 FNABs were as follows: 287 (12.57%) nondiagnostic or unsatisfactory, 1517 (66.42%) benign cytology, 316 (13.83%) atypia of undetermined significance/follicular lesion of undetermined significance, 63 (2.75%) follicular neoplasm or suspicious for a follicular neoplasm, 59 (2.59%) suspicious for malignancy and 42 (1.84%) malignant cytology. Histologically, 245 (74.70%) of the 328 cases were benign, while 83 (25.30%) were malignant. The number of true negative cases was 216 (65.85%), the number of true positive cases was 62 (19.90%), the number of false positive cases was 29 (8.84%) and the number of false negative cases was 21 (6.40%). In this case, diagnostic sensitivity, specificity, accuracy rates, positive and negative predictive values were 74.7%, 88.16%, 84.76%, 68.13% and 91.14%, respectively. Conclusion:In our study, it was observed that the sensitivity, specificity, accuracy rates, positive and negative predictive values of thyroid FNABs were compatible with the literature. We think that as the experience of the clinician and cytopathologist increases, false negative and positive results will decrease and at the same time, the confidence in thyroid FNABs will increase even more with the participation of some recent molecular methods (BRAF, RET/PTC, PAX8/PPARG and RAS) applied to FNABs.

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Section: Discussionsupporting

confidence: 41%

Tiroid Nodüllerinin Değerlendirilmesinde Bethesda Sistemi ve İnce İğne Aspirasyon Biopsisinin Yeri

Akgün

Aslan

2021

Anadolu Kliniği Tıp Bilimleri Dergisi

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“…Currently, TBSRTC DC IV (SFN) is recommended for nodules that are at least moderately cellular and show prominent architectural alteration including cellular crowding, microfollicles, and dispersed isolated cells [ 1 , 2 ]. Nevertheless, many researchers have reported poor cytohistologic correlation of DC IV (SFN) [ 22 , 27 , 30 – 33 ].Up to 44% of the nodules of which the cytologic features were concordant with DC IV (SFN), turned out to be non-neoplastic lesions [ 27 ], implying that diagnosing follicular-patterned neoplasms remains challenging.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, microfollicles were sometimes arranged in trabecular or branching pattern, which was more frequently identified in FTCs (40.0%) than FAs (15.2%). Han et al have also described that this trabecular pattern was more commonly observed in FAs and FTCs than in nodular hyperplasia although the frequency did not differ between FAs and FTCs [ 22 ]. Further evaluation in a larger cohort is required to elucidate the significance of this unique pattern.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, types of architectural alteration reported in FN and Hurthle cell neoplasm (HN) were analyzed: the presence of architectural crowding, 3-dimensional branching pattern, microfollicles arranged in trabecular pattern, and transgressing vessels (Figs 1 and 2 ). Of these, “microfollicles arranged in trabecular pattern” was defined as microfollicles forming 3-dimensional clusters and trabecular arrangement as described in a previous study by Han et al [ 22 ] ( Fig 3 ). Regarding nuclear features, the presence of nuclear enlargement, anisonucleosis, nuclear hyperchromasia, prominent nucleoli, small cell or large cell dysplasia, and the presence of PTC-like nuclear atypia was described.…”

Section: Methodsmentioning

confidence: 99%

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Preoperative diagnostic categories of fine needle aspiration cytology for histologically proven thyroid follicular adenoma and carcinoma, and Hurthle cell adenoma and carcinoma: Analysis of cause of under- or misdiagnoses

Moon

Choi

et al. 2020

PLoS ONE

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Cytologic diagnosis of thyroid follicular adenoma and carcinoma, and Hurthle cell adenoma and carcinoma (FACHAC) is challenging due to cytomorphologic features that overlap with other follicular-patterned lesions. This study was designed to analyze diagnostic categories (DCs) of preoperative fine needle aspiration cytology (FNAC) of histologically proven thyroid FACHACs to evaluate under- or misdiagnoses in FNAC and elucidate potential causes for such phenomena. A total of 104 thyroid nodules with preoperative FNAC which were diagnosed as FACHAC in resection specimens were included in this study. Of these, 66 cases had also undergone thyroid core needle biopsy (CNB); FNAC and CNB DCs were compared in these cases. Various cytologic and histologic parameters were compared between the nodules with different FNAC DCs. After a review of FNAC slides, DCs were re-assigned in 20 (19.2%) out of the 104 cases. Of the 66 cases with CNB diagnoses which were mostly classified as lower DCs in FNAC, 31 (47.0%) were diagnosed as suspicious for a follicular neoplasm in CNB. Cases which were underdiagnosed in FNACs were associated with lower cellularity, predominant macrofollicular pattern, absence of microfollicles arranged in trabecular pattern, and absence of transgressing vessels in cytology smears. High cellularity, microfollicles arranged in trabecular pattern, nucleolar prominence, and large cell dysplasia were more frequently found in malignancy than in benign neoplasm. In conclusion, thyroid FACHACs seem to be under- and misdiagnosed in preoperative FNAC. Innate characteristics of the nodules were associated with under-diagnosis as well as the quality of the FNAC specimens. Certain cytomorphologic features can be helpful in differentiating malignancy among FACHACs.

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“…Unfortunately, this method is applicable only to PTC. Identifying other types of DTC (FVPTC, FTC, and HTC) is hampered by a lack of distinguishing cytological characteristics in ultrasound images ( Figure 1 ), such as hypo-echogenicity, irregular margins, or microcalcifications [ 10 ]. In many cases, surgical resection of the tumor is necessary to confirm DTC subtypes, such as FTC and HCC.…”

Section: Introductionmentioning

confidence: 99%

Using Deep Convolutional Neural Networks for Enhanced Ultrasonographic Image Diagnosis of Differentiated Thyroid Cancer

et al. 2021

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Differentiated thyroid cancer (DTC) from follicular epithelial cells is the most common form of thyroid cancer. Beyond the common papillary thyroid carcinoma (PTC), there are a number of rare but difficult-to-diagnose pathological classifications, such as follicular thyroid carcinoma (FTC). We employed deep convolutional neural networks (CNNs) to facilitate the clinical diagnosis of differentiated thyroid cancers. An image dataset with thyroid ultrasound images of 421 DTCs and 391 benign patients was collected. Three CNNs (InceptionV3, ResNet101, and VGG19) were retrained and tested after undergoing transfer learning to classify malignant and benign thyroid tumors. The enrolled cases were classified as PTC, FTC, follicular variant of PTC (FVPTC), Hürthle cell carcinoma (HCC), or benign. The accuracy of the CNNs was as follows: InceptionV3 (76.5%), ResNet101 (77.6%), and VGG19 (76.1%). The sensitivity was as follows: InceptionV3 (83.7%), ResNet101 (72.5%), and VGG19 (66.2%). The specificity was as follows: InceptionV3 (83.7%), ResNet101 (81.4%), and VGG19 (76.9%). The area under the curve was as follows: Incep-tionV3 (0.82), ResNet101 (0.83), and VGG19 (0.83). A comparison between performance of physicians and CNNs was assessed and showed significantly better outcomes in the latter. Our results demonstrate that retrained deep CNNs can enhance diagnostic accuracy in most DTCs, including follicular cancers.

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Cytological Features That Differentiate Follicular Neoplasm from Mimicking Lesions

Cited by 7 publications

References 22 publications

Tiroid Nodüllerinin Değerlendirilmesinde Bethesda Sistemi ve İnce İğne Aspirasyon Biopsisinin Yeri

Tiroid Nodüllerinin Değerlendirilmesinde Bethesda Sistemi ve İnce İğne Aspirasyon Biopsisinin Yeri

Preoperative diagnostic categories of fine needle aspiration cytology for histologically proven thyroid follicular adenoma and carcinoma, and Hurthle cell adenoma and carcinoma: Analysis of cause of under- or misdiagnoses

Using Deep Convolutional Neural Networks for Enhanced Ultrasonographic Image Diagnosis of Differentiated Thyroid Cancer

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