Morphologic predictors of papillary carcinoma on fine‐needle aspiration of thyroid with ThinPrep® preparations

Abstract

Although the cytologic features of papillary carcinoma of the thyroid are well-known, none is entirely specific. We conducted this study to determine the minimal criteria necessary to achieve 100% specificity for the diagnosis of papillary carcinoma on fine-needle aspiration (FNA). Forty patients with histologically confirmed papillary carcinoma and 17 patients with other thyroid lesions who underwent preoperative FNA at Beth Israel Deaconess Medical Center during a 4-yr period were included in the study. All cytology slides were prepared with the ThinPrep processing technique. Various architectural and nuclear features were evaluated, with a score assigned to each feature, and correlated with the histologic diagnosis of papillary carcinoma. Intranuclear inclusions, papillary and/or sheet arrangements, nuclear grooves, powdery chromatin, nuclear molding, high cellularity, and small nucleoli were significantly associated with papillary carcinoma (P < 0.05). The requirement of any intranuclear inclusions and many nuclear grooves, or a minimum of sum of scores (of the above eight features) of 10, yields 100% specificity and approximately 70% sensitivity. Cases with fewer features can be reported as suspicious or indeterminate for papillary carcinoma. A quantitative/probabilistic approach in the reporting of thyroid FNA provides a practical guide for management of patients with thyroid nodules.

Diagnostic Efficacy of Conventional as Compared to Liquid-Based Cytology in Thyroid Lesions

“…This observation means that, apart from slight morphologic differences between CS and LBC, the typical features of malignancy can be clearly evaluated with both methods. This is an important advantage of LBC, which, after a variable learning period, is quite accurate in diagnosing malignancies, as also reported by Malle and coworkers, 18 Zhang et al 19 and our group. 21 The most complex discussion refers to the group of follicular neoplasms/lesions (Thy 3 of the British Thyroid Association classification), which trend is reflected by the values of INDR.…”

‘Suspicious for Papillary Thyroid Carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: Impact of Standardized Terminology

“…Thirteen studies in the pre-TBSRTC [13,14,15,16,17,18,19,20,21,22,23,24,25] and 8 studies in the post-TBSRTC [11,26,27,28,29,30,32,33] provided the specific histopathological diagnoses for their cases with malignant follow-up, and these are detailed in table 3. From this data, the rate of the follicular variant of papillary thyroid carcinoma (FV-PTC) as a fraction of all malignancy was equivalent, i.e.…”

Liquid-Based Cytology in Fine-Needle Aspiration Biopsies of the Thyroid Gland

“…To also contribute to this purpose, recent advances in the molecular genetics of thyroid cancer are being applied for the development of new diagnostic markers for FNA samples in an attempt to differentiate benign thyroid nodules from malignant ones [62,63,64]. PC, the most common thyroid malignancy, may carry BRAF, RET/PTC, or RAS mutations [65,66,67].…”