Split Sample Comparison of a Liquid-Based Method and Conventional Smears in Thyroid Fine Needle Aspiration

Jung, Chan-Kwon; Lee, Ahwon; Jung, Eun-Young; Choi, Yeong-Jin; Jung, So-Lyung; Lee, Kyo‐Young

doi:10.1159/000325513

Cited by 61 publications

(115 citation statements)

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“…Jung et al combined the cytomorphology with immunocytochemistry for galectin-3 to improve the diagnosis of papillary carcinoma. 4 This illustrates interesting applications of liquid-based cytology. FNAC indicates fine-needle aspiration cytology.…”

Section: Discussionmentioning

confidence: 90%

“…8,13,14 Jung et al compared the efficacy of the SurePath to conventional smears in thyroid FNAC. 4 In their study, SurePath showed increased cellularity and more clustered tissue fragments. Nuclear details and irregularities were more easily detected, making the diagnosis of papillary carcinoma easier.…”

Section: Discussionmentioning

confidence: 92%

“…To our knowledge, only 1 report is available on thyroid FNAC using the Tripath PREP system. 4 In daily practice, surgeons add an intraoperative frozen section examination to the previously performed FNAC to avoid unnecessary total thyroidectomy for benign diseases. The contribution of frozen section analysis in thyroid pathology remains questionable.…”

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confidence: 99%

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Liquid‐based FNAC of the thyroid

Geers

Bourgain²

2010

Cancer Cytopathology

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BACKGROUND:The aims of this study were to analyze cytomorphological features of Tripath PREP (BD SurePath, Burlington, NC) preparations in thyroid nodules and to examine adequacy and accuracy of SurePath and frozen sections for both clinical outcome and histological diagnosis when applicable.METHODS:Gathered during a period of 4 years, 712 SurePath specimens of the thyroid were included. Histological (n = 207) or clinical follow‐up (n = 505) was available in all cases. During the same period, 253 frozen sections of surgical thyroid resection specimens were also assessed. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated.RESULTS:Sensitivity was 77% for SurePath and 29% for frozen section; specificity was 81% for SurePath and 100% for frozen section; accuracy was 80% for SurePath and 90% for frozen section. One hundred seventy‐eight (25%) SurePath patients were considered unsatisfactory for diagnosis. In this study, sensitivity, specificity, and accuracy were comparable for SurePath and other reported results of liquid‐based thyroid cytology. Presence of free colloid or pure cystic changes favored a benign diagnosis. Cellular smears with nuclear atypia of papillary carcinoma allowed an overt diagnosis of malignancy.CONCLUSIONS:The authors concluded that SurePath is a reliable technique for assessment of thyroid nodules and offers the advantage of easy identification of colloid and atypical nuclei. Supplementary frozen section analysis should be limited to an FNAC diagnosis of suspicious for papillary carcinoma. Cancer (Cancer Cytopathol) 2011. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 92%

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Liquid‐based FNAC of the thyroid

Geers

Bourgain²

2010

Cancer Cytopathology

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“…There were several studies that showed better diagnostic performance in LBC than in CS in evaluating thyroid nodule (18,32). However, there were rarely studies showing the usefulness of LBC in FNAC of the LN.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound-guided FNAC was performed by one of several radiologists with the use of a 23-gauge needle. While a liquid-based cytology (LBC) was used in the diagnosis of primary thyroid tumor (18), FNAC for suspicious LN was evaluated by the conventional method: the aspirates were immediately smeared on slides, fixed in 95% ethanol and processed by both hematoxylin and eosin (H&E) and Papanicolaou stain. The same needle and syringe were rinsed with 2 ml of normal saline, and the washout fluid was submitted for FNA-Tg measurement.…”

Section: Patientsmentioning

confidence: 99%

Lowered cutoff of lymph node fine-needle aspiration thyroglobulin in thyroid cancer patients with serum anti-thyroglobulin antibody

Kim

Lim

et al. 2015

European Journal of Endocrinology

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Objective: Fine needle aspiration cytology (FNAC) and measurement of thyroglobulin (Tg) in needle washout (FNA-Tg) are recommended for the diagnosis of metastatic or recurrent lymph nodes (LNs) in differentiated thyroid cancer (DTC). However, the effect of serum Tg antibody (TgAb) on FNA-Tg levels still remains unclear in the preoperative setting. We analyze the interference of serum TgAb on FNA-Tg levels as proof of concept in the diagnostic advantage of serum TgAb combined with FNA-Tg. Subjects and methods: A total of 370 suspicious cervical LNs from 273 patients with DTC were included. The primary tumor was confirmed as DTC on preoperative pathology in all patients. We performed FNA-Tg measurement and FNAC on suspicious LNs and evaluated the diagnostic performance of FNAC and FNA-Tg according to TgAb status. Final diagnoses were confirmed by histological examination of excised specimens or by follow-up ultrasonography for at least 6 months. Results: Data from 273 subjects with suspicious 370 LNs were evaluated. Fifty-five LNs (14.9%) were from TgAbC positive serum TgAb (TgAbC) patients. Serum Tg and FNA-Tg levels were significantly lower in patients with TgAbC than in those with TgAb-negative (TgAbK). Final pathology confirmed 109 LNs (29.5%) asmalignant. Diagnostic performance of FNA-Tg at the same cutoff level was lower in the TgAbC than TgAbK group. FNA-Tg cutoff levels determined by ROC curve were lower in the TgAbC group. Conclusion: The results suggested that the cutoff value of FNA-Tg should be lowered in suspicious LN before thyroidectomy in thyroid cancer patients with TgAb.

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Use of conventional smears versus liquid‐based preparations for fine‐needle aspirate specimens: The time has not come to abandon your conventional smears!

Faquin

2014

Cancer Cytopathology

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There is a longstanding controversy about the use of conventional smears (CSs) versus liquid-based preparations (LBPs) for thyroid fine-needle aspiration (FNA) specimens, 1-7 and recently, there has been the suggestion that LBPs alone might be a good strategy for all FNAs. This is an unfortunate, and in my opinion, very misguided proposal on multiple levels. Although LBPs have certain redeeming qualities such as reducing the number of slides that the cytologist and cytotechnologist need to evaluate, when used alone for FNA evaluation, they can also reduce the overall amount of cytomorphologic information readily available to the cytopathologist to make a well-informed diagnosis. Use of an LB-only approach, in many instances, is analogous to reading Cliffs Notes instead of the full novel: certainly, it is less material to review but useful information may be missing! A lack of quality FNA sample procurement secondary to poor FNA technique, and a lack of good smear preparation skills, should not be the rationale for adoption of an LB-only approach and abandonment of CSs, but unfortunately, in many cases, it is.The earliest LBPs were developed in the form of the ThinPrep, which was first approved by the US Food and Drug Administration for the evaluation of FNA specimens in 1991. 1 Proponents of LBPs list as their advantages the ease of preparation without learning smearing techniques and the reduction in background blood and debris. I will mention that the Cytopathology Division where I practice uses CSs sometimes in combination with a single LBP from the rinsings for many of our FNA specimens, but we avoid using LBPs alone for FNAs. I consider myself fortunate to have this advantage at my institution. Having ample experience with both CSs and with LBPs, I view the LB-only strategy to FNA as a significant diagnostic disadvantage. Even laboratories that use only LBPs for thyroid FNAs, typically do not carry this approach over to other FNA specimens.Conventional smears, either alcohol-fixed and Papanicolaou-stained or air-dried and Romanowsky stained, have been the mainstay of FNA evaluation for many decades, 1,8 and it is for good reason that they have withstood the test of time. In FNAs from various anatomic sites including the thyroid gland, salivary glands, breast, lung, and soft tissues, advantages of CSs include the maintenance of the relative cellularity of the specimen and maintenance of the quantitities of background material such as colloid, mucin, matrix, stromal elements, or necrotic debris. CSs also preserve the cytoarchitectural integrity of the tissue as reflected in the arrangement of cells in medium-to large-size groups. These are all features which are irrefutably key to the

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Split Sample Comparison of a Liquid-Based Method and Conventional Smears in Thyroid Fine Needle Aspiration

Cited by 61 publications

References 13 publications

Liquid‐based FNAC of the thyroid

Liquid‐based FNAC of the thyroid

Lowered cutoff of lymph node fine-needle aspiration thyroglobulin in thyroid cancer patients with serum anti-thyroglobulin antibody

Use of conventional smears versus liquid‐based preparations for fine‐needle aspirate specimens: The time has not come to abandon your conventional smears!

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