Value of combined cytomorphological parameters in improving diagnostic accuracy of papillary thyroid carcinoma on cytology - The five dependable features

Abstract

Background: Fine-needle aspiration cytology remains the preliminary test for diagnosing papillary thyroid carcinoma (PTC). Numerous features are established to arrive at the diagnosis. However, few cases pose a challenge to correctly diagnose PTC. Our study aims to elicit the combination of features to aid in the diagnosis of such cases. Materials and Methods: Cytology smears of histologically proven cases of PTC and benign diagnoses were included as case (n = 36) and control group (n = 38), respectively. Features including papillae with cores, 3-D caps, nuclear grooves (NG), intranuclear cytoplasmic inclusions (INCI), giant cells, macrophages, cellular swirls, psammoma bodies, pale chromatin, nuclear overlapping, nuclear enlargement, and metaplastic cells were assessed. Statistic tests including Independent t test/Mann–Whitney Test and Chi-Square test/Fisher's Exact test were used. Receiver operating characteristic curve was used to assess the cut-off point of many cytological features to predict PTC. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cytological features was calculated to predict PTC. Results: Presence of five or more cytological features (papillae with cores, cellular swirls, NG, INCI, and psammoma bodies) together could diagnose PTC (PPV) in 78.95% of the cases, with a NPV of 83.33%. Diagnostic accuracy of these five features combined was 81.08%. Papillae with cores and nuclear grooving were the most sensitive cytological features, whereas INCI followed by cellular swirls and NG were the most specific features. Conclusion: Relying on a combination of the most sensitive and specific features rather than any one cytological feature can help reduce the misdiagnoses in PTC.

Utility of solid area diameter in management of cystic papillary thyroid carcinoma

“…As with ultrasonography, we showed that the diagnostic accuracy (84.8%) of cytology for CPTCs was lower than that for WTD-MC (94.3%). However, this was higher than the diagnostic accuracy of conventional PTC (65–79%) reported in previous studies ( 10 , 11 , 12 ). The aspiration cytology of lesions with marked cystic changes can be difficult to diagnose because of low cellularity and degenerative changes ( 1 , 4 , 13 ).…”