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Fine Needle Aspiration Biopsies of the Head and Neck: The Surgical Pathologist's Perspective.
Cerilli LA, Wick MR.
Robert E. Fechner Laboratory of Surgical Pathology, University of Virginia Medical Center, Charlottesville, Virginia.
Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgical pathologist and surgeon. Fine needle aspiration cytology is an increasingly popular technique in the initial evaluation of such lesions. The high diagnostic accuracy of this technique makes it generally preferable to traditional surgical biopsy. It is particularly useful in the sampling of histologically uniform neoplasms of the salivary glands, identification of classical papillary carcinoma and medullary carcinoma of the thyroid, separation of colloid goiter from follicular neoplasms, and confirmation of clinically suspicious lymph node metastases in cases with already documented malignant diseases. Despite its usefulness, aspiration cytology of head and neck lesions has certain inherent pitfalls, and these are briefly examined in this review. Int J Surg Pathol 8(1):17-28, 2000
PMID: 11493961 [PubMed - as supplied by publisher]
Ultrasound-guided fine-needle aspiration of the thyroid assessed by Ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to six-year follow-up.
Yang GC, Liebeskind D, Messina AV.
Department of Pathology, New York University School of Medicine, New York, USA. [email protected]
One of the limitations of fine-needle aspiration (FNA) of the thyroid is difficulty in distinguishing the follicular variant (FV) of papillary thyroid carcinomas (PTC) from follicular neoplasms. By highlighting the "Orphan Annie-eyed" clear nuclei of the former, the Ultrafast Papanicolaou stain (UFP) easily separates these two entities. One thousand one hundred thirty-five ultrasound-guided FNAs of the thyroid were assessed by UFP with immediate biopsy results reported to the patients in a busy radiology office in Manhattan from November 1994 to December 1998. Of the 77 thyroid cancers resected, 22 were FVPTC and 17 were microcarcinomas (1 medullary carcinoma, 16 PTC). The rates of "unsatisfactory," "cancer," "suspicious for cancer," "follicular neoplasm," and "benign" cytology were 0.7%, 4.4%, 2.6%, 10.2%, and 82.1%, respectively and the cancer yields at surgery were 98%, 81.8%, 15.8%, and 0% respectively. Of the 1127 satisfactory FNAs in the series with a 2- to -6 years of clinical follow-up, a false-negative rate of 0% and a false-positive rate of 1.5% were obtained. Of the 169 surgical follow-ups with satisfactory FNAs, a sensitivity of 100%, specificity of 66.7%, positive predictive value of 87.4%, negative predictive value of 100%, and global accuracy of 89.9% were achieved. The paradoxical combination of low unsatisfactory rate and low false-negative rate is attributed to (1) the use of needle puncture without syringe to obtain enough microfollicles from the exceedingly bloody aspirates from follicular neoplasms for a diagnosis, (2) eliciting history of neck trauma to confirm hematomas, (3) using UFP to highlight the grape-like watery clear nuclei of FVPTC evident with a 4x objective, and (4) the precise guidance by ultrasound in sampling microcarcinomas.
PMID: 11442006 [PubMed - in process]
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Ultrasound-guided fine-needle aspiration biopsy of the thyroid bed.
Krishnamurthy S, Bedi DG, Caraway NP.
Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. [email protected]
BACKGROUND: Ultrasound (US) has been shown to be a sensitive technique for monitoring patients for recurrent thyroid carcinoma in the thyroid bed after total thyroidectomy. However, the role of US-guided fine-needle aspiration biopsy (FNAB) in the confirmation of sonographically indeterminate or suspicious masses has not been adequately addressed. The purposes of this study were to determine the sensitivity and specificity of US-guided FNAB of the thyroid bed for diagnosing recurrent carcinoma after total thyroidectomy and to highlight potential diagnostic pitfalls. METHODS: Twenty-one patients with a history of total thyroidectomy and histologically confirmed thyroid carcinoma who had undergone US-guided FNAB of hypoechoic lesions in the thyroid bed were included in this retrospective study. Fifteen of the 21 had papillary carcinoma (PC), 5 had medullary carcinoma (MC), and 1 had Hurthle cell carcinoma (HTC). The cytologic features of the aspirates were compared with histopathologic findings of pre- and post-FNA surgery. Immunohistochemical staining for thyroglobulin, calcitonin, and parathyroid hormone was performed in four cases. RESULTS: The cytologic diagnosis from the US-guided FNABs was conclusive in 20 of 21 cases. Fifteen cases were diagnosed as recurrent tumor (12 PC, 2 MC, and 1 HTC), and 13 of the 15 were confirmed subsequently by histology. Five cases were diagnosed as benign (two residual benign thyroid tissue, one parathyroid gland [PG] tissue, and two reparative changes) and hence were not resected. There was one false-positive diagnosis in which PG was misdiagnosed as PC. Immunohistochemical studies helped to confirm the diagnosis of PG tissue in two cases and of MC in two cases. The sensitivity of US-guided FNA for diagnosing recurrent carcinoma in the thyroid bed after total thyroidectomy was 100% and the specificity was 85.7%. CONCLUSIONS: US-guided FNAB was found to be a sensitive and specific test for diagnosing sonographically indeterminate lesions in the thyroid bed. One potential diagnostic pitfall was the misdiagnosis of normal residual thyroid or PG tissue as recurrent tumor. Careful attention to cytologic details and the use of selected immunohistochemical staining may help to prevent these misdiagnoses. Copyright 2001 American Cancer Society.
PMID: 11391607 [PubMed - indexed for MEDLINE]
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