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Items 1-15 of 15 |
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One page. |
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Clear nuclei of papillary thyroid carcinoma conspicuous in fine-needle aspiration and intraoperative smears processed by ultrafast papanicolaou stain.
Yang GC, Greenebaum E.
Department of Pathology, New York University Medical Center, NY 10016, USA.
The Orphan Annie-eyed clear nucleus, defined as a large, optically clear nucleus, devoid of chromatin strands, with sharp chromatin rim, is a more specific feature than are nuclear grooves or intranuclear cytoplasmic inclusions in papillary thyroid carcinoma. In addition, this characteristic nuclear feature is detectable at low magnification. Although these clear nuclei are routinely seen in paraffin sections, they are inconspicuously seen in conventionally processed touch-imprints and fine-needle aspiration (FNA) smears. Among our two institutions, there have been 148 thyroid cases processed by Ultrafast Papanicolaou stain (UFP), including 43 papillary carcinomas, 38 cellular follicular lesions, and 67 cases of nodular hyperplasia. We observed clear nuclei in all of the cases of UFP-processed FNA and intraoperative smears of papillary carcinoma but not of other thyroid lesions. The clear nuclei are most evident in tumor cells with direct contact to the glass slide and are not seen in tumor cells soaked in cystic fluid. UFP is a valuable way to detect Orphan Annie-eyed clear nuclei of papillary thyroid carcinoma early in the diagnostic evaluation, either at immediate on-site evaluation of FNA or at intraoperative consultation and before the availability of permanent sections.
PMID: 9195571 [PubMed - indexed for MEDLINE]
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Accuracy of fine-needle aspiration of thyroid.
Amrikachi M, Ramzy I, Rubenfeld S, Wheeler TM.
Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
CONTEXT: Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules. OBJECTIVES: To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls. Design, Setting, and Participants.-Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982-1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes. RESULTS: The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively. CONCLUSIONS: Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.
PMID: 11260620 [PubMed - indexed for MEDLINE]
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To operate or not to operate? The value of fine needle aspiration cytology in the assessment of thyroid swellings.
Leonard N, Melcher DH.
Department of Cytopathology, Brighton General Hospital, UK.
AIMS: To evaluate all thyroid fine needle aspirations (FNA) done over a six year period to assess the accuracy and value of the technique. METHODS: There were 335 FNAs of which 184 had subsequent histology and 49 others had clinical follow up, providing 233 patients for analysis. All cytology and histology was reviewed with no significant alterations in diagnosis. The FNAs were classified into three groups: benign, suspicious (recommend excision), and malignant. The histology and medical records were reviewed to determine whether the cytology was accurate. RESULTS: There were 130 benign FNAs, 126 had non-malignant histology or normal clinical follow up, and four had malignancies on histology (two lymphomas, one follicular carcinoma, and one carcinoma not otherwise specified). There were 45 suspicious FNAs. Of these five had either follicular or papillary carcinoma, 14 had follicular adenomas, and 26 had colloid nodular goitres or normal clinical follow up. Of the 21 malignant FNAs, 11 had carcinoma and 10 had either a non-malignant histology or normal follow up. There were 126 true negatives, 30 true positives, 4 false negatives, and 36 false positives. This gives a sensitivity of 88%, a specificity of 78%, a positive predictive value of 46%, a negative predictive value of 97%, and an accuracy of 80%. CONCLUSIONS: FNA cytology of the thyroid has a high negative predictive value, which is useful to reassure the majority of patients presenting with thyroid enlargement. However, a negative FNA should never exclude malignancy if there is a strong clinical suspicion. If this rule is adhered to a large number of patients will be spared unnecessary surgery and no malignant nodule will go untreated.
PMID: 9462245 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration of thyroid: an institutional experience.
Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK.
Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, USA.
In this report we describe our institutional experience with fine-needle aspiration (FNA) of the thyroid. Six hundred sixty-two FNAs were performed in 616 patients in a 3 1/2 year period. The cytological diagnoses were categorized as: negative for malignancy, 455 (69%); indeterminate, 30 (4%); neoplasm/malignant, 105 (16%), and nondiagnostic, 72 (11%) including 29 cases from outside institutions. Surgical follow-up was available in 140 (21%) cases, 95 of which had preceding cytological diagnoses of positive or indeterminate for neoplasm/malignancy. For those cases with definite benign or neoplastic/malignant cytodiagnosis, a sensitivity of 92% and specificity of 84% was achieved. The cumulative false-positive and false-negative rates for these categories were 16% and 7.5%, respectively. On comparing discrepant diagnosis between cytological and histological specimens, two major factors were identified as causes for diagnostic misinterpretations: overlapping cytological features among follicular-derived lesions and inadequate/suboptimal specimens. The cytological features of follicular variant of papillary carcinoma were found to overlap those of hyperplastic/adenomatous nodules and follicular neoplasms due to the presence of abundant thin colloid, monolayer sheets of follicular cells and subtle nuclear features of papillary carcinoma. We suggest that awareness of variable cytological features in follicular lesions (especially in follicular variant of papillary carcinoma), following strict criteria of specimen adequacy in thyroid FNA, and clinicopathological correlation can markedly reduce false-negative results.
PMID: 9709908 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration of thyroid nodules in radiation-exposed patients.
Hatipoglu BA, Gierlowski T, Shore-Freedman E, Recant W, Schneider AB.
Department of Medicine, University of Illinois College of Medicine, Chicago, USA.
External radiation used to treat benign conditions in the head and neck area results in an increased risk of thyroid cancer in exposed individuals. Fine-needle aspiration (FNA) biopsy is the standard procedure used to evaluate suspicious thyroid nodules. Its accuracy has been extensively studied, but little is known about FNA in irradiated patients. We analyzed the FNA experience of 136 irradiated subjects. Fifty-two had surgery enabling a comparison of the histologic diagnosis with the FNA results. In these 52 patients with a total of 53 FNAs, 20 were reported as benign, 14 as follicular neoplasms, 6 as papillary cancer, and 13 as inadequate samples. Seven malignant nodules were aspirated; 4 were reported as papillary cancer, 1 was reported as benign and 2 had inadequate specimens. An additional 11 patients had thyroid cancer in foci that were not subjected to FNA. For the nodules that were aspirated, and considering an FNA report of follicular neoplasm as a false-positive when a follicular adenoma or a colloid nodule was found at surgery, the calculated sensitivity was 80%, specificity 54%, positive predictive value 20%, and negative predictive value 95%. Of the 14 follicular neoplasm FNA diagnoses, 10 were colloid nodules (71%), and 4 only were follicular adenomas. We conclude that the sensitivity of FNA in irradiated patients is similar to what is reported for the general population. However, smaller malignant nodules are common and are not diagnosed by the FNA. Also, the FNA diagnosis of follicular neoplasm is often inaccurate and inadequate aspirations are frequent in this patient group.
PMID: 10691315 [PubMed - indexed for MEDLINE]
Riu's stain and the cytologic diagnosis of thyroid fine-needle aspiration: a single cancer center experience.
Tsou MH, Lin HH, Ko JS.
Department of Pathology and Laboratory Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, ROC.
Riu's stain, a Romanowsky-type stain, has been in use in Taiwan over the past 40 years. In order to determine whether it is useful for the diagnosis of thyroid disease in thyroid fine-needle aspiration, we reviewed 254 of these aspirates obtained between April 1990 and June 1996 from patients seen in Koo Foundation Sun Yat-Sen Cancer Center in Taipei. Surgical follow-up was available for confirmation in 61 aspirations. The cytologic diagnosis was categorized into four groups: benign, 174; suspicious, 30; malignant, 41): and inadequate specimen, 9. There were two false-negative and no false-positive diagnoses. Our results showed a sensitivity of 93.5% and a specificity of 100% for the detection of malignancy. If suspicious cases were considered positive, the specificity decreased to 55%, while the sensitivity increased to 95%. We conclude that Riu's stain is a reliable quick stain in the diagnosis of thyroid malignancy. Compared to Papanicolaou stain, it shortens the time needed for a cytopathologist to reach a diagnosis. Papanicolaou stain can be reserved for confirmation.
PMID: 9181323 [PubMed - indexed for MEDLINE]
Comment in:
- Clin Endocrinol (Oxf). 2000 Jun;52(6):797
Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view.
Cap J, Ryska A, Rehorkova P, Hovorkova E, Kerekes Z, Pohnetalova D.
First Medical Clinic, University Hospital, Charles University, Hradec Kralove, Czech Republic. [email protected]
INTRODUCTION: The rates of sensitivity and specificity of fine needle aspiration biopsy (FNAB) for the diagnosis of thyroid malignancy differ considerably among various reported series. These values are influenced by three factors: (a) whether only clearly positive and negative results are considered, or whether the commonly encountered 10-20% of indeterminate/suspicious ones are included; (b) whether adenomas are considered as neoplasms in one group with carcinomas; and (c) whether only histologically proven cases are used in calculations or whether patients with benign clinical follow-up are included. AIM: The aim of the study was to evaluate the sensitivity and specificity of FNABs performed at this institution in the last 7 years from the clinical point of view, considering only benign vs. suspicious/malignant FNAB results (indicating surgery), and benign (including adenomas) vs. malignant definitive histology. STUDY DESIGN: Retrospective study comparing pre-operative FNAB results with definitive histological examination after operation. PATIENTS: A total of 2492 FNABs were performed in 2100 patients (1875 women and 225 men); their ages ranged from 9 to 85 years, with a median of 46 years. Clinical diagnosis was multinodular goitre in 1330, single nodule in 591, Hashimoto's thyroiditis in 147 and subacute thyroiditis in 32 cases. In 148 instances, the nodule was cystic. A history of previous treatment for carcinoma of the thyroid was present in 12 patients. Five hundred and thirty-six patients subsequently underwent thyroid surgery. STATISTICS: The values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were calculated. RESULTS: The sensitivity was 86%, specificity 74%, PPV 34%, NPV 97% and diagnostic accuracy 75%. CONCLUSIONS: The specificity and positive predictive value are low when fine needle aspiration biopsy results are divided into two categories only (these being indication for surgery or not), and when only suspicious/malignant fine needle aspiration biopsies with subsequent malignant histology are considered to be true positive. Nevertheless, the ability to discriminate 11.7% of patients with a 34% probability of malignancy (suspicious/malignant cytology) from 81.2% of patients (benign cytology) with a probability of only 3% is very helpful.
PMID: 10583320 [PubMed - indexed for MEDLINE]
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Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease.
Rosen IB, Azadian A, Walfish PG, Salem S, Lansdown E, Bedard YC.
Department of Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
During a 23-month period, 59 patients were referred for ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) of the thyroid gland because of inadequate orthodox (office) FNAB, a clinically small lesion, or an occult lesion. Seventy percent of the group (41 patients) was referred for surgery, which revealed cancer in 37% of patients, adenoma in 19%, and benign disease in 44%. US-guided FNAB yielded false-positive reports in 0% of patients, false-negative reports in 5% to 12%, and inadequate aspirates in 32%. The US-guided FNAB technique had a sensitivity of 60% to 90%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 80%, and an accuracy of 85%. US-guided FNAB provides cytologic information in 60% of patients in whom a diagnosis cannot be established by orthodox (office) means, thus enhancing the diagnostic ability of clinicians who can recommend a treatment program with confidence.
PMID: 8214289 [PubMed - indexed for MEDLINE]
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Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer.
Lin JD, Huang BY, Weng HF, Jeng LB, Hsueh C.
Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Hsien, Taiwan, ROC.
This series retrospectively reviewed 3657 patients who received thyroid ultrasonography with fine-needle aspiration cytological (FNAC) examinations at Chang Gung Memorial Hospital during the period from January 1, 1993 to December 31, 1993. Thyroid ultrasonography studies were performed using a real-time ultrasonographic machine with a 10 MHz transducer. The aspirates were air dried and stained by the Romanowsky-based Liu method. Three hundred seventy-eight cases (10.3%) received surgical treatment after the ultrasonographic and FNAC examinations. Benign lesions were diagnosed in 269 patients. Thyroid malignancy was confirmed histopathologically in 109 cases including 76 papillary thyroid carcinomas, 17 follicular carcinomas, 5 medullary thyroid carcinomas, 3 anaplastic carcinomas, 3 Hurthle cell carcinomas, and 3 lymphomas. Another 2 cases were metastatic cancer to thyroid. The results demonstrated that 28.8% of the surgically treated patients had histopathologically proven malignancies. The incidence of thyroid malignancy was 2.98% in this study. The sensitivity of the cytological diagnosis was 79.80% and the specificity was 98.66%. The positive predictive value was 96.34%. Negative predictive value was 91.70%. The false negative index was 20.20%. The diagnostic accuracy was 92.89%. Thyroid ultrasonography with the FNAC can provide high specificity and sensitivity in differentiating malignant lesions from benign.
PMID: 9058259 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance.
Bakhos R, Selvaggi SM, DeJong S, Gordon DL, Pitale SU, Herrmann M, Wojcik EM.
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA.
Fine-needle aspiration (FNA) of the thyroid gland is a widely utilized, sensitive, specific, and cost-effective method for the evaluation of thyroid nodules. The purpose of this study was to evaluate the accuracy of thyroid FNA and causes of cytohistological discordance in our institution. Six hundred twenty-five thyroid FNAs obtained from 503 females (mean age, 54) and 122 males (mean age, 51) in whom histopathologic follow-up material was available for review, were analyzed. FNAs were classified as: nondiagnostic, negative, intermediate, and positive for malignancy, and the histopathologic material was categorized as benign or malignant. The review revealed 93% sensitivity and 96% specificity for the FNA diagnoses. The FNA results were diagnostic in 87%, indeterminate in 6%, and nondiagnostic in 7% of the cases. Cytohistologic correlation was achieved in 88% of the cases. The false-negative rate was 4% and the false-positive rate was 8%. The most common pitfalls for false-negative diagnoses consisted of suboptimal material and underdiagnosis of papillary carcinoma due to cystic degeneration. The most common pitfall for false-positive cases was overdiagnosis of follicular neoplasms. Our study confirmed that FNA of thyroid nodules can be performed with high sensitivity and specificity by experienced clinicians or pathologists. The application of strict specimen adequacy rules for FNA interpretation is likely to decrease the rate of false-negative and false-positive diagnoses. Copyright 2000 Wiley-Liss, Inc.
PMID: 11002362 [PubMed - indexed for MEDLINE]
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Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses.
Grant CS, Hay ID, Gough IR, McCarthy PM, Goellner JR.
Department of Surgery, Mayo Clinic and Medical Center, Rochester, Minn 55905.
Reliance on fine-needle aspiration (FNA) of the thyroid as the key determinant whether to observe only or proceed surgically is predicated on achieving a minimal false-negative error rate (the incidence of malignant disease in nodules diagnosed benign by means of FNA). To provide convincing data that malignant disease has not been overlooked requires extended follow-up on a large number of patients with cytologically benign lesions. The intent of our study was to assess the long-term accuracy of thyroid FNA-based diagnoses--particularly with respect to false-negative errors. From our total experience of more than 8000 patients, we reviewed the cases of 680 patients who underwent FNA in 1980, the first year we used it clinically. Follow-up information was obtained on 641 (94%) of the patients with a mean time since FNA of 6.1 years. Benign cytologic findings were reported on 439 (68%) of these patients, and only three (0.7%) had false-negative diagnoses. The false-positive rate was 0% for the 24 (4%) patients with positive aspirates. FNA is a safe, reliable, effective means of accurately discriminating benign from malignant thyroid lesions.
PMID: 2588125 [PubMed - indexed for MEDLINE]
Fine-needle aspiration biopsy diagnosis of follicular variant of papillary thyroid cancer: therapeutic implications.
Shemen LJ, Chess Q.
Cornell University Medical Center, New York, New York, USA.
OBJECTIVE: Frozen-section analysis of follicular lesions is often inconclusive because capsular or vascular invasions are the hallmarks of malignancy with this technique and may not be seen in the particular field studied. Using preoperative fine-needle aspiration biopsy specimens, we attempted to identify malignant follicular lesions and compare these results against frozen-section analysis. METHODS: A retrospective study of 1000 consecutive thyroid fine-needle aspiration biopsy specimens was performed. Surgical pathologic correlation was available in 179 cases. RESULTS: Fine-needle aspiration biopsy yielded a suspicious or positive rate of 23%. Surgical pathology was available in 179 patients, of which 95% had thyroid cancer. The follicular variant of papillary cancer was identified in 26 cases, or 15% of the positive cases. Frozen-section analysis yielded false-negative results in 7 of these 26 cases (27%). CONCLUSIONS: Preoperative recognition of the follicular variant of papillary cancer by fine-needle aspiration biopsy may reduce the overall incidence of false-negative frozen-section findings.
PMID: 9852532 [PubMed - indexed for MEDLINE]
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Fine needle aspiration cytology of thyroid gland diseases.
Altavilla G, Pascale M, Nenci I.
Institute of Pathology, University of Ferrara, Italy.
From 1982 to 1987, 2,433 lesions of the thyroid gland in 1,796 patients were examined by fine needle aspiration (FNA). Cytopathology classified 66.91% of the aspirates as benign, 10.76% as thyroiditis, 4.89% as suspected (unspecified) neoplasia, 1.31% as positive for malignancy and 16.11% (392) as unsatisfactory. The histologic diagnoses in 257 cases were compared with cytologic diagnoses to determine the accuracy of FNA cytology of thyroid lesions, yielding a sensitivity of 71.43%, a specificity of 100% and an accuracy of 95.09%. This data strongly supports thyroid FNA as an important preoperative diagnostic tool. Follicular carcinomas were difficult to cytologically differentiate from nonmalignant follicular neoplasms, and papillary thyroid carcinomas less than 2 cm in diameter in elderly patients were frequently misdiagnosed or diagnosed only as "suspect lesion."
PMID: 2321461 [PubMed - indexed for MEDLINE]
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Thyroid nodules. Role of fine needle aspiration and intraoperative frozen section examination.
Aguilar-Diosdado M, Contreras A, Gavilan I, Escobar-Jimenez L, Giron JA, Escribano JC, Beltran M, Garcia-Curiel A, Vazquez JM.
Department of Medicine, Puerta del Mar, University Hospital, Cadiz, Spain.
OBJECTIVE: To determine the accuracy of fine needle aspiration (FNA) and intraoperative frozen section examination (IFSE) on thyroid nodules. STUDY DESIGN: The study group consisted of 470 patients who underwent thyroidectomy. FNA was performed on 289 patients and IFSE on 326. The FNA and IFSE results were compared with the final histologic diagnosis obtained after examination of permanent sections. RESULTS: The overall FNA sensitivity was 65%, specificity 88% and positive predictive value 61%. The IFSE sensitivity was 50%, and the specificity and positive predictive value were 100%. When both procedures were used together, FNA identified 16 of 45 (36%) carcinomas as malignant and an additional 13 (29%) as follicular proliferative lesions; IFSE correctly identified only 23 of 45 (51%) carcinomas. CONCLUSION: FNA provides enough information for determining the extent of thyroid surgery when a diagnosis of cancer is made. However, IFSE should be considered a supplementary procedure when FNA is not positive for cancer.
PMID: 9167682 [PubMed - indexed for MEDLINE]
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Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.
Chang HY, Lin JD, Chen JF, Huang BY, Hsueh C, Jeng LB, Tsai JS.
Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan Hsien, Taiwan, Republic of China.
AIMS: To evaluate the correlation of fine needle aspiration (FNA) cytology and frozen section biopsy in the diagnosis of thyroid nodules. METHODS: The medical records of 662 patients who underwent FNA cytology of the thyroid and thyroid surgery were analysed. Frozen section biopsies were taken from 586 of the 662 patients. The diagnostic correlations of FNA cytology, frozen section, and both FNA cytology and frozen section with definitive histological assessment were evaluated. RESULTS: Among the 662 patients who received FNA cytology, there were 356 cases (53.8%) diagnosed as benign, 114 cases (17.2%) as malignant, 148 cases (22.4%) as indeterminate, and 44 cases (6.6%) as unsatisfactory. The positive predictive value for the detection of malignancy by FNA cytology was 92.1% and the negative predictive value was 95.2%. The incidence of malignancy in the indeterminate cytological diagnosis was 23%. The diagnosis from frozen sections was benign in 445 cases (75.9%), malignant in 134 cases (22.9%), and deferred in 7 cases (1.2%). By frozen section, the positive and negative predictive values were 97% and 95.5%, respectively. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses were in agreement. No false positives were observed when FNA cytology and frozen sections were both positive for malignancy. When FNA cytology and frozen section diagnoses were discordant, frozen section showed a higher accuracy (78.9%) than FNA cytology (21.1%). In the face of an indeterminate or unsatisfactory cytological diagnosis, the diagnostic accuracy of frozen sections reached 92.6%. CONCLUSIONS: The results confirm that FNA cytology is a useful tool in the initial evaluation of thyroid nodules. Intraoperative frozen section is a valuable procedure to confirm the cytological diagnosis and identify malignancy in patients with indeterminate or unsatisfactory cytological diagnosis. With reliance on frozen sections as an intraoperative guide of thyroid surgery, the possibility of unnecessary extensive surgery and the need for the second operation are considerably lower.
PMID: 9516882 [PubMed - indexed for MEDLINE]
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