Skip to main content
SpringerLink
Log in

Cytopathological review of patients that underwent thyroidectomies based on the diagnosis of papillary thyroid carcinoma by fine needle aspiration cytology but were later found to have benign tumors by histopathology

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to evaluate the specificity of diagnosing PTC by fine needle aspiration (FNA) cytology.

Methods

This study retrospectively reviewed the cytopathological reports of 1066 patients that underwent thyroidectomy based on a diagnosis of PTC by FNA between January 1993 and December 2008. This study re-evaluated the cytology and histopathology of the patients that received false positive diagnoses of PTC by FNA.

Results

Ten patients (0.9 %) received false positive diagnoses of PTC by FNA. Three patients were overdiagnosed as having PTC by FNA cytology. In contrast, the nuclear features of PTC in the other seven cases were confirmed by the retrospective reviews of the patients’ FNA cytology. Three of the seven patients showed follicular structures in their resection specimens, thus resulting in a diagnosis of either adenomatous goiter or follicular adenoma. However, PTC could not be diagnosed by histopathology in the remaining four patients, even though the histopathology showed the nuclear features of PTC.

Conclusions

Most cases of PTC can be easily diagnosed by cytological and morphological atypia with certain limitations. The difficulty in diagnosing PTC by cytology is because the pathological features of PTC also occur in some benign thyroid tumors. Therefore, immunohistochemical or molecular biological approaches must be combined with current cytological diagnostic techniques for the diagnosis of PTC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22:901–11.

    Article  PubMed  Google Scholar 

  2. Gharib H, Papini E, Paschke R. Thyroid nodules: a review of current guidelines, practices, and prospects. Eur J Endocrinol. 2008;159:493–505.

    Article  PubMed  CAS  Google Scholar 

  3. Carcangiu ML, Zampi G, Pupi A, Castagnoli A, Rosai J. Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer. 1985;15:805–28.

    Article  Google Scholar 

  4. Deveci MS, Deveci G, LiVolsi VA, Baloch ZW. Fine-needle aspiration of follicular lesions of the thyroid. Diagnosis and follow-up. Cytojournal. 2009;7:3–9.

    Google Scholar 

  5. Shah SS, Faquin WC, Izquierdo R, Khurana KK. FNA of misclassified primary malignant neoplasms of the thyroid: impact on clinical management. Cytojournal. 2009;19:6–12.

    Google Scholar 

  6. Ghossein R. Problems and controversies in the histopathology of thyroid carcinomas of follicular cell origin. Arch Pathol Lab Med. 2009;133:683–91.

    PubMed  Google Scholar 

  7. Suster S. Thyroid tumors with a follicular growth pattern: problems in differential diagnosis. Arch Pathol Lab Med. 2006;130:984–8.

    PubMed  Google Scholar 

  8. Khayyata S, Barroeta JE, LiVolsi VA, Baloch ZW. Papillary hyperplastic nodule: pitfall in the cytopathologic diagnosis of papillary thyroid carcinoma. Endocr Pract. 2008;14:863–8.

    Article  PubMed  Google Scholar 

  9. Batistatou A, Scopa CD. Pathogenesis and diagnostic significance of nuclear grooves in thyroid and other sites. Int J Surg Pathol. 2009;17:107–10.

    Article  PubMed  Google Scholar 

  10. Rosai J. Papillary thyroid carcinoma: a root-and-branch rethink. Am J Clin Pathol. 2008;130:683–86.

    Google Scholar 

  11. Perez-Montiel MD, Suster S. The spectrum of histologic changes in thyroid hyperplasia: a clinicopathologic study of 300 cases. Hum Pathol. 2008;39:1080–7.

    Article  PubMed  CAS  Google Scholar 

  12. Arora N, Scognamiglio T, Zhu B, Fahey TJ 3rd. Do benign thyroid nodules have malignant potential? An evidence-based review. World J Surg. 2008;32:1237–46.

    Article  PubMed  Google Scholar 

  13. Fonseca E, Soares P, Cardoso-Oliveira M, Sobrinho-Simões M. Diagnostic criteria in well-differentiated thyroid carcinomas. Endocr Pathol. 2006;17:109–17.

    Article  PubMed  CAS  Google Scholar 

  14. Rosai J. Handling of thyroid follicular patterned lesions. Endocr Pathol. 2005;16:279–83.

    Article  PubMed  Google Scholar 

  15. Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration. Acta Cytol. 1980;24:511–21.

    PubMed  CAS  Google Scholar 

  16. Renshaw AA. “ Histiocytoid” cells in fine-needle aspirations of papillary carcinoma of the thyroid: frequency and significance of an under-recognized cytologic pattern. Cancer. 2002;96:240–3.

    Article  PubMed  Google Scholar 

  17. Szporn AH, Yuan S, Wu M, Burstein DE. Cellular swirls in fine needle aspirates of papillary thyroid carcinoma: a new diagnostic criterion. Mod Pathol. 2006;19:1470–3.

    PubMed  CAS  Google Scholar 

  18. Renshow AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J Clin Pathol. 2007;128:370–4.

    Article  Google Scholar 

  19. Fonseca E, Soares P, Cardoso-Oliveira M, Sobrinho-Simões M. Diagnostic criteria in well-differentiated thyroid carcinomas. Endocr Pathol. 2006;17:109–17.

    Article  PubMed  CAS  Google Scholar 

  20. Harach HR, Soto MS, Zusman SB, Saravia Day E. Parenchymatous thyroid nodules: a histocytological study of 31 cases from a goitrous area. J Clin Pathol. 1992;45:25–9.

    Article  PubMed  CAS  Google Scholar 

  21. Fiorella RM, Isley W, Miller LK, Kragel PJ. Multinodular goiter of the thyroid mimicking malignancy: diagnostic pitfalls in fine-needle aspiration biopsy. Diagn Cytopathol. 1993;9:351–5.

    Article  PubMed  CAS  Google Scholar 

  22. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Am J Clin Pathol. (2006); 125 (Suppl.):S135–44.

    Google Scholar 

  23. Faser CR, Marley EF, Oertel YC. Papillary tissue fragments as a diagnostic pitfall in fine-needle aspirations of thyroid nodules. Diagn Cytopathol. 1997;16:454–9.

    Article  PubMed  CAS  Google Scholar 

  24. Rosai J, Kuhn E, Cargangiu ML. Pitfalls in thyroid tumor pathology. Histopathology. 2006;49:107–20.

    Article  PubMed  CAS  Google Scholar 

  25. Williams ED. Guest editorial: two proposals regarding the terminology of thyroid tumors. Int J Surg Pathol. 2008;8:181–3.

    Article  Google Scholar 

  26. Arora N, Scognamiglio T, Lubitz CC, Moo TA, Kato MA, Zhu B, Zarnegar R, Chen YT, Fahey TJ 3rd. Identification of borderline thyroid tumors by gene expression array analysis. Cancer. 2009;115:5421–31.

    Article  PubMed  CAS  Google Scholar 

  27. Hofman V, Lassalle S, Bonnetaud C, Butori C, Loubatier C, Ilie M, Bordone O, Brest P, Guevara N, Santini J, Franc B, Hofman P. Thyroid tumors of uncertain malignant potential: frequency and diagnostic reproducibility. Virchows Arch. 2009;455:21–33.

    Article  PubMed  CAS  Google Scholar 

  28. Zhu X, Sun T, Lu H, Zhou X, Lu Y, Cai X, Zhu X. Diagnostic significance of CK19, RET, galectin-3 and HBME-1 expression for papillary thyroid carcinoma. J Clin Pathol. 2010;63:786–9.

    Article  PubMed  Google Scholar 

  29. Liu Z, Zhou G, Nakamura M, Koike E, Li Y, Ozaki T, Mori I, Taniguchi E, Kakudo K. Encapsulated follicular thyroid tumor with equivocal nuclear changes, so-called well-differentiated tumor of uncertain malignant potential: a morphological, immunohistochemical, and molecular appraisal. Cancer Sci. 2010;102:288–94.

    Article  PubMed  Google Scholar 

  30. Takano T. Fetal cell carcinogenesis of the thyroid: a hypothesis for better understanding of gene expression profile and genomic alteration in thyroid carcinoma. Endocr J. 2004;51:509–15.

    Article  PubMed  CAS  Google Scholar 

  31. Papotti M, Rodriguez J, De Pompa R, Bartolazzi A, Rosai J. Galectin-3 and HBME-1 expression in well-differentiated thyroid tumors with follicular architecture of uncertain malignant potential. Mod Pathol. 2005;18:541–6.

    Article  PubMed  CAS  Google Scholar 

  32. Bukhari U, Sadiq S, Kehar SI. Differential expression of CK 19 in follicular adenoma, well-differentiated tumor of uncertain malignant potential (WDT-UMP) and follicular variant of papillary carcinoma. J Pak Med Assoc. 2009;59:15–8.

    PubMed  Google Scholar 

  33. Finley DJ, Arora N, Zhu B, Gallagher L, Fahey TJ 3rd. Molecular profiling distinguishes papillary carcinoma from benign thyroid nodules. J Clin Endocrinol Metab. 2004;89:3214–23.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

Dr. M. Kitano and the other co-authors have no conflict of interest. Dr. Kitano and the other co-authors also have no financial relationship with any organization.

Author information

Authors and Affiliations

  1. Division of Head and Neck Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Mutsukazu Kitano, Iwao Sugitani, Kazuhisa Toda, Muneki Hotomi, Yoshihide Fujimoto & Kazuyoshi Kawabata

  2. Department of Cytology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Motoko Ikenaga & Noriko Yamamoto

  3. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Noriko Motoi & Noriko Yamamoto

Authors
  1. Mutsukazu Kitano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iwao Sugitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuhisa Toda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Motoko Ikenaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Noriko Motoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Noriko Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muneki Hotomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshihide Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuyoshi Kawabata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iwao Sugitani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kitano, M., Sugitani, I., Toda, K. et al. Cytopathological review of patients that underwent thyroidectomies based on the diagnosis of papillary thyroid carcinoma by fine needle aspiration cytology but were later found to have benign tumors by histopathology. Surg Today 43, 632–637 (2013). https://doi.org/10.1007/s00595-012-0362-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0362-y

Keywords

Search

Navigation