Fine needle aspiration cytology of the thyroid: a comparison of 5469 cytological and final histological diagnoses

Objective:  We evaluated the efficacy of fine needle aspiration cytology (FNAC) of the thyroid in a series of 5469 lesions with histological control and studied the causes of, and the possibility of reducing the limitations of the method. Methods:  FNAC was always performed by a pathologist under th...

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Bibliographic Details
Published in:Cytopathology (Oxford) 2006-10, Vol.17 (5), p.245-250
Main Authors: Sangalli, G., Serio, G., Zampatti, C., Bellotti, M., Lomuscio, G.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biopsy, Fine-Needle
Child
False Negative Reactions
Female
fine needle aspiration cytology
Humans
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Thyroid Nodule - diagnosis
thyroid nodules
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Summary:Objective:  We evaluated the efficacy of fine needle aspiration cytology (FNAC) of the thyroid in a series of 5469 lesions with histological control and studied the causes of, and the possibility of reducing the limitations of the method. Methods:  FNAC was always performed by a pathologist under the guidance of a clinician, using a 22‐gauge needle. Generally two aspirations were carried out, and usually four slides were obtained for each nodule; they were then stained with May–Grünwald–Giemsa and with Papanicolaou. The cytological diagnoses were classified in four groups: inadequate, benign, suspicious and malignant. Results:  We obtained a complete sensitivity of 93.4%, a positive predictive value of malignancy of 98.6%, and a specificity of 74.9%. At histological control, the cytological diagnosis of Hurthle cell neoplasm corresponded to a significantly higher incidence of malignant neoplasms than the diagnosis of non‐Hurthle cell follicular neoplasm (32.1% versus 15.5%). There were 66 false‐negative findings, the main cause of diagnostic error (24 cases) being failure to recognize the follicular variant of papillary carcinoma. The number of inadequate FNACs was low (4.2%). Conclusion:  Our study confirmed the great efficacy of thyroid FNAC. A cytological diagnosis of Hurthle cell neoplasm should be considered an indicator of high risk. Awareness that failure to recognize the follicular variant of papillary carcinoma was the main problem in the interpretation of thyroid FNAC should lead to a decrease of false‐negative diagnoses. The inadequate rate was very low, as it was the pathologist personally who performed the needle aspiration.
ISSN:0956-5507
1365-2303
DOI:10.1111/j.1365-2303.2006.00335.x