Cover Image

Cytological features in the early diagnosis of papillary carcinoma of thyroid in clinically inapparent cases

Anshu Jain, Kiran Alam, Veena Maheshwari, Divya Rabindranath, Azka Anees Khan, Roobina Khan

Abstract


Background: Papillary thyroid carcinoma (PTC) is the most common among the thyroid malignancies. Fine needle aspiration cytology (FNAC) is the first line investigation in the diagnosis of thyroid lesions. Here we review the significance of certain features conventionally considered to be diagnostic of papillary thyroid carcinoma on FNAC – including type of background, type of colloid, presence or absence of papillary clusters, intranuclear inclusions and nuclear grooves which were also considered for their importance in early diagnosis of PTC.

Methods: We reviewed all the thyroid FNACs performed over 18 months period and correlated them clinically and histopathologically, wherever available. 

Results: Out of a total of 354 cases of thyroid FNACs, histopathological correlation was possible in 90 cases, with a concordant diagnosis in 82 cases. Analysis of the 8 discordant FNAC smears revealed papillary clusters along with nuclear features, especially nuclear grooves to be the most important finding in indicating a diagnosis of PTC.

Conclusion: Although the presence of papillary clusters along with characteristic nuclear features on FNAC is well known to indicate diagnosis of PTC, these findings can be easily missed on cytology smears, especially when the lesions are small (less than 1 cm) and diagnosis is clinically inapparent. Hence, we propose that the presence of papillary clusters in any case should alert the pathologist towards a diagnosis of PTC. A diligent search for nuclear features should follow. Thus a high index of suspicion while examining the FNAC smears in these patients will help in early detection of PTC.


Keywords


Papillary thyroid carcinoma; cytology; papillary clusters; nuclear grooves

Full Text:

FULL TEXT PDF

References


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

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

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;55:805-28.

Renshaw AA. Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves. Am J Clin Pathol. 2001; 116: 477-82.

Mahajan A, Lin X, Nayar R. Thyroid Bethesda reporting category, suspicious for papillary thyroid carcinoma, pitfalls and clues to optimize the use of this category. Cytopathology.2013; 24:85-91.

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.

Wu HH, Jones JN, Grzybicki DM, Elsheikh TM. Sensitive cytologic criteria for the identification of follicular variant of papillary thyroid carcinoma in fine-needle aspiration biopsy. Diagn Cytopathol.2003;29: 262-6.

Castro-Gómez L, Córdova-Ramírez S, Duarte-Torres R, Alonso de Ruiz P, Hurtado-López LM. Cytologic criteria of cystic papillary carcinoma of the thyroid. Acta Cytol. 2003;47:590-4.

Kumar S, Singh N, Siddaraju N. Cellular swirls and similar structures on fine needle aspiration cytology as diagnostic clues to papillary thyroid carcinoma: A report of 4 cases. Acta Cytol. 2010;54:939-42.

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.

Gould E, Watzak L, Chamizo W, Albores-Saavedra J. Nuclear grooves in cytologic preparations. A study of the utility of this feature in the diagnosis of papillary carcinoma. Acta Cytol.1989;33:16-20.

Ellison E, Lapuerta P, Martin SE. Psammoma bodies in fine needle aspirates of the thyroid: predictive value for papillary carcinoma. Cancer. 1988; 84:169-75.


Refbacks

  • There are currently no refbacks.




Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Creative Commons License
Annals of Pathology and Laboratory Medicine (APALM) is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at www.pacificejournals.com/apalm.