Tzu Chi Medical Journal
Volume 20, Issue 4 , Pages 296-303, December 2008

Fine Needle Aspiration Cytology of Thyroid Nodules: Evaluation of Diagnostic Accuracy

  • Chih-En Tseng

      Affiliations

    • Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Chang-Kuo Wei

      Affiliations

    • Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Chin-Sung Kuo

      Affiliations

    • Department of Endocrinology and Metabolism, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Shih-Tang Yan

      Affiliations

    • Department of Endocrinology and Metabolism, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Pin-Fan Chen

      Affiliations

    • Department of Endocrinology and Metabolism, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Wei-Cheng Lien

      Affiliations

    • Department of Endocrinology and Metabolism, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Shu-Mei Chang

      Affiliations

    • Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Tzu-Cheng Su

      Affiliations

    • Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Yun-Hsuan Tseng

      Affiliations

    • Department of Family Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Family Medicine, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan

Received 15 December 2007; received in revised form 24 January 2008; accepted 26 March 2008.

Article Outline

Abstract 

Objective

The aim of this study was to evaluate the results of thyroid fine needle aspiration cytology (FNAC) and identify reasons for discrepancies between the cytological and histological diagnoses in our institution.

Materials and Methods

We evaluated the results of 1064 FNACs obtained from 737 patients, of which 98 underwent subsequent thyroid surgery.

Results

Histological analyses revealed that benign diagnoses based on FNAC were correct in 76 of the 80 benign cases (95%), with four cases being underdiagnosed (false negatives). Two of the four cases were due to incidental findings of papillary microcarcinomas. The third case was due to a cytologic sampling error and the fourth was due to cytologic underdiagnosis. Furthermore, malignant diagnoses based on FNAC were correct in 17 of the 18 malignant cases (94%), with one case being over-diagnosed (false positive) due to over-interpretation of Hürthle cells as carcinomatous cells. The accuracy, positive predictive value, and negative predictive value were 94.9%, 94.4%, and 95.0%, respectively.

Conclusion

Overall, FNAC is a sensitive and specific method for the pre-operative screening of thyroid nodules. However, due to limitations under some specific circumstances, such as papillary microcarcinoma, bizarre Hürthle cells, follicular neoplasm and technical difficulty during the aspiration, the management of thyroid nodules must not only depend on the results of FNAC but should also be correlated with clinical findings before surgical intervention.

Keywords:  Accuracy , Fine needle aspiration cytology , Sensitivity , Specificity , Thyroid nodule

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Rojeski MT , Gharib H . Nodular thyroid disease. Evaluation and management . N Engl J Med . 1985;313:428–436
  2. Hsiao YL , Chang TC . Prevalence of goiter in Taiwanese adults: a preliminary study . J Formos Med Assoc . 1995;94:197–199
  3. Thompson NW . Current diagnostic techniques for single thyroid nodules . Curr Surg . 1983;40:255–259
  4. Mazzaferri EL . Thyroid cancer in thyroid nodules: finding a needle in the haystack . Am J Med . 1992;93:359–362
  5. Ashcraft MW , Van Herle AJ . Management of thyroid nodules. I: History and physical examination, blood tests, X-ray tests, and ultrasonography . Head Neck Surg . 1981;3:216–230
  6. Ashcraft MW , Van Herle AJ . Management of thyroid nodules. II: Scanning techniques, thyroid suppressive therapy, and fine needle aspiration . Head Neck Surg . 1981;3:297–322
  7. Gharib H , Goellner JR . Fine-needle aspiration biopsy of the thyroid: an appraisal . Ann Intern Med . 1993;118:282–289
  8. de Vos tot Nederveen Cappel RJ , Bouvy ND , Bonjer HJ , van Muiswinkel JM , Chadha S . Fine needle aspiration cytology of thyroid nodules: how accurate is it and what are the causes of discrepant cases? . Cytopathology . 2001;12:399–405
  9. Bajaj Y , De M , Thompson A . Fine needle aspiration cytology in diagnosis and management of thyroid disease . J Laryngol Otol . 2006;120:467–469
  10. Sclabas GM , Staerkel GA , Shapiro SE , et al.   Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients . Am J Surg . 2003;186:702–710
  11. Ko HM , Jhu IK , Yang SH , et al.   Clinicopathologic analysis of fine needle aspiration cytology of the thyroid. A review of 1,613 cases and correlation with histopathologic diagnoses . Acta Cytol . 2003;47:727–732
  12. Baloch ZW , Fleisher S , LiVolsi VA , Gupta PK . Diagnosis of “follicular neoplasm”: a gray zone in thyroid fine-needle aspiration cytology . Diagn Cytopathol . 2002;26:41–44
  13. Goellner JR , Gharib H , Grant CS , Johnson DA . Fine needle aspiration cytology of the thyroid, 1980 to 1986 . Acta Cytol . 1987;31:587–590
  14. Anonymous  . The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Guidelines of The Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules . Diagn Cytopathol . 1996;15:84–89
  15. Galen RS , Gambino SR . In: Beyond Normality: the Predictive Value and Efficiency of Medical Diagnosis . New York: John Wiley; 1975;p. 9–14
  16. Bakhos R , Selvaggi SM , DeJong S , et al.   Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance . Diagn Cytopathol . 2000;23:233–237
  17. Amrikachi M , Ramzy I , Rubenfeld S , Wheeler TM . Accuracy of fine-needle aspiration of thyroid . Arch Pathol Lab Med . 2001;125:484–488
  18. Morgan JL , Serpell JW , Cheng MS . Fine-needle aspiration cytology of thyroid nodules: how useful is it ? . ANZ J Surg . 2003;73:480–483
  19. Jogai S, Al-Jassar A, Temmim L, Dey P, Adesina AO, Adesina AO, et al. Fine needle aspiration cytology of the thyroid: a cytohistologic study with evaluation of discordant cases . Acta Cytol . 2005;49:483–488
  20. Cai XJ , Valiyaparambath N , Nixon P , Waghorn A , Giles T , Helliwell T . Ultrasound-guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules . Cytopathology . 2006;17:251–256
  21. Lee TI , Yang HJ , Lin SY , et al.   The accuracy of fine-needle aspiration biopsy and frozen section in patients with thyroid cancer . Thyroid . 2002;12:619–626
  22. Asa SL . My approach to oncocytic tumours of the thyroid . J Clin Pathol . 2004;57:225–232
  23. Ylagan LR , Farkas T , Dehner LP . Fine needle aspiration of the thyroid: a cytohistologic correlation and study of discrepant cases . Thyroid . 2004;14:35–41
  24. Lang W , Borrusch H , Bauer L . Occult carcinomas of the thyroid. Evaluation of 1020 sequential autopsies . Am J Clin Pathol . 1988;90:72–76
  25. Bondeson L , Ljungberg O . Occult papillary thyroid carcinoma in the young and the aged . Cancer . 1984;53:1790–1792
  26. Yamamoto Y , Maeda T , Izumi K , Otsuka H . Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases . Cancer . 1990;65:1173–1179
  27. Harach HR , Franssila KO , Wasenius VM . Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study . Cancer . 1985;56:531–538
  28. Perez LA , Gupta PK , Mandel SJ , LiVolsi VA , Baloch ZW . Thyroid papillary microcarcinoma. Is it really a pitfall of fine needle aspiration cytology? . Acta Cytol . 2001;45:341–346
  29. Yang GC , LiVolsi VA , Baloch ZW . Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up . Int J Surg Pathol . 2002;10:133–139
  30. Powari M , Dey P , Saikia UN . Fine needle aspiration cytology of follicular variant of papillary carcinoma of thyroid . Cytopathology . 2003;14:212–215
  31. Leung CS , Hartwick RW , Bédard YC . Correlation of cytologic and histologic features in variants of papillary carcinoma of the thyroid . Acta Cytol . 1993;37:645–650
  32. Bellantone R , Lombardi CP , Raffaelli M , et al.   Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy . Thyroid . 2004;14:43–47
  33. Chow LS , Gharib H , Goellner JR , van Heerden JA . Nondiagnostic thyroid fine-needle aspiration cytology: management dilemmas . Thyroid . 2001;11:1147–1151
  34. Werga P , Wallin G , Skoog L , Hamberger B . Expanding role of fine-needle aspiration cytology in thyroid diagnosis and management . World J Surg . 2000;24:907–912
  35. Cheung YS , Poon CM , Mak SM , Suen MW , Leong HT . Fineneedle aspiration cytology of thyroid nodules–how well are we doing? . Hong Kong Med J . 2007;13:12–15

PII: S1016-3190(08)60054-3

doi:10.1016/S1016-3190(08)60054-3

Tzu Chi Medical Journal
Volume 20, Issue 4 , Pages 296-303, December 2008

Article Tools