Fine-needle aspiration biopsy of cold thyroid nodules

Nathan, Annette R.; Raines, Kristen B.; Lee, Yeu-Tsu Margaret; Sakas, E. Lawrence; Ribbing, Judy M.

doi:10.1002/1097-0142(19881001)62:7<1337::aid-cncr2820620716>3.0.co;2-9

Cited by 18 publications

(3 citation statements)

References 24 publications

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“…The diagnostic accuracy in our series stained by Riu's method are comparable to the previously reported series [8][9][10][11][12] as to the sensitivity and specificity of detecting thyroid malignancy. The experiences in our laboratory of Riu's stain of other organs are equally good in both sensitivity and specificity such as seen in breast diseases (unpublished material).…”

Section: Discussionsupporting

confidence: 86%

Riu's stain and the cytologic diagnosis of thyroid fine‐needle aspiration: A single cancer center experience

Tsou¹,

Lin²,

Ko³

1997

Diagn. Cytopathol.

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Key Words: Riu's stain; fine-needle aspiration; thyroid gland; sensitivity; specificity Riu's stain 1 is a Romanowsky-type stain which was first described in Taiwan in 1953 and became widely used here by hematology laboratories. It is a stain of comparable quality to Wright-Giemsa but is a much faster stain which takes only 2 minutes to complete a two-step procedure. The details of the stain have recently been elaborated. 2 Our Department is one of the progressive surgical pathology departments in the Far East that use Riu's stain routinely on fine-needle aspiration (FNA) specimens. Herein we review our experience on thyroid FNAs over a 6-yr period with special emphasis on the diagnostic usefulness of Riu's stain. Materials and MethodsBetween April 1990 and June 1996, 254 thyroid FNAs from 218 patients were performed at Koo Foundation Sun YatSen Cancer Center. The aspirates were procured by clinicians either by palpation or under ultrasonography guide to locate the lesion for aspiration with a 23-or 25-gauge needle. Alcohol-fixed and air-dried smears were both obtained. The air-dried smears were immediately stained by Riu's method. The alcohol-fixed smears were stained by Papanicolaou stain in batches later in the afternoon on the same day or on the following day. Cytospin preparations were also made in situations where fluid was aspirated.The cytologic results were reported immediately after the Riu-stained slides were reviewed. The Papanicolaou-stained slides were later reviewed for confirmation. The results were categorized into four groups: benign, suspicious for malignancy, positive for malignancy, and inadequate specimen. Benign category encompassed goiter (colloid cyst, nodular hyperplasia) and thyroiditis. The suspicious for malignancy category including inconclusive cases encompassed follicular neoplasm and the aspirates that did not fulfill strict criteria for papillary carcinoma. The adenomatous goiters were also placed in this category because of the difficulty in separating it from follicular neoplasm. The positive for malignancy category encompassed either primary or metastatic malignancies. The adequacy of the specimen and the cytologic diagnosis of all primary thyroid malignancies were based on Kini's criteria. 3 Surgical pathology sections were available in 61 cases. The cytologic interpretations were confirmed by and correlated with the histologic findings. Sensitivity, specificity, positive predictive, and negative predictive value were determined using the methods of Galen and Gambino. 4 Results Table I summarizes the results of the 254 aspirates obtained during a 6-yr period. The 218 patients (38 male/180 female) ranged in age from 22 to 94 yr. Surgical follow-up was available in 61 patients. Cytological and surgical findings are compared in Table II.

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Section: Discussionsupporting

confidence: 86%

Riu's stain and the cytologic diagnosis of thyroid fine‐needle aspiration: A single cancer center experience

Tsou¹,

Lin²,

Ko³

1997

Diagn. Cytopathol.

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“…In contrast, in the study of Nathan and Raines, vascularity as demonstrated by radionuclide scans did not reliably differentiate carcinoma from adenoma or adenomatous nodules [27].…”

Section: Discussionmentioning

confidence: 65%

A comparison of radionuclide thyroid angiography, 99mTc-MIBI scintigraphy and power Doppler ultrasonography in the differential diagnosis of solitary cold thyroid nodules

Koray

Kapucu

Yücel

et al. 2003

Eur J Nucl Med Mol Imaging

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We prospectively studied 43 patients with solitary cold thyroid nodules greater than 1.5 cm in diameter to determine the comparative diagnostic value of radionuclide thyroid angiography (RTA), technetium-99m methoxyisobutylisonitrile ((99m)Tc-MIBI) scintigraphy and power Doppler ultrasonography (PDUS) in the differentiation of benign and malignant thyroid nodules. Perfusion of the nodules in RTA was compared with the perfusion in the surrounding normal thyroid tissue and classified as follows: 0, avascular; 1, hypovascular; 2, isovascular; 3, hypervascular. (99m)Tc-MIBI uptake in the nodules compared with that in surrounding thyroid tissue was scored for both early and delayed images as follows: 0, cold; 1, decreased; 2, equal; 3, increased. PDUS patterns were classified as nodule vascularisation patterns. The malignancy criteria were set as follows: hypervascular nodule with rapid washout in RTA; complex ring sign with anarchic structure or delta sign in PDUS, and positive retention and increased uptake in the nodule in the early and delayed (99m)Tc-MIBI images. These data were compared with the histopathological results. Histology revealed thyroid carcinoma in nine patients (five cases of papillary carcinoma, three of follicular carcinoma and one of medullary carcinoma) and benign conditions in 34 patients (30 cases of nodular goitre, three of lymphocytic thyroiditis and one of follicular adenoma). Sensitivity, specificity and accuracy were, respectively, 0.89, 1.00 and 0.97 for RTA, 1.00, 0.76 and 0.81 for PDUS, and 0.67, 0.91 and 0.86 for (99m)Tc-MIBI scintigraphy (when nodules with increased uptake in both the early and the delayed images and a positive retention index were considered as malignant). RTA, (99m)Tc-MIBI scintigraphy and PDUS could be helpful in the preoperative assessment of solitary cold thyroid nodules. In this study, RTA was found to be the most accurate and specific method for differentiation of malignant from benign thyroid nodules.

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“…The last two decades have seen a growing worldwide acceptance of fine needle aspiration cytology (FNAC) in the investigation of thyroid lesions 1–5 . As such, FNAC of the thyroid has now become a routine diagnostic procedure in providing information complementary to the clinical and scintigraphy data 6–10 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of qualitative and quantitative variables in thyroid lesions

Rout

Shariff

1999

Cytopathology

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Two hundred and thirty-three thyroid lesions were studied by fine needle aspiration (FNA) cytology using standard cytologic criteria available in the literature. These included 114 cases of nodular colloid goitre (NCG), 47 cases of Hashimoto's thyroiditis (HT), 12 follicular adenomas (FAd), five cases of subacute thyroiditis and three cases of thyrotoxicosis among the benign lesions. The malignant lesions seen were 30 cases of papillary carcinoma (PCa), 16 follicular carcinomas (FCa), three cases with double lesions, e.g. papillary carcinoma with coexisting NCG, and three of papillary carcinoma with HT. Emphasis was given to eight qualitative and quantitative (morphometric) variables in these various thyroid lesions. Cell measurements were done using a Visopan Lux projection microscope. The three qualitative variables included type of nuclear membrane (regular/irregular), type of nuclear chromatin and the presence or absence of conspicuous nucleoli. The quantitative variables studied were nuclear diameter, nuclear area, cytoplasmic diameter, cytoplasmic area & N/C ratio. Statistical analysis was performed in order to know whether the standard cytologic criteria used at FNA cytology in the literature (increased cellularity, microfollicles, increased N/C ratio, absence of significant haemosiderin-laden macrophages and scanty colloid) could differentiate a follicular adenoma from a follicular carcinoma. A statistical analysis was also performed to establish the utility of the qualitative and quantitative variables. The results showed that none of the standard cytologic criteria applied could differentiate follicular adenoma from a follicular carcinoma. With regard to qualitative variables, irregularity of nuclear membrane and presence of conspicuous nucleoli were most significant in papillary carcinoma, followed by follicular carcinoma, then by follicular adenoma; these features being hardly evident in nodular colloid goitre and Hashimoto's thyroiditis. A coarse nuclear chromatin was most significant in follicular carcinomas followed by follicular adenomas. It was less obvious in the benign conditions, but more prominent in Hashimoto's thyroiditis compared with a goitre. It was also not obvious in a papillary carcinoma. Of the quantitative variables, all measurements were greatest in PCa > FCa > FAd > NCG = HT. When differentiating follicular adenoma from follicular carcinoma the qualitative variables of significance were the presence or absence of nucleoli, the chromatin pattern and regularity/irregularity of nuclear membrane; the nuclear area was the most important feature among quantitative variables.

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Fine-needle aspiration biopsy of cold thyroid nodules

Cited by 18 publications

References 24 publications

Riu's stain and the cytologic diagnosis of thyroid fine‐needle aspiration: A single cancer center experience

Riu's stain and the cytologic diagnosis of thyroid fine‐needle aspiration: A single cancer center experience

A comparison of radionuclide thyroid angiography, 99mTc-MIBI scintigraphy and power Doppler ultrasonography in the differential diagnosis of solitary cold thyroid nodules

Diagnostic value of qualitative and quantitative variables in thyroid lesions

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