Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland

Abstract

The aim of this study was twofold. The first aim was to estimate the diagnostic reliability of urinary cytology for detection and management of urothelial neoplasms by using a specific preserving fluid for sample collection, and the liquid‐based thin layer method for specimen preparation, the estimate was based on the correlation between the cytological findings of 10,000 non‐hospitalized patients, and their histological diagnoses. A second aim was to compare the reliability of two instruments for thin‐layer preparation, i.e., TP2000, TP3000, capable of processing the specimens at very different rates. The preservation of cell structure is ameliorated by the procedure of sample collection and treatment here described. This allows a more accurate reading of LBC slides as shown by: (a) the significant concordance between cytological and histological diagnosis (92%); (b) the significant number of low‐grade urothelial carcinomas (20.5%) revealed by urinary cytology and validated by histologic diagnosis; (c) the low rate (8%) of misjudgement of cytological diagnosis reached in this study. The quality of performances of the two instruments tested for thin‐layer preparation, i.e., TP2000 and TP3000, is statistically comparable. We recommend the procedure that makes use of preserving fluid for sample collection (cytolyt™) and treatment (preservcyt ™) as here described. We also recommend the use of thin‐layer method for specimen preparation since it allows a more uniform distribution of the cells on the support with reduction of overlapping phenomena. Finally, economic considerations suggest the preferential use of Thin Prep 3000. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.

Fine-Needle Aspiration Cytology of Thyroid Nodules with Hürthle Cells: Cytomorphologic Predictors for Neoplasms, Improving Diagnostic Accuracy and Overcoming Pitfalls

“…This feature is not frequently detected. Similar to the findings of Elliott et al [5], only 27% of HCNs in our study showed transgressing vessels to be present, i.e. pointing to a neoplastic process.…”

“…Overinterpretation of HCs on a background of Hashimoto's thyroiditis is a well-known pitfall [15,16,17,18,19,20]. As observed in other studies [5], a feature that we found to be helpful in distinguishing lymphocytic thyroiditis from HN is when lymphocytes infiltrate clusters of follicular epithelial cells (fig. 1).…”

“…Cytomorphologic characteristics including overall cellularity, percentage of HCs, monotony, naked nuclei, nucleoli, percentage of single cells, percent of follicular cells forming sheets, microfollicles, transgressing vessels, small-cell dysplasia, large-cell dysplasia, background colloid and lymphocytes were noted. The description of small-cell dysplasia and large-cell dysplasia by Renshaw [4] was applied, as was that by Elliott et al [5 ]of transgressing vessels being capillaries coursing through sheets or clusters of HCs. We tabulated the cytologic features and assigned a scoring system (table 1).…”

“…It is imperative to distinguish between a reactive HC lesion and a neoplastic process because HC neoplasms (HCNs) are surgically resected whereas reactive nodules do not necessarily undergo resection [3]. There are studies describing cytomorphologic features that are more often seen in HCC than all HCNs [4,5,6]. In spite of these attempts, 63% of HCAs and 25% of reactive HC nodules could not be reliable classified as benign [3].…”

Liquid-Based Cytology in Fine-Needle Aspiration Biopsies of the Thyroid Gland

“…Unlike their follicular counterpart, oxyphilic cells may feature nuclear enlargement and pleomorphism either in benign neoplasms or even in hyperplastic lesions. The most paradigmatic case is represented by hyperplastic nodules in CAT which may show a striking nuclear pleomorphism of the oxyphilic component [1,2,41,42,43,44,45,46,47,48,49]. Some authors have attempted to correlate the atypia of oxyphilic cells (and some other features such as transgressing vessels) with the risk of malignancy, but their results are still debatable [47,49].…”