Interobserver and Intraobserver Variation Among Experts in the Diagnosis of Thyroid Follicular Lesions With Borderline Nuclear Features of Papillary Carcinoma

Elsheikh, Tarik M.; Sylvia, L.; Chan, John K.; DeLellis, Ronald A.; Heffess, Clara S.; LiVolsi, Virginia A.; Wenig, Bruce M.

doi:10.1309/ajcpkp2quvn4rccp

Cited by 298 publications

(220 citation statements)

References 40 publications

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“…However, it is known that there are disagreements among even endocrine pathologists analyzing the same lesion, in suspicious thyroid nodules [2]. Factors that affect the variety among observers include education of pathologists in different centers and by different educators [19].…”

Section: Discussionmentioning

confidence: 99%

“…While it is generally easy to diagnose cases that show characteristic nuclear details for papillary carcinoma, there may be diagnostic conflicts even among experienced endocrine pathologists regarding cases that have follicular growth patterns [2]. Correct pathological diagnosis is necessary to minimize emotional stress, over-treatments and related financial costs brought by the diagnosis of thyroid cancer [3].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic value of TROP-2 expression in papillary thyroid carcinoma and comparison with HBME-1, galectin-3 and cytokeratin 19

Mürtezaoğlu¹,

Güçer²

2017

pjp

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In this study, we compared the diagnostic value of TROP-2 expression in distinguishing between benign and malignant thyroid lesions to those of HBME-1, CK19 and galectin-3. We selected 102 cases from our archive including 20 normal thyroid tissues, 23 follicular nodular diseases, 17 follicular adenomas, 20 follicular variant papillary carcinomas and 22 classical variant papillary carcinomas. Tissue microarrays constructed from these cases were immunohistochemically analyzed with HBME-1, CK19, galectin-3 and TROP-2. Respectively 73.8%, 83.3%, 69% and 50% of all papillary carcinomas were positive with HBME-1, CK19, galectin-3 and TROP-2. CK19 was positive respectively by 100%, 43.5% and 35.3% in cases of normal thyroid, follicular nodular diseases and follicular adenoma, while the other markers were negative. In distinguishing benign and malignant lesions, which constitutes this study, HBME-1, CK19, galectin-3 and TROP-2 were statistically significant (p < 0.001). In distinguishing cases of follicular variant papillary carcinoma from follicular nodular diseases and follicular adenoma, HBME-1 and galectin-3 were statistically significant (p < 0.001). Consequently, in this study, we found that all immunohistochemical markers were effective in distinguishing benign and malignant thyroid lesions. In determining malignancy, HBME-1 had the highest diagnostic accuracy, while CK19 was the most sensitive marker. The sensitivity increased when the markers were used together.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic value of TROP-2 expression in papillary thyroid carcinoma and comparison with HBME-1, galectin-3 and cytokeratin 19

Mürtezaoğlu¹,

Güçer²

2017

pjp

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“…Although this finding has significant implications, it must be noted that these findings are specific for our institution. Because the decrease in the risk of malignancy depends on the prevalence of the diagnosis of FVPTC, and FVPTC is known to be a diagnosis with low interobserver reproducibility (23,30), it is essential that additional studies are performed at other institutions. The magnitude of the impact will vary, and the biggest impact will be seen at institutions where the rate of diagnosis of FVPTC is the highest.…”

Section: Strickland Et Almentioning

confidence: 99%

The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories

Strickland

Howitt

Marqusee

et al. 2015

Thyroid

229

299

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Background: Increased recognition of the indolent nature of noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) along with greater insight into the molecular alterations of these tumors has prompted endocrine pathologists to question whether these tumors warrant a diagnosis of carcinoma. However, a change in terminology would affect the rates of malignancy of fine-needle aspiration (FNA) diagnostic categories. Therefore, the aim of this study was to determine the percentage decrease in associated risk of malignancy for each FNA diagnostic category if NFVPTCs were no longer termed carcinomas. Methods: We evaluated a cohort of 655 FNAs with subsequent resection specimens over a 22-month time period. The diagnoses of the preceding FNAs were recorded according to the Bethesda System for Reporting Thyroid Cytopathology. For cases with more than one preceding FNA, the FNA diagnosis associated with the highest risk of malignancy was identified. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify noninvasive tumors. By definition, all of these tumors were encapsulated, partially encapsulated, or well circumscribed and lacked any indication of infiltrative growth, capsular penetration, or lymphovascular invasion. Results: Our cohort of 655 FNAs with subsequent resection specimens included 53 (8.1%) nondiagnostic (ND), 167 (25.5%) benign, 97 (14.8%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 88 (13.4%) suspicious for follicular neoplasm (SFN), 94 (14.4%) suspicious for malignancy (SUS), and 156 (23.8%) malignant cases (POS). Surgical resections demonstrated benign findings in 309 (47.2%) and malignant tumors in 346 (52.8%), including 85 NFVPTCs accounting for 24.6% of malignancies. Our rates of malignancy for ND, benign, AUS/FLUS, SFN, SUS, and POS were 18.9%, 13.2%, 39.2%, 45.5%, 87.2%, and 98.7%, respectively. If NFVPTC were no longer termed carcinoma, these rates would drop to 17.0% (10% decrease), 5.4% (59% decrease), 21.6% (45% decrease), 37.5% (18% decrease), 45.7% (48% decrease), and 93.6% (5% decrease), respectively. Conclusion: Our findings demonstrate that if terminology were changed and NFVPTCs were not considered carcinomas, the rates of malignancy for FNA diagnostic categories would be substantially decreased, with the most clinically significant decrease seen in the SUS category, which demonstrated a relative decrease of nearly 50%.

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“…[1][2][3][4] There are many controversies involving the diagnostic criteria, treatment and follow-up assessment of well-differentiated thyroid carcinoma that usually has an indolent biological course. [5][6][7][8] Current risk stratification schemes used in the management of patients with well-differentiated thyroid carcinoma do not adequately incorporate the prognostic implications of detailed pathological features such as vascular invasion, mitoses, tumor cell necrosis, extra-thyroidal extension, histological subtypes and the molecular biological profile of the primary tumor. 7,9 Among the histopathological parameters, vascular invasion has been reported as an important and independent prognosticator in many other head and neck cancers.…”

mentioning

confidence: 99%

Pathological definition and clinical significance of vascular invasion in thyroid carcinomas of follicular epithelial derivation

2011

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There are many controversies involving the diagnostic criteria and treatment of well-differentiated thyroid carcinoma. Vascular invasion has been identified as an important and independent prognosticator in many cancers. The majority of pathologists recognize the importance of vascular invasion as a diagnostic marker of malignancy in follicular lesions of thyroid; however, several reports have suggested that angioinvasion is not a predictor of bad prognosis in thyroid carcinomas. We suggest that the criteria for diagnosing angioinvasion in thyroid carcinomas as well as in other endocrine tumors are inconsistent and the controversy may be attributed to application of inappropriate criteria. We carried out a study of a potential cause of artefactual vascular invasion in a series of autopsy thyroids and established the morphology of mimics of angioinvasion. We then reviewed retrospectively the clinicopathological features of a series of 4000 thyroid carcinomas of follicular epithelial derivation to identify the features and significance of the most rigid criteria of vascular invasion: tumor cells invading through a vessel wall and thrombus adherent to intravascular tumor. These features were identified in 118 (3%) lesions. Follow-up information was available for 98 patients. Of these, 35% developed distant metastases. When using the rigid criteria, B1/3 of angioinvasive well-differentiated thyroid carcinomas and 1/2 of angioinvasive poorly differentiated thyroid carcinomas developed distant metastases at a mean 5.3 years of follow-up. Our results indicate that the application of rigid criteria for vascular invasion provide a clinically relevant prediction of distant metastasis in patients with thyroid carcinomas, especially in well-differentiated thyroid carcinomas.

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Interobserver and Intraobserver Variation Among Experts in the Diagnosis of Thyroid Follicular Lesions With Borderline Nuclear Features of Papillary Carcinoma

Cited by 298 publications

References 40 publications

Diagnostic value of TROP-2 expression in papillary thyroid carcinoma and comparison with HBME-1, galectin-3 and cytokeratin 19

Diagnostic value of TROP-2 expression in papillary thyroid carcinoma and comparison with HBME-1, galectin-3 and cytokeratin 19

The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories

Pathological definition and clinical significance of vascular invasion in thyroid carcinomas of follicular epithelial derivation

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