Fine-needle aspirates of thyroid microcarcinoma

Kristen L. Partyka, Howard Wu

Research output: Contribution to journalArticle

Abstract

Introduction: Widespread use of ultrasound allows for detection of smaller thyroid nodules and preoperative evaluation with fine-needle aspiration (FNA). Both incidental and non-incidental microcarcinoma can be found, leading to uncertainty with clinical management. Materials and methods: A retrospective analysis of thyroid FNAs performed at our institution was conducted for the 5-year period from 2010 to 2014. Aspirates were categorized using the Bethesda System for Reporting Thyroid Cytopathology. Cytologic diagnoses were then correlated with final histopathology. Among samples with malignancy on surgical resection, nodules were stratified by size. Results: A total of 2531 thyroid FNAs were identified; 587 samples had histologic correlation, and 259 malignancies were reported. They were separated into nodules >1 cm (n = 144, 56%) and ≤1 cm (n = 115, 44%). Microcarcinoma was further subdivided into incidental (size ≤0.5 cm, n = 55, 48%) and non-incidental (size >0.5 cm and ≤1 cm, n = 60, 52%). The preoperative cytologic diagnoses for incidental microcarcinoma were: benign (B, n = 11, 20%), follicular lesion of undetermined significance (FLUS, n = 15, 27%), follicular neoplasm (FN, n = 11, 20%), suspicious for malignancy (SM, n = 7, 13%), malignant (M, n = 8, 15%), and nondiagnostic (ND, n = 3, 5%). The FNA categories for non-incidental microcarcinoma were: B (n = 13, 22%), FLUS (n = 3, 5%), FN (n = 3, 5%), SM (n = 10, 17%), M (n = 29, 48%), and ND (n = 2, 3%). Conclusions: Incidental microcarcinoma is not an uncommon entity, making up 21% (55 of 259) of malignant nodules on thyroidectomy. Indeterminate diagnoses (FLUS + FN + SM) accounted for the majority (60%) of preoperative FNAs for incidental microcarcinoma, compared with 27% for those of non-incidental microcarcinoma (P < 0.05, χ2 test).

Original languageEnglish (US)
JournalJournal of the American Society of Cytopathology
DOIs
StateAccepted/In press - 2017

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Needles
Thyroid Gland
Fine Needle Biopsy
Neoplasms
Thyroid Nodule
Thyroidectomy
Uncertainty

Keywords

  • Cytology
  • FNA
  • Microcarcinoma
  • The Bethesda System
  • Thyroid

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Fine-needle aspirates of thyroid microcarcinoma. / Partyka, Kristen L.; Wu, Howard.

In: Journal of the American Society of Cytopathology, 2017.

Research output: Contribution to journalArticle

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abstract = "Introduction: Widespread use of ultrasound allows for detection of smaller thyroid nodules and preoperative evaluation with fine-needle aspiration (FNA). Both incidental and non-incidental microcarcinoma can be found, leading to uncertainty with clinical management. Materials and methods: A retrospective analysis of thyroid FNAs performed at our institution was conducted for the 5-year period from 2010 to 2014. Aspirates were categorized using the Bethesda System for Reporting Thyroid Cytopathology. Cytologic diagnoses were then correlated with final histopathology. Among samples with malignancy on surgical resection, nodules were stratified by size. Results: A total of 2531 thyroid FNAs were identified; 587 samples had histologic correlation, and 259 malignancies were reported. They were separated into nodules >1 cm (n = 144, 56{\%}) and ≤1 cm (n = 115, 44{\%}). Microcarcinoma was further subdivided into incidental (size ≤0.5 cm, n = 55, 48{\%}) and non-incidental (size >0.5 cm and ≤1 cm, n = 60, 52{\%}). The preoperative cytologic diagnoses for incidental microcarcinoma were: benign (B, n = 11, 20{\%}), follicular lesion of undetermined significance (FLUS, n = 15, 27{\%}), follicular neoplasm (FN, n = 11, 20{\%}), suspicious for malignancy (SM, n = 7, 13{\%}), malignant (M, n = 8, 15{\%}), and nondiagnostic (ND, n = 3, 5{\%}). The FNA categories for non-incidental microcarcinoma were: B (n = 13, 22{\%}), FLUS (n = 3, 5{\%}), FN (n = 3, 5{\%}), SM (n = 10, 17{\%}), M (n = 29, 48{\%}), and ND (n = 2, 3{\%}). Conclusions: Incidental microcarcinoma is not an uncommon entity, making up 21{\%} (55 of 259) of malignant nodules on thyroidectomy. Indeterminate diagnoses (FLUS + FN + SM) accounted for the majority (60{\%}) of preoperative FNAs for incidental microcarcinoma, compared with 27{\%} for those of non-incidental microcarcinoma (P < 0.05, χ2 test).",
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AB - Introduction: Widespread use of ultrasound allows for detection of smaller thyroid nodules and preoperative evaluation with fine-needle aspiration (FNA). Both incidental and non-incidental microcarcinoma can be found, leading to uncertainty with clinical management. Materials and methods: A retrospective analysis of thyroid FNAs performed at our institution was conducted for the 5-year period from 2010 to 2014. Aspirates were categorized using the Bethesda System for Reporting Thyroid Cytopathology. Cytologic diagnoses were then correlated with final histopathology. Among samples with malignancy on surgical resection, nodules were stratified by size. Results: A total of 2531 thyroid FNAs were identified; 587 samples had histologic correlation, and 259 malignancies were reported. They were separated into nodules >1 cm (n = 144, 56%) and ≤1 cm (n = 115, 44%). Microcarcinoma was further subdivided into incidental (size ≤0.5 cm, n = 55, 48%) and non-incidental (size >0.5 cm and ≤1 cm, n = 60, 52%). The preoperative cytologic diagnoses for incidental microcarcinoma were: benign (B, n = 11, 20%), follicular lesion of undetermined significance (FLUS, n = 15, 27%), follicular neoplasm (FN, n = 11, 20%), suspicious for malignancy (SM, n = 7, 13%), malignant (M, n = 8, 15%), and nondiagnostic (ND, n = 3, 5%). The FNA categories for non-incidental microcarcinoma were: B (n = 13, 22%), FLUS (n = 3, 5%), FN (n = 3, 5%), SM (n = 10, 17%), M (n = 29, 48%), and ND (n = 2, 3%). Conclusions: Incidental microcarcinoma is not an uncommon entity, making up 21% (55 of 259) of malignant nodules on thyroidectomy. Indeterminate diagnoses (FLUS + FN + SM) accounted for the majority (60%) of preoperative FNAs for incidental microcarcinoma, compared with 27% for those of non-incidental microcarcinoma (P < 0.05, χ2 test).

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