title: Fine-needle aspiration biopsy of the thyroid: review of cytopathologic features predictive of malignancy.
abstract: OBJECTIVE
  To determine the value of specific cytopathologic features on fine-needle aspiration biopsies (FNABs) at predicting thyroid malignancy.
  
  
  METHODS
  Retrospective review of consecutive patients undergoing thyroidectomy between 2005 and 2007 following FNAB of thyroid nodules.
  
  
  METHODS
  Two McGill University teaching hospitals in Montreal.
  
  
  METHODS
  One hundred forty-seven patients were reviewed and further categorized into two groups (benign vs malignant) based on the final histopathologic diagnosis. The frequency of specific cytopathologic features from the preoperative FNAB samples was recorded for 106 patients from the first hospital and 41 patients from the second.
  
  
  RESULTS
  The presence of atypical cells (30% vs 72%; p = 3.23 x 10(-7)), nuclear grooves (5% vs 23%; p = .002), anisonucleosis (8% vs 36%; p = .00011), variable chromatin staining (10% vs 28%; p = .007), hypochromasia (11% vs 47%; p = 7.19 x 10(-6)), nuclear overlapping/crowding (8% vs 29%; p = .0019), irregular nuclear membranes (15% vs 52%, p = 3.22 x 10(-6)), micronucleoli (15% vs 60%, p = .003), and powdery chromatin (8% vs 47%, p = .004) correlates with an increased risk of malignancy. Alternatively, siderophages (44% vs 23%; p = .007) and honeycomb arrangements (92% vs 60%; p = .012) were more associated with benign processes. HBME-1 staining (n = 53) was positive or focally positive on 61% of the malignant cases (p = .0002), with a specificity of 100%. All biopsies demonstrating intranuclear inclusions, papillary fragments, or atypical architecture were malignant.
  
  
  CONCLUSIONS
  Some cytopathologic features are more significantly associated with thyroid malignancy. The cytopathologic features listed in FNAB reports and HBME-1 immunoreactivity are, alone or in combination, additional tools available to the physician to guide management of thyroid nodules.
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Tamara
authors.initials: T
authors.lastname: Mijovic
authors.forename: Olguta
authors.initials: O
authors.lastname: Gologan
authors.forename: Louise
authors.initials: L
authors.lastname: Rochon
authors.forename: Michael
authors.initials: M
authors.lastname: Hier
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Black
authors.forename: Jonathan
authors.initials: J
authors.lastname: Young
authors.forename: Juan
authors.initials: J
authors.lastname: Rivera
authors.forename: Michael
authors.initials: M
authors.lastname: Tamilia
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Payne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000378:metabolism / Q000473:pathology*; D013965:Thyroidectomy; D055815:Young Adult; D000951:Antigens, Neoplasm
chemical_list: D014408:Biomarkers, Tumor; C432845:HBME-1 antigen; D000951:Antigens, Neoplasm