Diagnosis of papillary thyroid carcinoma in fine needle aspiration smears: factors that affect decision making.
OBJECTIVE
To investigate into the limitations in decision making in papillary thyroid carcinoma (PTC) in fine needle aspiration smears.


METHODS
We studied the cytology reports of 21 cases with definitive diagnoses of PTC, 17 suspicious/suggestive of (S/O) PTC, and 17 rule out (R/O) PTC, 8 R/O neoplasms and 15 nonneoplastic lesions with 1 or more cytologic features of PTC. Five important cytomorphologic features-papillary formation, intranuclear cytoplasmic inclusions, nuclear grooves, fine nuclear chromatin and psammoma bodies--were analyzed for their frequency and through a scoring system.


RESULTS
Three or more cytologic features of PTC were present in 18 (85.7%) cases with a definitive diagnosis of PTC as opposed to 7 (41.2%) cases diagnosed as S/O PTC, 2 (11.8%) of R/O PTC, 0% of R/O neoplasia and 0% of nonneoplastic lesions (p =0.0062-<0.0001). The scores of PTC cases (5.8+/-1.14) were significantly higher (p <0.0001) than those of S/O PTC (3.8+/-1.47), R/O PTC (2.4+/-1.27), R/O neoplasia (1.4+/-0.69) and nonneoplastic lesions (1.1+/-0.62). Available histopathology reports in PTC, S/O PTC and R/O PTC cases confirmed the presence of PTC in 92.9%, 62.5% and 16.7%, respectively.


CONCLUSIONS
During decision making, the number of cytomorphologic features as well as some specific features and their extent in FNA smears give varying amounts of confidence to the cytopathologist in diagnosing the cases as PTC or otherwise.
Das
Dilip K
DK
Department of Pathology, Faculty of Medicine, Kuwait University, Mubarak Al-Kabeer Hospital, Safat, Kuwait. dilip76@hotmail.com
Sharma
Prem N
PN
D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000473:pathology*; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013964:Thyroid Neoplasms / Q000473:pathology*; D055815:Young Adult