title: Fine-needle aspiration cytology of thyroid nodules with Hürthle cells: cytomorphologic predictors for neoplasms, improving diagnostic accuracy and overcoming pitfalls.
abstract: OBJECTIVE
  Hürthle cells (HCs) are follicular-derived oncocytic cells seen in a variety of neoplastic and nonneoplastic pathologic entities of the thyroid gland. This study was to report our experience of the surgical outcome on the finding of HCs on fine-needle aspiration biopsies (FNABs) of thyroid nodules, to identify cytologic predictors of HC neoplasms and an attempt to overcome diagnostic pitfalls.
  
  
  METHODS
  This was a retrospective study of all FNAB of thyroid nodules with findings of HCs with subsequent surgical resection. The FNAB slides of 70 thyroid nodules were blindly reviewed for specific cytomorphologic characteristics. The cytologic findings were correlated with the corresponding final surgical pathology diagnosis.
  
  
  RESULTS
  The patients ranged in age from 25 to 78 years with a male:female ratio of 1:2. There were 19 false-negative and 4 false-positive cases. Overall high cellularity, scant colloid and >90% HCs on FNAB are consistently seen in a neoplastic HC process. All cases of Hashimoto's thyroiditis were associated with prominent nucleoli and 92% of cases demonstrating transgressing vessels were neoplastic.
  
  
  CONCLUSIONS
  Diagnostic accuracy can be improved by following the current Bethesda classification system. A constellation of cytomorphologic features in conjunction with clinical findings can be considered a strong predictor of a neoplastic process.
authors: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wis., USA.
authors: K A
authors: KA
authors: Kasper
authors: J
authors: J
authors: Stewart
authors: K
authors: K
authors: Das
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D024862:Oxyphil Cells / Q000473:pathology*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000473:pathology*