title: Diagnostic Accuracy of Fine Needle Aspiration in Thyroid Nodules Arising in Patients with Graves Disease.
abstract: OBJECTIVE
  Cytopathologic interpretation in Graves disease (GD) is considered challenging due to significant cellular atypia.
  
  
  METHODS
  We retrospectively identified 55 fine needle aspirations (FNAs) from 43 patients with GD that subsequently underwent thyroidectomy from 1995 to 2016.
  
  
  RESULTS
  There were 5 patients with papillary thyroid carcinoma (PTC) and 4 with follicular adenoma (FA). Of the 5 patients with PTC, FNA was interpreted as PTC in 3, atypia of undetermined significance (AUS) in 1, and adenomatoid nodule (AN) in 1 (with a 0.5-cm incidental microcarcinoma). Of the 4 patients with FA, FNA was interpreted as follicular neoplasm (FN) in 2, AUS in 1, and AN in 1. Of the 46 nonneoplastic nodules, FNA was interpreted as nondiagnostic in 2, benign in 26, AUS in 15, FN in 1, and suspicious for PTC in 2. None was diagnosed as malignant. The sensitivity, specificity, positive predictive value, and negative predictive value of PTC diagnosis in FNA were 60, 100, 100, and 96.2%, respectively.
  
  
  CONCLUSIONS
  FNA is a useful tool for identifying neoplastic nodules arising in GD. However, cytologic atypia often leads to indeterminate diagnoses (18/46, 39.1%). Awareness of clinical information regarding prior treatment for GD may be helpful to avoid overinterpretation.
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Jen-Fan
authors.initials: JF
authors.lastname: Hang
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Lilo
authors.forename: Justin A
authors.initials: JA
authors.lastname: Bishop
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Ali
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006111:Graves Disease / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
keywords: Cytopathology; Fine needle aspiration; Graves disease; Thyroid