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Abstract
Background and Objectives
We investigated the clinical value of additional von Kossa staining in thyroid nodules with “suspicious for malignancy” on cytology.
Materials and Methods
From March 2010 to November 2010, 55 patients with 55 nodules which were diagnosed as “suspicious for malignancy” on cytology and had microcalcifications on ultrasound (US) underwent surgery and made up our final study population. We evaluated the role of the von Kossa stain as a preoperative diagnostic factor for thyroid cancer using histopathology as the “gold standard”. Diagnostic performances were calculated of the presence of psammoma bodies on both cytology and the von Kossa staining and of US in predicting thyroid cancers.
Results
Of 55 nodules with microcalcifications on US and “suspicious for malignancy” on cytology, 53 (96.4%) were malignant and 2 (3.6%) were benign on histopathology. All pathologically benign nodules were negative on the von Kossa stain. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the von Kossa stain were 28.3%, 100%, 30.9%, 100%, and 5% for diagnosis, respectively.
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Fig. 1.
Two types of calcifications on cytologic slides. (A) “Psammoma bodies” showing calcified concentric rings (smear, Papanicolaou stain, ×400). (B) “Dystrophic calcifications” showing irregular plates (smear, Papanicolaou stain, ×200).
Fig. 2.
A 23-year-old female diagnosed with papillary thyroid carcinoma. A 5-cm hypoechogenic mass with internal microcalcifications was seen on (A, left-transverse scan, right-longitudinal scan) the right-longitudinal scan. On the cytology smear, there was a crowded group of follicular epithelial cells with powdery chromatin, nuclear grooves and micronucleoli, which were interpreted as “suspicious for papillary thyroid carcinoma” (B, smear, Papanicolaou stain, ×400). Psammoma bodies were seen in cytologic slides and the von Kossa stain was positive (C, arrow, smear, ×400). On the surgical slide, psammoma bodies were associated with tumor cells (D, arrow, ×400).
Table 1.
Demographics of the 55 patients
Table 2.
Final histopathologic diagnosis
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