Journal List > Korean J Cytopathol > v.19(2) > 1006518

Korean J Cytopathol. 2008 Sep;19(2):144-151. Korean.
Published online September 30, 2008.
Copyright © 2008 The Korean Society for Cytopathology
Correlation and Accuracy Between Fine Needle Aspiration Cytology of Thyroid Lesions and Histopathologic Diagnosis -Analysis of 322 Histopathologically Confirmed Cases -
Jaseung Koo, M.D., Woo-Hee Jung, M.D., Seokwoo Yang, M.D. and SoonWon Hong, M.D.
Department of Pathology, Yonsei University Health System, Yongdong Severance Hospital, Seoul, Korea.
Received July 09, 2008; Accepted August 25, 2008.


Fine needle aspiration (FNA) cytology is the decisive test in the preoperative diagnostics of thyroid nodules. Here we share our institutional experience about thyroid aspiration and give suggestions for suspicious cytology results. Three hundred twenty-two cases in 270 patients (mean age 47.4 years, 243 women and 27 men) who underwent thyroidectomy were reviewed. Among the 322 cases, the FNA diagnosis of "positive for malignancy" was 87 cases (27.0%), "suggestive of malignancy" 30 cases (9.3%), "suspicious for malignancy" 61 cases (18.9%), "negative for malignancy" 102 cases (31.7%), and "unsatisfactory smear" 42 cases (13.0%). Eighty seven cases (100%) out of "positive for malignancy", 29 cases (96.7%) out of "suggestive of malignancy", and 39 cases (64.0%) out of "suspicious for malignancy" were papillary carcinoma (148 cases, 95.5%), or follicular carcinoma (2 cases, 1.3%), or metastatic carcinoma (1 case, 0.6%). Seventeen patients who had only negative or unsatisfactory cytology underwent thyroidectomy and nine cases (52.9%) were papillary carcinoma. We suggest that: the cytology diagnosis of "suggestive of malignancy" could be regarded as "positive for malignancy", the cytology diagnosis of "suspicious of malignancy" should be carefully correlated with clinico-radiologic manifestation, and even a negative or unsatisfactory smear should be carefully followed up.

Keywords: Thyroid; Fine needle aspiration cytology


Fig. 1
A suspicious case in cytologic smear. This case shows high cellularity(A), and nuclear clearing, grooves and rare pseudoinclusion(B)(Papanicolaou stain). This case represents similar nuclear feature of papillary carcinoma(C)(H&E). The immunohistochemical stains reveal weak positive reaction to cytokeratin 19, and negative reaction to galectin-3. Therefore, the diagnosis of this case is cellular adenomatous hyperplasia(Immunohistochemical stain; D: CK19; E: galectin-3).
Click for larger image


Table 1
FNA cytologic diagnosis and corresponding histologic findings after thyroid surgery
Click for larger image

Table 2
Case review of histologically non-tumor cases with suspicious cytology
Click for larger image

1. Ashcraft MW, Van Herle AJ. Management of thyroid nodules. II: acanning techniques, thyroid suppressive therapy, and fine needle aspiration. Head Neck Surg 1981;3:297–322.
2. Burch HB, Burman KD, Reed HL, Buckner L, Raber T, Ownbey JL. Fine needle aspiration of thyroid nodules. Determinants of insufficiency rate and malignancy yield at thyroidectomy. Acta Cytol 1996;40:1176–1183.
3. Dwarakanathan AA, Ryan WG, Staren ED, Martirano M, Economou SG. Fine-needle aspiration biopsy of the thyroid. Diagnostic accuracy when performing a moderate number of such procedures. Arch Intern Med 1989;149:2007–2009.
4. Silverman JF, West RL, Larkin EW, et al. The role of fine-needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer 1986;57:1164–1170.
5. Goellner JR, Gharib H, Grant CS, Johnson DA. Fine needle aspiration cytology of the thyroid, 1980 to 1986. Acta Cytol 1987;31:587–590.
6. Miller TR, Bottles K, Holly EA, Friend NF, Abele JS. A step-wise logistic regression analysis of papillary carcinoma of the thyroid. Acta Cytol 1986;30:285–293.
7. Caraway NP, Sneige N, Samaan NA. Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases. Diagn Cytopathol 1993;9:345–350.
8. Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993;118:282–289.
9. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;328:553–559.
10. Ridgway EC. Clinical review 30: Clinician's evaluation of a solitary thyroid nodule. J Clin Endocrinol Metab 1992;74:231–235.
11. Bakhos R, Selvaggi SM, DeJong S, et al. Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance. Diagn Cytopathol 2000;23:233–237.
12. Blansfield JA, Sack MJ, Kukora JS. Recent experience with preoperative fine-needle aspiration biopsy of thyroid nodules in a community hospital. Arch Surg 2002;137:818–821.
13. Duek SD, Goldenberg D, Linn S, Krausz MM, Hershko DD. The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules. Surg Today 2002;32:857–861.
14. Hamming JF, Vriens MR, Goslings BM, Songun I, Fleuren GJ, van de Velde CJ. Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy. World J Surg 1998;22:575–579.
discussion 9-80.
15. Kelman AS, Rathan A, Leibowitz J, Burstein DE, Haber RS. Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens. Thyroid 2001;11:271–277.
16. Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients. Cancer 2000;90:357–363.
17. Park IA, Ham EK. Fine Needle Aspiration Cytology of Thyroid Nodules: assessment of diagnostic accuracy and evaluation of each cytologic diagnosis. Korean J Cytopathol 1999;10:43–53.
18. Park KM, Ko IH. Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Lesions: analysis of Histologically Confirmed 153 Cases. Korean J Cytopathol 1996;7:122–133.
19. Sohn JH, Chae SW, Cho EY, Kim EJ. Diagnostic Correlation and Accuracy Between Fine Needle Aspiration Cytology and Histopathologic Examination. Korean J Cytopathol 2003;14:53–59.
20. Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK. Fine-needle aspiration of thyroid: an institutional experience. Thyroid 1998;8:565–569.
21. Kini SR, Miller JM, Hamburger JI. Problems in the cytologic diagnosis of the "cold' thyroid nodule in patients with lymphocytic thyroiditis. Acta Cytol 1981;25:506–512.
22. Tuttle RM, Lemar H, Burch HB. Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration. Thyroid 1998;8:377–383.
23. Baloch Z, LiVolsi VA, Jain P, et al. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol 2003;29:203–206.
24. Sidawy MK, Del Vecchio DM, Knoll SM. Fine-needle aspiration of thyroid nodules: correlation between cytology and histology and evaluation of discrepant cases. Cancer 1997;81:253–259.