Diagnostic Dilemma of a Follicular Lesions/Neoplasm in Thyroid Fine Needle Aspiration Cytology

Chan Kwon Jung

doi:10.11106/jkta.2012.5.2.104

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Jung: Diagnostic Dilemma of a Follicular Lesions/Neoplasm in Thyroid Fine Needle Aspiration Cytology

Review Article

Journal of Korean Thyroid Association

Journal of Korean Thyroid Association 2012; 5(2): 104-108.

Published online: 28 November 2012

DOI: https://doi.org/10.11106/jkta.2012.5.2.104

Diagnostic Dilemma of a Follicular Lesions/Neoplasm in Thyroid Fine Needle Aspiration Cytology

Chan Kwon Jung

Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence: Chan Kwon Jung, MD, PhD, Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Korea. Tel: 82-2-2258-1622, Fax: 82-2-2258-1628, ckjung@catholic.ac.kr

Received 28 March 2012 Revised 6 June 2012 Accepted 25 June 2012

(open-access):

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fine needle aspiration cytology (FNAC) of thyroid nodules is the best screening test for the selection of patients that may require surgical management. However, the diagnosis of follicular neoplasm on FNAC remains a gray area and the main differential diagnosis of follicular neoplasm includes benign (nodular hyperplasia and follicular adenoma) and malignant (follicular carcinoma and follicular variant of papillary carcinoma) lesions. The cytologic diagnosis of follicular neoplasm is based on the high cellularity, microfollicular or trabecular pattern, overlapping follicular cells, and scanty or absent colloid. Histologically, the diagnosis of follicular carcinoma requires the presence of tumor capsular invasion or vascular invasion. In the follicular variant of papillary carcinoma, nuclear features of papillary carcinoma may be subtle and seen in only a small number of cells, and thus may not be readily appreciated. Analyses of BRAF and RAS point mutations and RET/PTC and PAX8/PPARγ rearrangements have been reported to be a useful ancillary tool for diagnosing thyroid cancer in cytology specimens. The presence of BRAF or RET/PTC mutation is a strong indicator of papillary carcinoma. PAX8/PPARγ rearrangement is exclusively found in follicular carcinoma. RAS mutations are found in follicular adenoma/carcinoma and follicular variant of papillary carcinoma. Therefore, molecular testing of FNAC samples can improve the accuracy of cytologic diagnosis.

Keywords: Thyroid neoplasm, Fine-needle aspiration, Differential diagnosis, Molecular diagnostic testing

Figures and Tables

Table 1

The utility of BRAF mutation testing for diagnosis of malignancy in thyroid FNAC

When calculating diagnostic values the indeterminate cytological diagnosis was considered negative cytology in the studiesof Kim SW, Nam SY and Yeo MK, whereas the indeterminate was catego rized as positive cytology in the studies of Kim SK and Chung KW. FNAC: fine needle aspiration cytology, NPV: negative predictive value, PPV: positive predictive value, RFLP: restriction fragment length polymorphism. ^*Histological diagnoses of five false positive results were follicular adenoma in one case and nodular hyperplasia in four cases. ^†One false positive case was histologically diagnosed as atypical nodular hyperplasia

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