Potential pitfalls for false suspicion of papillary thyroid carcinoma: A Cytohistologic Review of 22 Cases

The findings demonstrated that the following factors may contribute to the false suspicion of papillary thyroid carcinoma: misinterpretation of papillary-like tissue fragments with honeycomb arrangement and fragments of fibrocollagenous tissue with entrapped follicular cells; overinterpretation of suboptimal intranuclear grooves and rare intranuclear pseudoinclusion in the absence of the other features of PTC; misinterpretation of the polygonal, epithelioid,

Xin Jing

2011

Scholarcy highlights

  • To evaluate the diagnostic pitfalls attributing to false suspicious interpretation of papillary thyroid carcinoma, we performed a retrospective cytohistologic review of thyroid nodules diagnosed as suspicious for papillary carcinoma with histologyproven false suspicion of PTC
  • The recently published ‘‘The Bethesda System for Reporting Thyroid Cytopathology’’ demonstrates the criteria of ‘‘suspicious for malignancy’’ and ‘‘suspicious for PTC’’ represents the majority of the lesions falling into suspicious category
  • Psammoma bodies, and multinucleated giant cells were inconspicuous. This retrospective review of 22 thyroid aspirates with a histology-proven false suspicious diagnosis of PTC demonstrated that the following factors were the main contributing features to the false suspicion of PTC: misinterpretation of papillary-like tissue fragments with honeycomb arrangement or fragments of fibrocollagenous tissue with entrapped follicular cells; overinterpretation of suboptimal intranuclear grooves in the nuclei with minimal diagnostic features of PTC; overinterpretation of rare intranuclear pseudoinclusion in the absence of the other features of PTC; misinterpretation of the elongate or spindle cells that represented atypical cyst lining cells
  • The presence of nuclear enlargement, pale chromatin, and occasional intranuclear grooves in the ‘‘atypical’’ cells is a worrisome finding for PTC, the suspicious diagnosis of PTC should be made with great caution due to the lack of other features associated with PTC such as nuclear crowding/overlapping, intranuclear pseudoinclusions, etc
  • Challenge does exist in routing cytologic practice with regard to separation of ‘‘suspicious for PTC’’ from ‘‘AUS/FLUS.’’ Weber et al. reported histology-proven PTC in 25 of 57 aspirates which were interpreted as ‘‘atypical epithelial cells, cannot exclude papillary thyroid carcinoma.’’ The blind, retrospective review of 123 aspirates which were originally interpreted as AUS/FLUS and followed by surgeries in our institution re-classified two aspirates as PTC which were confirmed by the corresponding surgical specimens while three cases of histology-proven PTC were still not diagnosed despite the secondary review
  • It is essential to recognize that the presence of focal atypical features that are reported in PTC could be recognized in non-PTC fine needle aspiration and are not sufficient to raise the suspicion for PTC unless other corroborating features are noted

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