Image analysis of papillary thyroid carcinoma fine-needle aspirates - Significant association between aneuploidy and death from disease

BACKGROUND. Papillary thyroid carcinoma is the most common thyroid malignan cy in the U.S. As many as half of patients with papillary carcinoma present with cervical lymph node metastases at the time of diagnosis. Metastatic d isease involving cervical lymph node tissue has not historically been prove n to correlate with a more aggressive course; however, distant metastases w orsen prognosis. METHODS. Diagnostic fine-needle aspiration (FNA) smears from 26 primary and metastatic papillary carcinomas underwent Feulgen reaction and were studie d by image analysis to determine DNA pattern, proliferation index, and the percentage of cells with DNA content >5C. The medical records of all the pa tients were reviewed for metastatic disease pattern and survival data. For metastatic pattern, two groups were defined: 1) confined to thyroid/local l ymph node metastases/soft tissues of die neck involved by tumor, and 2) dis tant metastases. RESULTS. Among the 26 patients, 16 had "nonaggressive" DNA patterns describ ed as diploid, abnormal diploid, or tetraploid, and 10 had "aggressive" DNA patterns described as aneuploid. Only 2 of the 16 patients in the "nonaggr essive" DNA pattern group developed distant metastases, whereas 5 of the 10 patients in the aneuploid group developed distant metastatic disease. In a ddition, none of the 16 patients with "nonaggressive" DNA patterns died of disease, whereas 3 of the 10 individuals with DNA histograms interpreted as aneuploid did die of metastatic disease complications. CONCLUSIONS, Aneuploidy identified by image analysis of FNA of papillary th yroid carcinoma is significantly associated with death from papillary carci noma (log rank test, P= 0.027. (C) 1999 American Cancer Society.