Morphologic predictors of papillary carcinoma on fine-needle aspiration ofthyroid with ThinPrep (R) preparations

Although the cytologic features of papillary carcinoma of the thyroid are w ell-known, none is entirely specific. We conducted this study to determine the minimal criteria necessary to achieve 100% specificity fbr the diagnosi s of papillary carcinoma on fine-needle aspiration (FNA). Forty patients wi th histologically confirmed papillary carcinoma and 17 patients with other thyroid lesions who underwent preoperative FNA at Beth Israel Deaconess Med ical Center during a 4-yr period were included in the study. All cytology s lides were prepared with the ThinPrep (R) processing technique. Various arc hitectural and nuclear features were evaluated with a score assigned to eac h feature, and correlated with the histologic diagnosis of papillary carcin oma. tranuclear inclusions, papillary and/or sheet arrangements, nuclear gr ooves, powdery chromatin, nuclear molding, high cellularity and small nucle oli were significantly associated with papillary carcinoma (P < 0.05). The requirement of any intranuclear inclusions and many nuclear grooves, or a m inimum of sum of scores (of the above eight features) of 10, yields 100% sp ecificity and approximately 70% sensitivity Cases with Server features can be reported as suspicious or indeterminate for papillary carcinoma. A quant itative/probabilistic approach in the reporting of thyroid FNA provides a p ractical guide for management of patients with thyroid modules. (C) 2001 Wi ley-Liss, Inc.