Skip to main content

Advertisement

SpringerLink
Log in

Follicular Variant of Papillary Thyroid Carcinoma: Accuracy of FNA Diagnosis and Implications for Patient Management

  • Published:
Endocrine Pathology Aims and scope Submit manuscript

Abstract

Follicular variant of papillary thyroid carcinoma (FVPTC) creates a continuous diagnostic dilemma among pathologists because of the paucity of nuclear changes of papillary carcinoma and overlapping features with benign and other neoplastic follicular lesions. Current guidelines for the management of thyroid nodules recommend surgery for confirmed PTC, suspicious for PTC, and follicular neoplasm cases, while further immediate diagnostic studies or treatment are not routinely required if the nodule is benign on cytology. This study is designed to determine the accuracy of cytology in the diagnosis of FVPTC, based on the Bethesda classification system, and determine the implications for patient management based on the current recommendation. Based on a retrospective review of cytologic diagnoses between January 2008 and December 2011, thyroid fine needle aspiration (FNA) cytology specimens with subsequent surgical intervention and a final diagnosis of FVPTC were selected. The cytologic diagnoses were compared with the final diagnoses, and the percentage of cases contributing to the final diagnosis of FVPTC was calculated for each diagnostic category. Triage efficiency and diagnostic accuracy were calculated. One hundred and fifty-two cases with histologic confirmation of FVPTC were identified (representing 128 patients—101 female, 27 male). All patients had undergone either lobectomy with completion thyroidectomy or total thyroidectomy. The cytologic diagnosis of “positive for malignancy” accounted for only 27 % of the final histologic diagnosis of FVPTC, while suspicious for carcinoma, follicular neoplasm, follicular lesion of undetermined significance, and benign accounted for 11, 23, 23, and 16 % of the final diagnosis of FVPTC, respectively. Only 18 % of the 55 cases tested were positive for BRAF mutation. The subtle nuclear features of FVPTC pose challenges for an accurate diagnosis. Therefore, a better approach is to triage these cases for surgical intervention and/or further evaluation of the particular nodule. Our triage efficacy for FVPTC was 84 %; however, the diagnostic accuracy of PTC was 38 %. A negative diagnosis on FNA has diagnostic and management implications for up to 16 % of cases because they may have no further immediate diagnostic studies or treatment. BRAF mutation analysis provides minimal effect on diagnostic accuracy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ramacciotti CE, Pretorius HT, Chu EW, et al. Diagnostic accuracy and use of aspiration biopsy in the management of thyroid nodules. Arch Intern Med 144:1169–1173, 1984.

    Article  PubMed  CAS  Google Scholar 

  2. Wang HH Reporting thyroid fine needle aspiration: Literature review and a proposal. Diagn Cytopathol 34:67–76, 2006.

    Article  PubMed  Google Scholar 

  3. Adeniran AJ, Zhu Z, Gandhi M, et al. Correlation between genetic alterations and microscopic features, clinical manifestations, and prognostic characteristics of thyroid papillary carcinomas. Am J Surg Pathol 30:216–222, 2006.

    Article  PubMed  Google Scholar 

  4. Lam AK, Lo CY, Lam KS. Papillary carcinoma of thyroid: A 30-yr clinicopathological review of the histological variants. Endocrine Pathol 16:323–30,2005.

    Article  Google Scholar 

  5. Kesmodel SB, Terhune KP, Canter RJ, et al. The diagnostic dilemma of follicular variant of papillary thyroid carcinoma. Surgery 134:1005–1012, 2003.

    Article  PubMed  Google Scholar 

  6. Shih SR, Shun CT, Su DH, et al. Follicular variant of papillary thyroid carcinoma: Diagnostic limitations of fine needle aspiration cytology. Acta Cytol 49:383–386, 2005.

    Article  PubMed  Google Scholar 

  7. Lin HS, Komisar A, Opher E, Blaugrund SM. Follicular variant of papillary carcinoma: the diagnostic limitations of preoperative fine-needle aspiration and intraoperative frozen section evaluation. Laryngoscope 110:1431–1436, 2000.

    Article  PubMed  CAS  Google Scholar 

  8. Caraway NP, Sneige N, Samaan NA. Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases. Diagn Cytopathol 9:345–50, 1993.

    Article  PubMed  CAS  Google Scholar 

  9. Powari M, Dey P, Saikia UN. Fine needle aspiration cytology of follicular variant of papillary carcinoma of thyroid. Cytopathology 14:212–215, 2003.

    Article  PubMed  CAS  Google Scholar 

  10. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: A study of 4703 patients with histologic and clinical correlations. Cancer 111:306–315, 2007.

    Article  PubMed  Google Scholar 

  11. Miller JM, Hamburger JI, Kini SR. The needle biopsy diagnosis of papillary thyroid carcinoma. Cancer 48:989 –993, 1981.

    Article  PubMed  CAS  Google Scholar 

  12. Salajegheh A, Petcu EB, Smith RA, Lam AK. Follicular variant of papillary thyroid carcinoma: a diagnostic challenge for clinicians and pathologists. Postgrad Med J 84:78–82, 2008.

    Article  PubMed  CAS  Google Scholar 

  13. El Hag IA, Kollur SM. Benign follicular thyroid lesions versus follicular variant of papillary carcinoma: Differentiation by architectural pattern. Cytopathology 15:200–205, 2004.

    Article  PubMed  Google Scholar 

  14. Zacks JF, de las Morenas A, Beazley RM, O’Brien MJ. Fine-needle aspiration cytology diagnosis of colloid nodule versus follicular variant of papillary carcinoma of the thyroid. Diagn Cytopathol 18:87–90, 1998.

    Article  PubMed  CAS  Google Scholar 

  15. Wu HH, Jones JN, Grzybicki DM, Elsheikh TM. Sensitive cytologic criteria for the identification of follicular variant of papillary thyroid carcinoma in fine-needle aspiration biopsy. Diagn Cytopathol 29:262–266, 2003.

    Article  PubMed  Google Scholar 

  16. Williams MD, Suliburk JW, Staerkel GA, et al. Clinical significance of distinguishing between follicular lesion and follicular neoplasm in thyroid fine-needle aspiration biopsy. Ann Surg Oncol 16:3146–3153, 2009.

    Article  PubMed  Google Scholar 

  17. Jogai S, Adesina AO, Temmim L, et al. Follicular variant of papillary thyroid carcinoma—A cytological study. Cytopathology 15:212–216, 2004.

    Article  PubMed  CAS  Google Scholar 

  18. Dobrinja C, Trevisan G, Liguori G, et al. Sensitivity evaluation of fine-needle aspiration cytology in thyroid lesions. Diagn Cytopathol 37:230–235, 2009.

    Article  PubMed  Google Scholar 

  19. Tielens ET, Sherman SI, Hruban RH, Ladenson PW. Follicular variant of papillary thyroid carcinoma. A clinicopathologic study. Cancer 73:424–31, 1994.

    CAS  Google Scholar 

  20. Lin HW, Bhattacharyya N. Clinical behavior of follicular variant of papillary thyroid carcinoma: presentation and survival. Laryngoscope 120:712–716, 2010.

    Article  PubMed  Google Scholar 

  21. Chang HY, Lin JD, Chou SC, et al. Clinical presentations and outcomes of surgical treatment of follicular variant of the papillary thyroid carcinomas. Jpn J Clin Oncol 36:688–693, 2006.

    Article  PubMed  Google Scholar 

  22. Lang BH, Lo CY, Chan WF, et al. Classical and follicular variant of papillary thyroid carcinoma: a comparative study on clinicopathologic features and long-term outcome. World J Surg 30:752–758, 2006.

    Article  PubMed  Google Scholar 

  23. Jain M, Khan A, Patwardhan N, et al. Follicular variant of papillary thyroid carcinoma: A comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract 7:79–84, 2001.

    Article  PubMed  CAS  Google Scholar 

  24. Logani S, Gupta PK, LiVolsi VA, et al. Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: follow-up and management. Diagn Cytopathol 23:380–385, 2000

    Article  PubMed  CAS  Google Scholar 

  25. Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142, 2006

    Article  PubMed  Google Scholar 

  26. Baloch ZW, Cibas ES, Clark DP, et al. The National Cancer Institute Thyroid fine needle aspiration state of the science conference: A summation. Cytojournal 5:6, 2008

    Article  PubMed  PubMed Central  Google Scholar 

  27. Theoharis CG, Schofield KM, Hammers L, et al. The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution. Thyroid 19:1215–1223, 2009.

    Article  PubMed  Google Scholar 

  28. Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of “follicular neoplasm”: A gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol 26:41–44, 2002.

    Article  PubMed  Google Scholar 

  29. Yang GC, Goldberg JD, Ye PX. Risk of malignancy in follicular neoplasms without nuclear atypia statistical analysis of 397 thyroidectomies. Endocr Pract 9:510–516, 2003.

    Article  PubMed  Google Scholar 

  30. Raber W, Kaserer K, Niederle B, Vierhapper H. Risk Factors for Malignancy of Thyroid Nodules Initially Identified as Follicular Neoplasia by Fine-Needle Aspiration: Results of a Prospective Study of One Hundred Twenty Patients. Thyroid 10:709–712, 2000.

    Article  PubMed  CAS  Google Scholar 

  31. Marhefka GD, McDivitt JD, Shakir KM, Drake AJ 3rd Diagnosis of follicular neoplasm in thyroid nodules by fine needle aspiration cytology: does the result, benign vs. suspicious for a malignant process, in these nodules make a difference? Acta Cytol. 53:517–523, 2009.

    Article  PubMed  Google Scholar 

  32. Fu L, Chhieng D, Theoharis C, et al. Impact of Second Review of Thyroid FNA on the Implementation of Bethesda Classification: An Analysis of Cases on a Consult Service. Modern Pathol. 26(S2):89A, 2013.

    Google Scholar 

  33. Yoon JH, Kim E, Hong SW, et al. Sonographic features of the follicular variant of papillary thyroid carcinoma. J Ultrasound Med 27:1431–1437, 2008.

    PubMed  Google Scholar 

  34. Gupta S, Ajise O, Dultz L, et al. Follicular variant of papillary thyroid cancer, encapsulated, non-encapsulated and diffuse: Distinct biologic and clinical entities. Arch Otolaryngol Head Neck Surg. 138:227–233, 2012.

    Article  PubMed  Google Scholar 

  35. Proietti A, Giannini R, Ugolini C, et al. BRAF status of follicular variant of papillary thyroid carcinoma and its rela\tionship to its clinical and cytological features. Thyroid 20:1263–1270, 2010.

    Google Scholar 

  36. Fadda G, Rossi ED, Raffaelli M, et al. Follicular thyroid neoplasms can be classified as low- and high-risk according to HBME-1 and Galectin-3 expression on liquid-based fine-needle cytology. Eur J Endocrinol. 165:447–453, 2011.

    Article  PubMed  CAS  Google Scholar 

  37. Cochand-Priollet B, Dahan H, Laloi-Michelin M, et al. Immunocytochemistry with cytokeratin 19 and anti-human mesothelial cell antibody (HBME1) increases the diagnostic accuracy of thyroid fine-needle aspirations: preliminary report of 150 liquid-based fine-needle aspirations with histological control. Thyroid. 21:1067–1073, 2011.

    Article  PubMed  CAS  Google Scholar 

  38. Rossi ED, Raffaelli M, Minimo C, et al. Immunocytochemical evaluation of thyroid neoplasms on thin-layer smears from fine-needle aspiration biopsies. Cancer. 105:87–95, 2005

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by funding from the Department of Pathology, Yale University School of Medicine, New Haven, CT.

Financial Disclosures

The authors have no financial disclosures.

Author information

Authors and Affiliations

  1. Department of Pathology, Yale University School of Medicine, 310 Cedar Street, CB 510A, New Haven, CT, 06510, USA

    Berrin Ustun, David Chhieng, Manju L. Prasad & Adebowale J. Adeniran

  2. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Elizabeth Holt

  3. Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA

    Lynwood Hammers

  4. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Tobias Carling & Robert Udelsman

Authors
  1. Berrin Ustun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Chhieng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manju L. Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Holt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lynwood Hammers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tobias Carling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Udelsman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Adebowale J. Adeniran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adebowale J. Adeniran.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ustun, B., Chhieng, D., Prasad, M.L. et al. Follicular Variant of Papillary Thyroid Carcinoma: Accuracy of FNA Diagnosis and Implications for Patient Management. Endocr Pathol 25, 257–264 (2014). https://doi.org/10.1007/s12022-014-9301-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12022-014-9301-3

Keywords

Search

Navigation