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Follicular Lesions of Thyroid Cytopathology-Diagnostic Pitfalls

Parinitha Sadashivappa Sangam, Associate Professor, Department of Pathology, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka 580009, India. , Keerti Hiremath1 , Parinitha Sadashivappa Sangam2 , Hephzibah Rani3

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Indian Journal of Pathology: Research and Practice 7(7):p 835-840, July 2018. | DOI: http://dx.doi.org/10.21088/ijprp.2278.148X.7718.4

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Abstract

Context: Fine-needle aspiration (FNA) is well known non invasive tool for diagnosis of thyroid nodules thereby drastically reducing the number of surgeries. However the most  common limitation of FNA is in follicular lesions termed ‘follicular neoplasms’. This is due to the inability in differentiating benign follicular lesions from malignant. The aim of the study was to study the cytomorphology of follicular lesions of thyroid and to study the sensitivity and specificity of FNA in follicular lesions.

Settings and Design: Retrospective study of 5 years duration from January 2011 to June 2016. All cases which have undergone both FNA and biopsy in our institute and diagnosed as follicular/hurthle cell adenoma, follicular/hurthle cell carcinoma and follicular variant of papillary carcinoma on histopathology are included. 

Statistical analysis used: The data collected was tabulated and analysed by proportions and percentages. Statistical Package for the social sciences (SPSS) version 20.0 software was used to analyse the data.

Results: Out of the 39 cases studied, 14 were given a diagnosis of “follicular neoplasms” on FNA. 16 were given as benign lesions (nodular goitre, adenomatoid goitre, colloid nodule). One each reported as hurthle cell neoplasm and suspicious for malignancy. Seven cases reported as suspicious for papillary carcinoma. 10 out of 14 reported as follicular neoplasms on FNAC were benign and 4 were malignant on histopathology. The rate of malignancy was 35.8%. The most common malignancy was follicular carcinoma. 

Conclusions: There was overlap between benign and malignant follicular patterned lesions on cytology. Follicular lesions prove to be a major challenge in the application of FNA in thyroid lesions.

Keywords: Fine-Needle Aspiration; Follicular Cell Carcinoma; Histopathology.

 

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DOI: http://dx.doi.org/10.21088/ijprp.2278.148X.7718.4

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