Limit of FNA cytology in diagnosis of thyroid tumor

June 6, 2009 at 11:26 am | Posted in medicine | Leave a comment

Microarray Analysis of Thyroid Nodule Fine-Needle Aspirates Accurately Classifies Benign and Malignant Lesions

Carrie C. Lubitz*, Stacy K. Ugras*, J. Jacob Kazam{dagger}, Biaxin Zhu*, Theresa Scognamiglio{ddagger}, Yao-Tseng Chen{ddagger} and Thomas J. Fahey, III*§

Although FNA has greatly increased the preoperative diagnostic accuracy of thyroid nodules throughout the past few decades, significant limitations remain. The majority of FNAs performed are classified as benign, while 5 to 10% are classified as malignant.4, 5, 6, 7 However, a subset of 10 to 20% of FNAs are found to be nondiagnostic, frequently secondary to cystic or hemorrhagic fluid and resultant hypocellularity in the aspirate.8, 9 An additional 10 to 20% of FNAs are classified as indeterminate or suspicious, diagnoses that typically include follicular neoplasms and atypical lesions (suggestive of, but not diagnostic for, malignancy). Only one in five of these cases diagnosed as indeterminate will prove to be malignant at surgery. The inability to classify follicular lesions by cytology (which requires nodule architecture for diagnosis), varying extent and spectra of nuclear pleomorphism allowing for subjectivity during histological examination, lack of specific classification algorithms, and fear of liability have all been cited for the difficulty in categorizing this intermediate group.10, 11

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