Clinical parameters and echographic patterns are poor predictive of malignancy in follicular and Hürthle cell nodules at cytology
T Rago, G Di Coscio, F Basolo, M Scutari, P Berti, R Romani, P Faviana, P Miccoli, A Pinchera & P Vitti
Aim of the study was to establish the diagnostic value of nuclear atypia thyroid nodules with cytological diagnosis of follicular (FOL) and Hv¨rthle cell (HC) neoplasia. 1039/23.313 fine needle aspiration (FNA) performed in January 2002 June 2005 in the Department of Endocrinology, University of Pisa had cytological diagnosis of FOL e CH. FNA was performed under echo guidance, using 23 gauge needle attached to 10 mL syringe. The material was air-dryed and stained with Papanicolau e Giemsa. Cytological criteria used for diagnosis of follicular nodule included hypercellularity with small, uniform cells and poor and watery colloid content. The presence of nuclear enlargement and hypercromic nuclei with irregular / coarse chromatin was defined as atypia. 495 patients (388 F: mean age 45±14 yr; 107 M: mean age 46±14 yr) with cold nodule at scintiscan underwent thyroidectomy at the Department of Surgery, University of Pisa. Histology was made according to the World Health Organization guide lines.
Results: 418/ 495 patients had a cytological diagnosis of FOL: 82 with nuclear atypia and 336 without nuclear atypia; 77/495 had HC diagnosis: 18 with nuclear atypia and 59 without nuclear atypia. CA hystological diagnosis was made in 45/100 (45%) nodules with nuclear atypia and in 79/395 (20%) nodules without nuclear atypia (X2=26.5; P<0.0001).
In conclusion, nuclear atypia characterized by nuclear enlargement and hypercromic nuclei with irregular/coarse chromatin is a pattern predictive of malignancy in follicular/Hürthle neoplasia at cytology.