Korean J Radiol.  2010 Apr;11(2):141-148. 10.3348/kjr.2010.11.2.141.

Histopathologic Findings Related to the Indeterminate or Inadequate Results of Fine-Needle Aspiration Biopsy and Correlation with Ultrasonographic Findings in Papillary Thyroid Carcinomas

• Jung SL
• Jung CK
• Kim SH
• Kang BJ
• Ahn KJ
• Kim BS
• Ahn MI
• Im DJ
• Bae JS
• Chung SK

• KMID: 1783189
• DOI: http://doi.org/10.3348/kjr.2010.11.2.141

Abstract

OBJECTIVE
To determine histopathologic findings related to the indeterminate or inadequate result of fine-needle aspiration biopsy (FNAB) in papillary thyroid carcinomas (PTCs) and to correlate histopathological findings with ultrasonographic features of tumors. Materials and
METHODS
We retrospectively reviewed the medical records of FNAB, histopathologic characteristics, and sonographic findings of the solid portion of 95 PTCs in 95 patients. All cases were pathologically confirmed by surgery. Histopathologic characteristics were analyzed for tumor distribution, microcystic changes, fibrosis, and tumor component. We assumed several histopathologic conditions to be the cause of indeterminate or inadequate results of FNAB, including: 1) an uneven tumor distribution, 2) > 30% microcystic changes, 3) > 30% fibrosis, and 4) < 30% tumor component. Ultrasonographic findings of each PTC were evaluated for echotexture (homogeneous or heterogeneous), echogenicity (markedly hypoechoic, hypoechoic, isoechoic, or hyperechoic), and volume of the nodule. We correlated histopathologic characteristics of the PTC with results of the FNAB and ultrasonographic findings.
RESULTS
From 95 FNABs, 71 cases (74%) were confirmed with malignancy or suspicious malignancy (PTCs), 21 (22%) had indeterminate results (atypical cells), and three (4%) were negative for malignancy. None of the assumed variables influenced the diagnostic accuracy of FNAB. Tumor distribution and fibrosis were statistically correlated with ultrasonographic findings of the PTCs (p < 0.05). Uneven tumor distribution was related with small tumor volume, and fibrosis over 30% was correlated with homogeneous echotexture, markedly hypoechoic and hypoechoic echogenicity, and small tumor volume (p < 0.05).
CONCLUSION
No histopathologic component was found to correlate with improper results of FNAB in PTCs. In contrast, two histopathologic characteristics, uneven distribution and fibrosis, were correlated with ultrasonographic findings.

Keyword

Thyroid; Ultrasonography; Pathology; Cancer

MeSH Terms

Adult
Aged
Biopsy, Fine-Needle/methods
Carcinoma, Papillary/*pathology/*ultrasonography
Female
Humans
Male
Middle Aged
Reproducibility of Results
Retrospective Studies
Thyroid Gland/pathology/ultrasonography
Thyroid Neoplasms/*pathology/*ultrasonography
Young Adult

Figure

• 

  Fig. 1 Histopathologic (A, ×12.5) and ultrasonographic images (B, C) of papillary thyroid carcinoma with uneven distribution and prominent fibrosis of right thyroid gland in 29-year-old male with improper result of fine-needle aspiration biopsy. Uneven distribution of tumor cells, prominent fibrosis (arrows) > 30%, and no microcystic change are seen on histopathologic image (A). Axial (B) and longitudinal (C) ultrasonographic images show heterogeneous echogenicity, markedly hypoechoic or hypoechoic echogenicity (arrows), and spiculated margin (arrowheads). Result of fine-needle aspiration biopsy was indeterminate (atypical cells).

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  Fig. 2 Histopathologic (A, ×12.5) and ultrasonographic (B) finding of small papillary thyroid carcinoma (8×5×9 mm, 0.2 ml) with uneven distribution and prominent fibrosis in left thyroid gland of 50-year-old female. Uneven distribution of tumor cells (A) is seen in nodule. Prominent fibrosis > 30% (arrow) is represented with hypoechoic and markedly hypoechoic echogenicity (arrowhead) on ultrasonography (B). Result of fine-needle aspiration biopsy is malignancy (papillary carcinoma).

• 

  Fig. 3 Histopathologic (A, ×12.5) and ultrasonographic (B) findings of papillary thyroid carcinoma with prominent fibrosis > 30% in right thyroid gland of 28-year-old female. Histopathologic image shows small nodule with uneven tumor distribution and prominent fibrosis (A). Fibrosis (arrow in A) of histopathologic characteristics is represented with homogeneous echotexture and markedly hypoechogenicity on ultrasonography (B). Result of fine-needle aspiration biopsy is malignancy (papillary carcinoma).

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  Fig. 4 Histopathologic (A, ×12.5) and ultrasonographic (B) findings of papillary thyroid carcinoma follicular variant with prominent tumor component > 30% in left thyroid gland of 50-year-old male. Prominent tumor component > 30% and no fibrosis are seen on histopathologic image (A). These findings are characterized as heterogeneous echotexture and hypoechoic echogenicity on ultrasonography. This mass is larger than 0.5 ml (16×24×28 mm, 21.5 ml). Result of fine-needle aspiration biopsy is negative for malignancy (benign).

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  Fig. 5 Histopathologic (A, ×12.5) and ultrasonographic findings (B) of papillary thyroid carcinoma with prominent tumor component (> 30%) in right thyroid gland of 32-year-old male. Histopathologic image shows even tumor distribution and prominent tumor component (> 30%), although some fibrosis > 30% is seen. No microcystic change is observed. Ultrasonography shows heterogeneous echotexture, isoechogenicity, and ill defined margin. It is larger than 0.5 ml (12×13×19 mm, 1.5 ml). Result of fine-needle aspiration biopsy is malignancy (papillary carcinoma).

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