J Pathol Transl Med.  2024 Nov;58(6):331-340. 10.4132/jptm.2024.10.12.

Fine needle aspiration cytology diagnoses of follicular thyroid carcinoma: results from a multicenter study in Asia

• Na HY
• Higuchi M
• Satoh S
• Kameyama K
• Jung CK
• Shin SJ
• Agarwal S
• Hang JF
• Zhu Y
• Liu Z
• Bychkov A
• Kakudo K
• Park SY

• KMID: 2560674
• DOI: http://doi.org/10.4132/jptm.2024.10.12

Abstract

Background
This study was designed to compare diagnostic categories of thyroid fine needle aspiration cytology (FNAC) and incidence of thyroid tumors in the multi-institutional Asian series with a special focus on diagnostic category IV (suspicious for a follicular neoplasm) and follicular thyroid carcinomas (FTCs). Methods: Distribution of FNAC categories, incidence of thyroid tumors in resection specimens and cytologic diagnoses of surgically confirmed follicular adenomas (FAs) and FTCs were collected from 10 institutes from five Asian countries and were compared among countries and between FAs and FTCs. Results: The frequency of category IV diagnoses (3.0%) in preoperative FNAC were significantly lower compared to those in Western countries (10.1%). When comparing diagnostic categories among Asian countries, category IV was more frequent in Japan (4.6%) and India (7.9%) than in Taiwan (1.4%), Korea (1.4%), and China (3.6%). Similarly, incidence of FAs and FTCs in surgical resection specimens was significantly higher in Japan (10.9%) and India (10.1%) than in Taiwan (5.5%), Korea (3.0%), and China (2.5%). FTCs were more commonly diagnosed as category IV in Japan (77.5%) than in Korea (33.3%) and China (35.0%). Nuclear pleomorphism, nuclear crowding, microfollicular pattern, and dyshesive cell pattern were more common in FTCs compared with FAs. Conclusions: Our study highlighted the difference in FNAC diagnostic categories of FTCs among Asian countries, which is likely related to different reporting systems and thyroid cancer incidence. Cytologic features such as nuclear pleomorphism, nuclear crowding, microfollicular pattern, and dyshesive cell pattern were found to be useful in diagnosing FTCs more effectively.

Keyword

Thyroid; Biopsy, fine-needle; Adenoma, follicular; Adenocarcinoma, follicular; Follicular neoplasm; Thyroid neoplasms

Figure

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  Fig. 1. The distribution of fine needle aspiration cytology diagnostic categories and surgical diagnoses of thyroidectomy specimens among Asian countries. (A) The frequency of diagnostic category IV (suspicious for a follicular neoplasm [SFN]) is higher in Japan and India than in other countries. The frequency of diagnostic category III (atypia of undetermined significance [AUS]), V (suspicious for malignancy [SM]), and VI (malignant) is higher in Korea and China. (B) Surgical diagnoses of follicular-patterned neoplasm including follicular adenoma (FA), Hürthle cell adenoma (HCA), Hürthle cell carcinoma (HCC), follicular thyroid carcinoma (FTC), noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP) and invasive encapsulated follicular variant papillary thyroid carcinoma (IEFVPTC), are significantly more frequent in Japan and India than in other Asian countries. In Korea and China, papillary thyroid carcinomas (PTCs), including papillary microcarcinomas (PMCs), are more prevalent than in other countries.

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  Fig. 2. Distribution of preoperative fine needle aspiration cytology diagnostic categories of follicular adenomas and follicular thyroid carcinomas. (A) Follicular adenomas are more frequently diagnosed as diagnostic category III (atypia of undetermined significance [AUS]) in Korea than in Japan. (B) Follicular thyroid carcinomas are more commonly diagnosed as category IV (suspicious for a follicular neoplasm [SFN]) in Japan and India than in Korea and China. On the other hand, they were more frequently diagnosed as category III (AUS) in Korea than in Japan. SM, suspicious for malignancy.

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  Fig. 3. Cytologic features of follicular thyroid carcinomas (FTCs). Predominant microfollicular pattern (A) and extensive dyshesive cells (B) are more commonly observed in FTCs. (C, D) High power view of microfollicles shows marked nuclear crowding and nuclear pleomorphism, which are more frequent in FTCs. Nuclear enlargement (E) and hyperchromatism (F) are more common in angioinvasive FTCs and widely invasive FTCs compared to minimally invasive FTCs.

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Reference

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