The Incidence and Clinicopathologic Characteristics of Patients Who Had False-Positive Fine-Needle Aspiration Results for Papillary Thyroid Cancer
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Fine needle aspiration (FNA) is a well-established method for diagnosis of thyroid tumors. However, FNA sometimes fails to distinguish benign thyroid nodules from papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the incidence and clinicopathologic characteristics of patients who had thyroidectomy due to consistent findings of PTC in FNA but turned out to bear no evidence of malignancy in surgically removed thyroids. Methods: We retrospectively reviewed 10,776 patients who underwent thyroid surgery from January 2009 to January 2019 due to suspicion for PTC, 40 of whom were diagnosed as benign in final histology. Results: We compared the clinical and pathologic characteristics of 2 groups, including subgroup analysis between Bethesda category V and VI. The false(+) rate for FNA was 0.4%. The ratio of patients aged ≥55 years was statistically higher in the false(+) group compared to the true(+) group. Age ≥55 years and Bethesda category V were risk factors for false(+) FNA in multivariate analysis. Conclusion: Although the false(+) rate is low (0.4%), surgeons should be aware of these circumstances and inform patients of the possibility of a false positive result in those with age >55 years, suspicion for malignancy on FNA (Bethesda category V), and low suspicion/benign for Korean thyroid imaging reporting and data system. To reduce unnecessary thyroidectomy, core needle biopsy or repeat FNA should be considered for a patient with these findings. Further large-scale studies are necessary to establish a firm conclusion.
Abstract
Purpose: Fine needle aspiration (FNA) is a well-established method for diagnosis of thyroid tumors. However, FNA sometimes fails to distinguish benign thyroid nodules from papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the incidence and clinicopathologic characteristics of patients who had thyroidectomy due to consistent findings of PTC in FNA but turned out to bear no evidence of malignancy in surgically removed thyroids. Methods: We retrospectively reviewed 10,776 patients who underwent thyroid surgery from January 2009 to January 2019 due to suspicion for PTC, 40 of whom were diagnosed as benign in final histology. Results: We compared the clinical and pathologic characteristics of 2 groups, including subgroup analysis between Bethesda category V and VI. The false(+) rate for FNA was 0.4%. The ratio of patients aged ≥55 years was statistically higher in the false(+) group compared to the true(+) group. Age ≥55 years and Bethesda category V were risk factors for false(+) FNA in multivariate analysis. Conclusion: Although the false(+) rate is low (0.4%), surgeons should be aware of these circumstances and inform patients of the possibility of a false positive result in those with age >55 years, suspicion for malignancy on FNA (Bethesda category V), and low suspicion/benign for Korean thyroid imaging reporting and data system. To reduce unnecessary thyroidectomy, core needle biopsy or repeat FNA should be considered for a patient with these findings. Further large-scale studies are necessary to establish a firm conclusion.
참고문헌 (29)
- Dean DS, "Epidemiology of thyroid nodules", Best Pract Res Clin Endocrinol Metab, 22, pp.901~911 (2008)
- Gharib H, "Thyroid nodules : a review of current guidelines, practices, and prospects", Eur J Endocrinol, 159, pp.493~505 (2008)
- Carcangiu ML, "Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy", Cancer, 55, pp.805~828 (1985)
- Nam-Goong IS, "Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma : correlation with pathological findings", Clin Endocrinol(Oxf), 60, pp.21~28 (2004)
- Bomeli SR, "Evaluation of a thyroid nodule", Otolaryngol Clin North Am, 43, pp.229~238 (2010)
- Kini SR, "Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration", Acta Cytol, 24, pp.511~521 (1980)
- Haugen BR, "2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer : the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer", Thyroid, 26, pp.1~133 (2016)
- Baloch ZW, "Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions : a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference", Diagn Cytopathol, 36, pp.425~437 (2008)
- Cibas ES, "The Bethesda system for reporting thyroid cytopathology", Thyroid, 19, pp.1159~1165 (2009)
- Yi KI, "False-positive cytopathology results for papillary thyroid carcinoma : a trap for thyroid surgeons", Clin Otolaryngol, 42, pp.1153~1160 (2017)
- Lew JI, "Fine needle aspiration of the thyroid : correlation with final histopathology in a surgical series of 797 patients", J Am Coll Surg, 213, pp.188~194 (2011)
- Richmond BK, "False-negative results with the Bethesda system of reporting thyroid cytopathology : predictors of malignancy in thyroid nodules classified as benign by cytopathologic evaluation", Am Surg, 80, pp.811~816 (2014)
- Malheiros DC, "Thyroid FNAC : causes of false-positive results", Cytopathology, 29, pp.407~417 (2018)
- Jang EK, "Positive cytology findings and a negative histological diagnosis of papillary thyroid carcinoma in the thyroid : is it a false-positive cytology or a disappearing tumor?", Eur Thyroid J, 2, pp.203~210 (2013)
- Khayyata S, "Papillary hyperplastic nodule : pitfall in the cytopathologic diagnosis of papillary thyroid carcinoma", Endocr Pract, 14, pp.863~868 (2008)
- Batistatou A, "Pathogenesis and diagnostic significance of nuclear grooves in thyroid and other sites", Int J Surg Pathol, 17, pp.107~110 (2009)
- Bhatia P, "Vanishing tumors of thyroid : histological variations after fine needle aspiration", Gland Surg, 5, pp.270~277 (2016)
- 신정희, "Ultrasonography Diagnosis and Imaging-Based Management of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations", Korean Journal of Radiology, 17(3), pp.370~395 (2016), 대한영상의학회[DOI]
- Arif S, "Hashimoto's thyroiditis shares features with early papillary thyroid carcinoma", Histopathology, 41, pp.357~362 (2002)
- Yoon JH, "The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3 cm or larger", Thyroid, 21, pp.993~1000 (2011)
- Baloch ZW, "Cytologic and architectural mimics of papillary thyroid carcinoma. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens", Am J Clin Pathol, (125 Suppl), pp.S135~S144 (2006)
- Harach HR, "Parenchymatous thyroid nodules : a histocytological study of 31 cases from a goitrous area", J Clin Pathol, 45, pp.25~29 (1992)
- Fiorella RM, "Multinodular goiter of the thyroid mimicking malignancy : diagnostic pitfalls in fine-needle aspiration biopsy", Diagn Cytopathol, 9, pp.351~355 (1993)
- Kitano M, "Cytopathological review of patients that underwent thyroidectomies based on the diagnosis of papillary thyroid carcinoma by fine needle aspiration cytology but were later found to have benign tumors by histopathology", Surg Today, 43, pp.632~637 (2013)
- Anderson L, "Hashimoto thyroiditis : part 1, sonographic analysis of the nodular form of Hashimoto thyroiditis", AJR Am J Roentgenol, 195, pp.208~215 (2010)
- 황세나, "Focal Lymphocytic Thyroiditis Nodules Share the Features of Papillary Thyroid Cancer on Ultrasound", Yonsei Medical Journal, 56(5), pp.1338~1344 (2015), 연세대학교의과대학[DOI]
- Renshaw AA, "Comparison of thyroid fine-needle aspiration and core needle biopsy", Am J Clin Pathol, 128, pp.370~374 (2007)
- El Demellawy D, "Application of CD56, P63 and CK19 immunohistochemistry in the diagnosis of papillary carcinoma of the thyroid", Diagn Pathol, 3, pp.5~ (2008)
- 정준우, "Immunohistochemical and Molecular Markers Associated with Differentiated Thyroid Carcinoma", International Journal of Thyroidology, 8(1), pp.50~60 (2015), 대한갑상선학회