J Endocr Surg.  2019 Dec;19(4):136-143. 10.16956/jes.2019.19.4.136.

The Incidence and Clinicopathologic Characteristics of Patients Who Had False-Positive Fine-Needle Aspiration Results for Papillary Thyroid Cancer

Affiliations
  • 1Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jskim0126@skku.edu

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.

Keyword

Papillary thyroid carcinoma; Fine needle aspiration; Risk factor

MeSH Terms

Biopsy, Fine-Needle*
Biopsy, Large-Core Needle
Diagnosis
Humans
Incidence*
Information Systems
Methods
Multivariate Analysis
Retrospective Studies
Risk Factors
Surgeons
Thyroid Gland*
Thyroid Neoplasms*
Thyroid Nodule
Thyroidectomy

Reference

1. Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008; 22:901–911.
Article
2. Gharib H, Papini E, Paschke R. Thyroid nodules: a review of current guidelines, practices, and prospects. Eur J Endocrinol. 2008; 159:493–505.
Article
3. Carcangiu ML, Zampi G, Pupi A, Castagnoli A, Rosai J. Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer. 1985; 55:805–828.
Article
4. Nam-Goong IS, Kim HY, Gong G, Lee HK, Hong SJ, Kim WB, et al. Ultrasonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathological findings. Clin Endocrinol (Oxf). 2004; 60:21–28.
Article
5. Bomeli SR, LeBeau SO, Ferris RL. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2010; 43:229–238. vii
Article
6. Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration. Acta Cytol. 1980; 24:511–521.
7. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 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. 2016; 26:1–133.
Article
8. Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph G, et al. 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. 2008; 36:425–437.
Article
9. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009; 19:1159–1165.
Article
10. Yi KI, Ahn S, Park DY, Lee JC, Lee BJ, Wang SG, et al. False-positive cytopathology results for papillary thyroid carcinoma: a trap for thyroid surgeons. Clin Otolaryngol. 2017; 42:1153–1160.
Article
11. Lew JI, Snyder RA, Sanchez YM, Solorzano CC. Fine needle aspiration of the thyroid: correlation with final histopathology in a surgical series of 797 patients. J Am Coll Surg. 2011; 213:188–194.
Article
12. Richmond BK, Judhan R, Chong B, Ubert A, AbuRahma Z, Mangano W, et al. 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. 2014; 80:811–816.
Article
13. Malheiros DC, Canberk S, Poller DN, Schmitt F. Thyroid FNAC: causes of false-positive results. Cytopathology. 2018; 29:407–417.
Article
14. Jang EK, Song DE, Gong G, Baek JH, Choi YM, Jeon MJ, et al. 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. 2013; 2:203–210.
Article
15. Khayyata S, Barroeta JE, LiVolsi VA, Baloch ZW. Papillary hyperplastic nodule: pitfall in the cytopathologic diagnosis of papillary thyroid carcinoma. Endocr Pract. 2008; 14:863–868.
Article
16. Batistatou A, Scopa CD. Pathogenesis and diagnostic significance of nuclear grooves in thyroid and other sites. Int J Surg Pathol. 2009; 17:107–110.
Article
17. Bhatia P, Deniwar A, Mohamed HE, Sholl A, Murad F, Aslam R, et al. Vanishing tumors of thyroid: histological variations after fine needle aspiration. Gland Surg. 2016; 5:270–277.
Article
18. Shin JH, Baek JH, Chung J, Ha EJ, Kim JH, Lee YH, et al. Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean J Radiol. 2016; 17:370–395.
Article
19. Arif S, Blanes A, Diaz-Cano SJ. Hashimoto's thyroiditis shares features with early papillary thyroid carcinoma. Histopathology. 2002; 41:357–362.
Article
20. Yoon JH, Kwak JY, Moon HJ, Kim MJ, Kim EK. 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. 2011; 21:993–1000.
Article
21. Baloch ZW, LiVolsi VA. Cytologic and architectural mimics of papillary thyroid carcinoma. Diagnostic challenges in fine-needle aspiration and surgical pathology specimens. Am J Clin Pathol. 2006; 125:Suppl. S135–44.
22. Harach HR, Soto MS, Zusman SB, Saravia Day E. Parenchymatous thyroid nodules: a histocytological study of 31 cases from a goitrous area. J Clin Pathol. 1992; 45:25–29.
Article
23. Fiorella RM, Isley W, Miller LK, Kragel PJ. Multinodular goiter of the thyroid mimicking malignancy: diagnostic pitfalls in fine-needle aspiration biopsy. Diagn Cytopathol. 1993; 9:351–355.
Article
24. Kitano M, Sugitani I, Toda K, Ikenaga M, Motoi N, Yamamoto N, et al. 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. 2013; 43:632–637.
Article
25. Anderson L, Middleton WD, Teefey SA, Reading CC, Langer JE, Desser T, et al. Hashimoto thyroiditis: part 1, sonographic analysis of the nodular form of Hashimoto thyroiditis. AJR Am J Roentgenol. 2010; 195:208–215.
Article
26. Hwang S, Shin DY, Kim EK, Yang WI, Byun JW, Lee SJ, et al. Focal lymphocytic thyroiditis nodules share the features of papillary thyroid cancer on ultrasound. Yonsei Med J. 2015; 56:1338–1344.
Article
27. Renshaw AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J Clin Pathol. 2007; 128:370–374.
Article
28. El Demellawy D, Nasr A, Alowami S. Application of CD56, P63 and CK19 immunohistochemistry in the diagnosis of papillary carcinoma of the thyroid. Diagn Pathol. 2008; 3:5.
Article
29. Jung JW, Choi JY, Lee KE, Park KW. Immunohistochemical and molecular markers associated with differentiated thyroid carcinoma. J Korean Thyroid Assoc. 2015; 8:50–60.
Article
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