Diagnostic significance of papillary structures and intranuclear inclusions in Hurthle-cell neoplasms of the thyroid

Citation
W. Blumenfeld et al., Diagnostic significance of papillary structures and intranuclear inclusions in Hurthle-cell neoplasms of the thyroid, DIAGN CYTOP, 20(4), 1999, pp. 185-189
Citations number
23
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology
Journal title
DIAGNOSTIC CYTOPATHOLOGY
ISSN journal
8755-1039 → ACNP
Volume
20
Issue
4
Year of publication
1999
Pages
185 - 189
Database
ISI
SICI code
8755-1039(199904)20:4<185:DSOPSA>2.0.ZU;2-W
Abstract
Papillary structures and intranuclear inclusions, features which are not or dinarily associated with Hurthle-cell lesions are occasionally noted within Hurthle-cell-rich aspirates. The diagnostic significance of these features in this setting, if any is unknown. The purpose of this study was to deter mine whether these features are diagnostically useful. Specifically, since fine-needle aspiration cytology cannot distinguish between Hurthle-cell ade noma and carcinoma, we wanted to know whether the presence of either featur e might aid irt preoperatively assessing the likelihood of carcinoma vs, ad enoma. We identified 12 cases in which a diagnosis of Hurthle-cell lesion w as made by thyroid fine-needle aspiration biopsy All cases had subsequent s urgery. For every case, all cytology slides were reviewed for the presence or absence of papillary structures and intranuclear inclusions, after which the findings were correlated with the final surgical pathological diagnosi s. Seven of the 12 cases had identifiable papillary structures, ranging fro m cases where papillary structures comprised the predominant architectural pattern to cases where rare papillary structures were found amidst a predom inance of sheets and single Hurthle cells. Four of the 12 cases had intranu clear inclusions. In all cases, intranuclear inclusions were uncommon. Of 6 cases that proved to be Hurthle-cell carcinoma, 5 had papillary structures on the antecedent fine-needle aspirate cytology, and 2 had intranuclear in clusions. Of 6 cases that proved to be Hurthle-cell adenoma, 2 had papillar y structures, and 2 had intranuclear inclusions. Papillary structures had a sensitivity of 83% for the presence of carcinoma, a specificity of 66%, a positive predictive value of 71%, and a negative predictive value of 80% (P = 0.2). Intranuclear inclusions had a sensitivity of 33%, a specificity of 66%, and positive and negative predictive values of 50%. Papillary structu res are more common in Hurthle-cell aspirates than previously recognised. T heir presence is not diagnostic of carcinoma, but neither does their absenc e rule out carcinoma. However; when Sound, the likelihood of an ultimate di agnosis of Hurthle-cell carcinoma is increased On the other hand, intranucl ear inclusions, when rare, appear to have no diagnostic value. (C) 1999 Wil ey-Liss, Inc.