Rossi E D, Morassi F, Santeusanio G, Zannoni G F, Fadda G
Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Largo Francesco Vito, Rome, Italy.
Cytopathology. 2010 Apr;21(2):97-102. doi: 10.1111/j.1365-2303.2009.00659.x. Epub 2010 Jan 29.
Fine needle aspiration cytology is the most accurate tool for diagnosing thyroid nodules. Its accuracy is related to the rate of inadequate samples, which can be minimized with the adoption of on-site assessment of the adequacy of the material. The introduction of liquid-based cytology (LBC) in the thyroid does not allow checking on the adequacy of the cellularity. The possibility of making a second LBC slide for decreasing the number of non-diagnostic cases is studied.
Out of 553 cases diagnosed in a single institution from January to March 2005, 166 consecutive cases with an LBC slide reviewed by the same pathologist were evaluated. The cases were classified in a five-tiered category system (Thy1 to 5 according to the British Thyroid Association guidelines) and all but two (with cystic degeneration) were processed by LBC and stained with Papanicolaou stain. The above-mentioned categories are defined as follows: Thy1 inadequate or haemorrhagic, Thy2 non-neoplastic lesion; Thy3 follicular lesion/suspected follicular neoplasm; Thy4 suspicious for malignancy; Thy5 diagnostic of malignancy. For each case the cytological diagnosis was made on the LBC slide and the adequacy of the cellularity for a conclusive diagnosis was assessed.
Of the 166 cases, 39 were non-diagnostic (Thy1-inadequate), ten presented features of cystic degeneration (Thy1-haemorrhagic), 90 were benign (Thy2), 22 were diagnosed as a follicular lesion (Thy3), one as suspicious of malignancy (Thy4) and four as papillary carcinoma (Thy5). Thirty-nine cases had a second LBC for achieving a definitive diagnosis with eventual re-classification. Of these cases, 23 (61.5%) led to a conclusive diagnosis (18 Thy2, five Thy3) with a 18.5% decrease of the inadequacy rate.
The making of an additional LBC slide helps in achieving a diagnosis in cases classified as non-diagnostic on the first standard slide (52.1% recovery rate). This procedure is particularly helpful for meeting the adequacy criteria in benign and indeterminate lesions and could also be used for refining the diagnosis of suspicious for a malignant thyroid neoplasm.
细针穿刺细胞学检查是诊断甲状腺结节最准确的方法。其准确性与样本不足率有关，通过采用现场评估材料的充足性可将该比率降至最低。甲状腺液体基细胞学检查（LBC）的引入无法检查细胞数量是否充足。本研究旨在探讨制作第二张LBC涂片以减少非诊断性病例数量的可能性。
对2005年1月至3月在单一机构诊断的553例病例进行分析，评估其中166例由同一位病理学家复查LBC涂片的连续病例。这些病例按照五级分类系统（根据英国甲状腺协会指南分为Thy1至5级）进行分类，除两例（伴有囊性变）外，所有病例均采用LBC处理并进行巴氏染色。上述分类定义如下：Thy1为样本不足或出血；Thy2为非肿瘤性病变；Thy3为滤泡性病变/疑似滤泡性肿瘤；Thy4为可疑恶性；Thy5为诊断为恶性。对每例病例在LBC涂片上进行细胞学诊断，并评估细胞数量对于明确诊断的充足性。
166例病例中，39例为非诊断性（Thy1-样本不足），10例呈现囊性变特征（Thy1-出血），90例为良性（Thy2），22例诊断为滤泡性病变（Thy3），1例可疑恶性（Thy4），4例为乳头状癌（Thy5）。39例病例制作了第二张LBC涂片以实现最终重新分类的明确诊断。其中，23例（61.5%）实现了明确诊断（18例Thy2，5例Thy3），不足率降低了18.5%。
制作额外的LBC涂片有助于对第一张标准涂片分类为非诊断性的病例进行诊断（回收率为52.1%）。该方法对于满足良性和不确定病变的充足标准特别有帮助，也可用于完善可疑甲状腺恶性肿瘤的诊断。
