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Thyroid FNA Update

The summary analyzes 247 thyroid FNA cases from the past year with histologic follow-up on 30 cases. It found that cytologic diagnoses of "positive for malignancy" and "negative for malignancy" correlated highly with malignant and benign histologic diagnoses respectively. A diagnosis of "follicular lesion" carried an intermediate 25% risk of malignancy in this study, though the actual risk may be lower due to selection bias. A "non-diagnostic" result did not rule out the possibility of malignancy. The study also noted that small, incidental papillary carcinomas were common histologically and unlikely to impact clinical outcomes.

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37 views1 page

Thyroid FNA Update

The summary analyzes 247 thyroid FNA cases from the past year with histologic follow-up on 30 cases. It found that cytologic diagnoses of "positive for malignancy" and "negative for malignancy" correlated highly with malignant and benign histologic diagnoses respectively. A diagnosis of "follicular lesion" carried an intermediate 25% risk of malignancy in this study, though the actual risk may be lower due to selection bias. A "non-diagnostic" result did not rule out the possibility of malignancy. The study also noted that small, incidental papillary carcinomas were common histologically and unlikely to impact clinical outcomes.

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TOPA Diagnostics
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TOPA Update on Thyroid FNAs

October 2009
In the past year, Thousand Oaks Pathology Associates has studied 247 thyroid FNAs with histologic
follow-up on 30 cases. The cytologic diagnoses on these 30 cases are as follows:
Diagnosis
Negative for malignancy
Follicular lesion
Suspicious for malignancy
Positive for malignancy
Non-diagnostic

# of cases (% of total)
10 (33%)
12 (40%)
2 (7%)
3 (10%)
3 (10%)

FNA/ histologic correlations are as follows:


Cytologic Diagnosis
Histologic Diagnosis (main lesion)
Negative for malignancy
10/10 benign
Follicular lesion
3/12 malignant
Suspicious for malignancy 2/2 malignant
Positive for malignancy
3/3 malignant
Non-diagnostic
1/3 malignant

Additional histologic findings


Microfoci of papillary CA in 3/10
Microfoci of papillary CA in 1/10

Please note that 4 of 30 cases had incidental microfoci of papillary carcinoma identified histologically. It
is unlikely that these microfoci would have been sampled by FNA. Excluding these microfoci from
consideration, the prevalence of malignancy based on cytologic diagnosis is as follows:
Cytologic Diagnosis
Prevalence of malignancy
Negative for malignancy
0%
Follicular lesion
25%
Suspicious for malignancy 100%
Positive for malignancy
100%
Non-diagnostic
33%
Conclusions:
1. Cytologic diagnoses of Positive for malignancy and Negative for malignancy correlate with
follow-up histologic diagnoses in most or all cases.
2. A cytologic diagnosis of Follicular lesion is associated with an intermediate risk of malignancy
(25% in this small study). The actual risk may be significantly lower than the observed rate of
25%, due to inherent bias in this study. Histologic follow-up is only available for patients who
underwent thyroid lobectomy, thereby selecting for the most clinically suspicious cases.
3. Microfocal papillary carcinoma is relatively common and is not evaluable by FNA. (These
incidental lesions are probably not clinically significant.)
4. A non-diagnostic FNA does not exclude the possibility of malignancy.

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