Skip to main content
NCBI home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 2000 May;82(3):149–155.

Thyroid aspiration cytology in Newcastle: a six year cytology/histology correlation study.

M A Tabaqchali 1, J M Hanson 1, S J Johnson 1, V Wadehra 1, T W Lennard 1, G Proud 1
PMCID: PMC2503437  PMID: 10858674

Abstract

BACKGROUND: Fine needle aspiration cytology (FNAC) is a well-established technique for pre-operative investigation of thyroid nodule(s). Thyroid FNAC was introduced in the teaching hospitals of Newcastle upon Tyne in 1981, initially with a small group of clinicians as aspirators. Audit results for 1981-1986 inclusive showed an unsatisfactory rate of 25.3% and prediction of malignancy with a sensitivity of 93.5%. FNAC has become more popular locally for the investigation of thyroid disease and the number of clinicians performing aspirates has increased. The results for recent years have, therefore, been audited. METHODS: Medical records were reviewed for 239 patients with a dominant thyroid nodule who had FNAC carried out in the 6 year period 1990-1995 and subsequent partial or complete thyroidectomy. RESULTS: Histology of thyroid specimens showed 60 follicular adenomas and 34 malignant lesions (including 19 papillary, 10 follicular and 3 medullary carcinomas, one lymphoma and one follicular neoplasm with indeterminate malignant potential). A total of 302 FNAC had been carried out on these 239 patients. On cytological grounds the unsatisfactory sample (AC0 and AC1) rate was 43.1% on initial aspiration which was reduced to 32.2% on repeated aspiration. FNAC predicted neoplasia (AC3, AC4 and AC5) with a sensitivity of 86.8%, a specificity of 67.0%, a negative predictive value of 87.5% and a positive predictive value of 65.5%. Malignancy was predicted by FNAC (AC3, AC4 and AC5) with a sensitivity of 88.9%. A FNAC report of AC5 had a positive predictive value for malignancy of 100%. CONCLUSIONS: FNAC is an invaluable and minimally invasive procedure for the pre-operative assessment of patients with a dominant thyroid nodule. It is, however, important that the number of aspirators and cytopathologists be kept small to maintain expertise and also that the results of FNAC be subjected to ongoing audit.

Full text

PDF
149

Images in this article

152Figure 1
on p.152

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altman D. G., Bland J. M. Diagnostic tests 2: Predictive values. BMJ. 1994 Jul 9;309(6947):102–102. doi: 10.1136/bmj.309.6947.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Altman D. G., Bland J. M. Diagnostic tests. 1: Sensitivity and specificity. BMJ. 1994 Jun 11;308(6943):1552–1552. doi: 10.1136/bmj.308.6943.1552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Anderson J. B., Webb A. J. Fine-needle aspiration biopsy and the diagnosis of thyroid cancer. Br J Surg. 1987 Apr;74(4):292–296. doi: 10.1002/bjs.1800740422. [DOI] [PubMed] [Google Scholar]
  4. Boey J., Hsu C., Collins R. J. False-negative errors in fine-needle aspiration biopsy of dominant thyroid nodules: a prospective follow-up study. World J Surg. 1986 Aug;10(4):623–630. doi: 10.1007/BF01655540. [DOI] [PubMed] [Google Scholar]
  5. Burch H. B., Burman K. D., Reed H. L., Buckner L., Raber T., Ownbey J. L. Fine needle aspiration of thyroid nodules. Determinants of insufficiency rate and malignancy yield at thyroidectomy. Acta Cytol. 1996 Nov-Dec;40(6):1176–1183. doi: 10.1159/000333977. [DOI] [PubMed] [Google Scholar]
  6. Carpi A., Ferrari E., Toni M. G., Sagripanti A., Nicolini A., Di Coscio G. Needle aspiration techniques in preoperative selection of patients with thyroid nodules: a long-term study. J Clin Oncol. 1996 May;14(5):1704–1712. doi: 10.1200/JCO.1996.14.5.1704. [DOI] [PubMed] [Google Scholar]
  7. Chang H. Y., Lin J. D., Chen J. F., Huang B. Y., Hsueh C., Jeng L. B., Tsai J. S. Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules. J Clin Pathol. 1997 Dec;50(12):1005–1009. doi: 10.1136/jcp.50.12.1005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cochand-Priollet B., Guillausseau P. J., Chagnon S., Hoang C., Guillausseau-Scholer C., Chanson P., Dahan H., Warnet A., Tran Ba Huy P. T., Valleur P. The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules: a prospective study comparing cytologic and histologic findings. Am J Med. 1994 Aug;97(2):152–157. doi: 10.1016/0002-9343(94)90025-6. [DOI] [PubMed] [Google Scholar]
  9. Cusick E. L., MacIntosh C. A., Krukowski Z. H., Williams V. M., Ewen S. W., Matheson N. A. Management of isolated thyroid swellings: a prospective six year study of fine needle aspiration cytology in diagnosis. BMJ. 1990 Aug 11;301(6747):318–321. doi: 10.1136/bmj.301.6747.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fadda G., Rabitti C., Minimo C., Ieraci A., Verzì A., Bianchi A., Lancia M., Gullotta G., Capelli A. Morphologic and planimetric diagnosis of follicular thyroid lesions on fine needle aspiration cytology. Anal Quant Cytol Histol. 1995 Aug;17(4):247–256. [PubMed] [Google Scholar]
  11. Franklyn J. A., Sheppard M. C. Aspiration cytology of the thyroid. Br Med J (Clin Res Ed) 1987 Aug 29;295(6597):510–511. doi: 10.1136/bmj.295.6597.510-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gardner H. A., Ducatman B. S., Wang H. H. Predictive value of fine-needle aspiration of the thyroid in the classification of follicular lesions. Cancer. 1993 Apr 15;71(8):2598–2603. doi: 10.1002/1097-0142(19930415)71:8<2598::aid-cncr2820710826>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  13. Gerfo P. L., Feind C., Weber C., Ting W. The incidence of carcinoma in encapsulated follicular thyroid lesions diagnosed by large needle biopsy. Surgery. 1983 Dec;94(6):1008–1010. [PubMed] [Google Scholar]
  14. Gharib H., Goellner J. R. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993 Feb 15;118(4):282–289. doi: 10.7326/0003-4819-118-4-199302150-00007. [DOI] [PubMed] [Google Scholar]
  15. Goldfinger M., Rothberg R., Stoll S. Sonographic guidance of thyroid needle biopsy. Can Assoc Radiol J. 1986 Sep;37(3):186–188. [PubMed] [Google Scholar]
  16. Haas S., Trujillo A., Kunstle J. Fine needle aspiration of thyroid nodules in a rural setting. Am J Med. 1993 Apr;94(4):357–361. doi: 10.1016/0002-9343(93)90145-f. [DOI] [PubMed] [Google Scholar]
  17. Hall T. L., Layfield L. J., Philippe A., Rosenthal D. L. Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer. 1989 Feb 15;63(4):718–725. doi: 10.1002/1097-0142(19890215)63:4<718::aid-cncr2820630420>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  18. Kendall L. W., Condon R. E. Prediction of malignancy in solitary thyroid nodules. Lancet. 1969 May 31;1(7605):1071–1073. doi: 10.1016/s0140-6736(69)91707-3. [DOI] [PubMed] [Google Scholar]
  19. Lennard T. W., Wadehra V., Farndon J. R. Fine needle aspiration biopsy in diagnosis of metastases to thyroid gland. J R Soc Med. 1984 Mar;77(3):196–197. doi: 10.1177/014107688407700308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Leonard N., Melcher D. H. To operate or not to operate? The value of fine needle aspiration cytology in the assessment of thyroid swellings. J Clin Pathol. 1997 Nov;50(11):941–943. doi: 10.1136/jcp.50.11.941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Löwhagen T., Granberg P. O., Lundell G., Skinnari P., Sundblad R., Willems J. S. Aspiration biopsy cytology (ABC) in nodules of the thyroid gland suspected to be malignant. Surg Clin North Am. 1979 Feb;59(1):3–18. doi: 10.1016/s0039-6109(16)41729-9. [DOI] [PubMed] [Google Scholar]
  22. Löwhagen T., Willems J. S., Lundell G., Sundblad R., Granberg P. O. Aspiration biopsy cytology in diagnosis of thyroid cancer. World J Surg. 1981 Jan;5(1):61–73. doi: 10.1007/BF01657837. [DOI] [PubMed] [Google Scholar]
  23. McHenry C. R., Walfish P. G., Rosen I. B. Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease. Am Surg. 1993 Jul;59(7):415–419. [PubMed] [Google Scholar]
  24. Miller J. M., Kini S. R., Hamburger J. I. The diagnosis of malignant follicular neoplasms of the thyroid by needle biopsy. Cancer. 1985 Jun 15;55(12):2812–2817. doi: 10.1002/1097-0142(19850615)55:12<2812::aid-cncr2820551216>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  25. Piromalli D., Martelli G., Del Prato I., Collini P., Pilotti S. The role of fine needle aspiration in the diagnosis of thyroid nodules: analysis of 795 consecutive cases. J Surg Oncol. 1992 Aug;50(4):247–250. doi: 10.1002/jso.2930500410. [DOI] [PubMed] [Google Scholar]
  26. Psarras A., Papadopoulos S. N., Livadas D., Pharmakiotis A. D., Koutras D. A. The single thyroid nodule. Br J Surg. 1972 Jul;59(7):545–548. doi: 10.1002/bjs.1800590711. [DOI] [PubMed] [Google Scholar]
  27. Rosen I. B., Azadian A., Walfish P. G., Salem S., Lansdown E., Bedard Y. C. Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease. Am J Surg. 1993 Oct;166(4):346–349. doi: 10.1016/s0002-9610(05)80329-0. [DOI] [PubMed] [Google Scholar]
  28. Tunbridge W. M., Evered D. C., Hall R., Appleton D., Brewis M., Clark F., Evans J. G., Young E., Bird T., Smith P. A. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977 Dec;7(6):481–493. doi: 10.1111/j.1365-2265.1977.tb01340.x. [DOI] [PubMed] [Google Scholar]
  29. Varhaug J. E., Segadal E., Heimann P. The utility of fine needle aspiration biopsy cytology in the management of thyroid tumors. World J Surg. 1981 Jul;5(4):573–577. doi: 10.1007/BF01655012. [DOI] [PubMed] [Google Scholar]
  30. Wheeler M. H. Management of the solitary thyroid nodule. J R Soc Med. 1988 Aug;81(8):437–438. doi: 10.1177/014107688808100803. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES