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Core needle biopsy and ultrasonography are superior to fine needle aspiration in the management of follicular variant papillary thyroid carcinomas

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Abstract

Purpose

Follicular variant papillary thyroid carcinoma (FVPTC) is a problematic entity. FVPTCs are often misdiagnosed by the standard fine needle aspiration (FNA); in addition, FVPTCs represent a mixed group of tumors with two biologically distinct subtypes: The indolent encapsulated FVPTC and the aggressive infiltrative FVPTC. Recent changes in guidelines suggests that FVPTC management may be improved if subtypes can be determined preoperatively. Preoperative assays, FNA, core needle biopsy (CNB), and ultrasonography (US) were compared for their ability to identify and subtype FVPTCs to determine the most appropriate test to manage FVPTCs.

Methods

The preoperative assays and clinicopathologic variables of 255 resected FVPTCs cases at Samsung Medical Center between 2012 and 2016 were retrospectively evaluated.

Results

CNB had the overall best ability to manage FVPTCs with the highest rate of diagnosis indicating surgery, lowest rate of inconclusive results, high sensitivity (88.9%), specificity (87.7%), negative predictive value (97.0%), diagnostic odds ratio (DOR; 56.9), and excellent predictive ability (AUC 0.906) for differentiating FVPTC subtypes. US had a moderate DOR (12.8), good predictive ability (AUC 0.802), high sensitivity (75.0%) and specificity (81.0%). CNB and US both had significantly higher accuracy for discriminating FVPTC subtypes than FNA (AUC 0.908 and 0.877 > 0.671; p < 0.05). The excellent performance of CNB could be attributed to distinct histologic differences between FVPTC subtypes.

Conclusion

CNB and US had superior performance to FNA in the identification and subtyping of FVPTC. In institutions with skilled and experienced operators, CNB is the preferred method for evaluating possible FVPTC lesions.

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Funding

This work was supported in part by the Korea Health Industry Development Institute (HI21C1137).

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  1. These authors contributed equally: Ji-Ye Kim, Sunhee Chang

Authors and Affiliations

  1. Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea

    Ji-Ye Kim & Sunhee Chang

  2. Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea

    Ah-Young Kwon

  3. Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Republic of Korea

    Eun Young Park

  4. Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Tae Hyuk Kim

  5. Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sangjoon Choi, Minju Lee & Young Lyun Oh

  6. Forensic Medicine Investigation Division, Seoul Institute National Forensic Service, Seoul, Republic of Korea

    Minju Lee

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  1. Ji-Ye Kim
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Kim, JY., Chang, S., Kwon, AY. et al. Core needle biopsy and ultrasonography are superior to fine needle aspiration in the management of follicular variant papillary thyroid carcinomas. Endocrine 75, 437–446 (2022). https://doi.org/10.1007/s12020-021-02864-1

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