Skip to main content
SpringerLink
Log in

Utility of Liquid-Based Cytology and Conventional Smears in Fine Needle Aspirates of Thyroid Lesions: A Comparative Study

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Fine needle aspiration (FNA) is an established technique in evaluation of thyroid nodules. Traditionally, conventional smears (CS) are prepared as an accepted method for cytologic interpretation. However, with the advent and success of liquid-based cytology (LBC) in gynecological and non-gynecological specimens, there has been an increased interest in its application in thyroid FNA as well. Studies evaluating LBC in thyroid aspirates have emerged in recent years and have shown variable results. Patients presenting with complaints of a palpable swelling in the thyroid/midline neck area or with a detectable lesion on ultrasound were subjected to FNA. A split sample technique was used to prepare CS and LBC smears. The cytological diagnosis of CS and LBC was compared with each other and with follow up. The performance of both methods was estimated in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The specificity, positive and negative predictive value, and accuracy of LBC were comparable to CS. The sensitivity of LBC was slightly lower than CS. The diagnostic accuracy of LBC was comparable to CS demonstrating its utility in thyroid FNAs. LBC offers the advantages of lesser screening time, decreased obscuration by blood, decreased artefactual changes, and potential for adjunctive immunocytochemistry/molecular testing. However, due to a higher unsatisfactory rate in benign lesions, LBC may be used as a supplement to CS in thyroid FNAs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Evans JG, Young E, Bird T, Smith PA (1977) The spectrum of thyroid disease in a community: the Wickham survey. Clin Endocrinol 7:481–493. https://doi.org/10.1111/j.1365-2265.1977.tb01340.x

    Article  CAS  Google Scholar 

  2. Menon VU, Sundaram KR, Unnikrishnan AG, Jayakumar RV, Nair V, Kumar H (2009) High prevalence of undetected thyroid disorders in an iodine sufficient adult south Indian population. J Indian Med Assoc 107:72–77

    Google Scholar 

  3. Frates MC, Benson CB, Charboneau JW et al (2005) Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology 237:794–800. https://doi.org/10.1148/radiol.2373050220

    Article  PubMed  Google Scholar 

  4. Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, Kawamoto H, Yamashita H (2001) Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 136:334–337. https://doi.org/10.1001/archsurg.136.3.334

    Article  CAS  PubMed  Google Scholar 

  5. Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167

    Article  CAS  PubMed  Google Scholar 

  6. Zhu J, Norman I, Elfgren K, Gaberi V, Hagmar B, Hjerpe A, Andersson S (2007) A comparison of liquid-based cytology and pap smear as a screening method for cervical cancer. Oncol Rep 18:157–160

    PubMed  Google Scholar 

  7. Tripathy K, Misra A, Ghosh JK (2015) Efficacy of liquid-based cytology versus conventional smears in FNA samples. J Cytol 32:17–20. https://doi.org/10.4103/0970-9371.155225

    Article  PubMed  PubMed Central  Google Scholar 

  8. Arul P (2016) Utility of manual liquid-based cytology and conventional smears in the evaluation of various fine-needle aspiration samples. J Cytol 33:177–181. https://doi.org/10.4103/0970-9371.190446

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Agrawal S, Mohanty P, Mohanty R (2018) Comparison of diagnostic efficacy between conventional cytopathology & liquid based cytology in thyroid FNA smears using Bethesda system of reporting. J Evid Based Med Healthc 5:790–794

    Article  Google Scholar 

  10. Kaur N, Poonam SH et al (2018) A study of comparison of conventional cytology with liquid based cytology of thyroid FNAC–a study of 100 cases. Ann Int Med Den Res 4:15–19

    Article  Google Scholar 

  11. Cibas ES, Ali SZ (2009) The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 132:658–665. https://doi.org/10.1309/AJCPPHLWMI3JV4LA

    Article  PubMed  Google Scholar 

  12. Das DK, Al-Waheeb SK, George SS, Haji BI, Mallik MK (2014) Contribution of immunocytochemical stainings for galectin-3, CD44, and HBME1 to fine-needle aspiration cytology diagnosis of papillary thyroid carcinoma. Diagn Cytopathol 42:498–505. https://doi.org/10.1002/dc.23062

    Article  PubMed  Google Scholar 

  13. Lacoste-Collin L, d’Aure D, Bérard E, Rouquette I, Delisle MB, Courtade-Saïdi M (2014) Improvement of the cytological diagnostic accuracy of follicular thyroid lesions by the use of the Ki-67 proliferative index in addition to cytokeratin-19 and HBME-1 immunomarkers: a study of 61 cases of liquid-based FNA cytology with histological controls. Cytopathology 4(25):160–169. https://doi.org/10.1111/cyt.12128

    Article  Google Scholar 

  14. Chong Y, Ji SJ, Kang CS, Lee EJ (2017) Can liquid-based preparation substitute for conventional smear in thyroid fine-needle aspiration? A systematic review based on meta-analysis. Endocr Connec 6:817–829. https://doi.org/10.1530/EC-17-0165

    Article  CAS  Google Scholar 

  15. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214. https://doi.org/10.1089/thy.2009.0110

    Article  PubMed  Google Scholar 

  16. Rossi ED, Raffaelli M, Zannoni GF, Pontecorvi A, Mulè A, Callà C, Lombardi CP, Fadda G (2009) Diagnostic efficacy of conventional as compared to liquid-based cytology in thyroid lesions: evaluation of 10,360 fine needle aspiration cytology cases. Acta Cytol 53:659–666. https://doi.org/10.1159/000325407

    Article  PubMed  Google Scholar 

  17. Malle D, Valeri RM, Pazaitou-Panajiotou K, Kiziridou A, Vainas I, Destouni C (2006) Use of a thin-layer technique in thyroid fine needle aspiration. Acta Cytol 50:23–27. https://doi.org/10.1159/000325890

    Article  PubMed  Google Scholar 

  18. Scurry JP, Duggan MA (2000) Thin layer compared to direct smear in thyroid fine needle aspiration. Cytopathology 11:104–115. https://doi.org/10.1046/j.1365-2303.2000.00228.x

    Article  CAS  PubMed  Google Scholar 

  19. Cochand-Priollet B, Prat JJ, Polivka M, Thienpont L, Dahan H, Wassef M, Guillausseau PJ (2003) Thyroid fine needle aspiration: the morphological features on ThinPrep slide preparations. Eighty Cases Histological Control Cytopathology 14:343–349. https://doi.org/10.1046/j.0956-5507.2003.00098.x

    Article  CAS  PubMed  Google Scholar 

  20. Jung CK, Lee A, Jung ES, Choi YJ, Jung SL, Lee KY (2008) Split sample comparison of a liquid-based method and conventional smears in thyroid fine needle aspiration. Acta Cytol 52:313–319. https://doi.org/10.1159/000325513

    Article  PubMed  Google Scholar 

  21. Chang H, Lee E, Lee H, Choi J, Kim A, Kim BH (2013) Comparison of diagnostic values of thyroid aspiration samples using liquid-based preparation and conventional smear: one-year experience in a single institution. APMIS 121:139–145. https://doi.org/10.1111/j.1600-0463.2012.02944.x

    Article  PubMed  Google Scholar 

  22. Afify AM, Liu J, Al-Khafaji BM (2001) Cytologic artifacts and pitfalls of thyroid fine-needle aspiration using ThinPrep: a comparative retrospective review. Cancer 93:179–186. https://doi.org/10.1002/cncr.9027

    Article  CAS  PubMed  Google Scholar 

  23. Renshaw AA, Wang E, Haja J, Wilbur D, Henry MR, Hughes JH, Committee C, College of American Pathologists, (2006) Fine-needle aspiration of papillary thyroid carcinoma: distinguishing between cases that performed well and those that performed poorly in the College of American Pathologists Nongynecologic Cytology Program. Arch Pathol Lab Med 130:452–455. https://doi.org/10.5858/2006-130-452-FAOPTC

    Article  PubMed  Google Scholar 

  24. Ljung BM (2008) Thyroid fine-needle aspiration: smears versus liquid-based preparations. Cancer 114:144–148. https://doi.org/10.1002/cncr.23541

    Article  PubMed  Google Scholar 

  25. Stamataki M, Anninos D, Brountzos E, Georgoulakis J, Panayiotides J, Christoni Z, Peros G, Karakitsos P (2008) The role of liquid-based cytology in the investigation of thyroid lesions. Cytopathology 19:11–18. https://doi.org/10.1111/j.1365-2303.2007.00512.x

    Article  CAS  PubMed  Google Scholar 

  26. Nagarajan N, Schneider EB, Ali SZ, Zeiger MA, Olson MT (2015) How do liquid-based preparations of thyroid fine-needle aspiration compare with conventional smears? An analysis of 5475 specimens. Thyroid 25:308–313. https://doi.org/10.1089/thy.2014.0394

    Article  PubMed  Google Scholar 

  27. Biscotti CV, Hollow JA, Toddy SM, Easley KA (1995) ThinPrep versus conventional smear cytologic preparations in the analysis of thyroid fine-needle aspiration specimens. Am J Clin Pathol 104:150–153. https://doi.org/10.1093/ajcp/104.2.150

    Article  CAS  PubMed  Google Scholar 

  28. Sharma S, Agarwal S, Jain M, Singh GB, Andley M (2018) Cytomorphological differences between liquid-based cytology and conventional smears in fine-needle aspirates of thyroid lesions. J Cytol 35:208–211. https://doi.org/10.4103/JOC.JOC_150_17

    Article  PubMed  PubMed Central  Google Scholar 

  29. Geers C, Bourgain C (2011) Liquid-based FNAC of the thyroid: a 4-year survey with SurePath. Cancer Cytopathol 119:58–67. https://doi.org/10.1002/cncy.20125

    Article  PubMed  Google Scholar 

  30. Kim DH, Kim MK, Chae SW et al (2007) The usefulness of SurePath(TM) liquid-based smear in sono-guided thyroid fine needle aspiration; a comparison of a conventional smear and SurePath(TM) liquid-based cytology. Korean J Cytopathol 18:143–152

    Google Scholar 

  31. Cavaliere A, Colella R, Puxeddu E, Gambelunghe G, Avenia N, d’Ajello M, Cartaginese F, Vitali R, Bellezza G, Giansanti M, Sidoni A, De Feo P (2008) Fine needle aspiration cytology of thyroid nodules: conventional vs thin layer technique. J Endocrinol Invest 31:303–308. https://doi.org/10.1007/BF03346362

    Article  CAS  PubMed  Google Scholar 

  32. Fadda G, Rossi ED, Raffaelli M, Pontecorvi A, Sioletic S, Morassi F, Lombardi CP, Zannoni GF, Rindi G (2011) Follicular thyroid neoplasms can be classified as low- and high-risk according to HBME-1 and galectin-3 expression on liquid-based fine-needle cytology. Eur J Endocrinol 165:447–453. https://doi.org/10.1530/EJE-11-0181

    Article  CAS  PubMed  Google Scholar 

  33. Kim MJ, Kim HJ, Hong SJ, Shong YK, Gong G (2006) Diagnostic utility of galectin-3 in aspirates of thyroid follicular lesions. Acta Cytol 50:28–34. https://doi.org/10.1159/000325891

    Article  PubMed  Google Scholar 

  34. Pazaitou-Panayiotou K, Mygdakos N, Boglou K, Kiziridou A, Chrisoulidou A, Destouni C (2010) The immunocytochemistry is a valuable tool in the diagnosis of papillary thyroid cancer in FNA’s using liquid-based cytology. J Oncol 2010:1–5. https://doi.org/10.1155/2010/963926

    Article  Google Scholar 

  35. Laddhad S, Deshmukh AT (2019) Comparative study of efficacy of liquid based cytology versus conventional pap smear in fine needle aspiration samples of thyroid nodule. Medpulse International Journal of Pathology 11:105–108

    Article  Google Scholar 

  36. Cochand-Priollet B, Dahan H, Laloi-Michelin M et al (2011) Immunocytochemistry with cytokeratin 19 and anti-human mesothelial cell antibody (HBME1) increases the diagnostic accuracy of thyroid fine-needle aspirations: preliminary report of 150 liquid-based fine-needle aspirations with histological control. Thyroid 21:1067–1073. https://doi.org/10.1089/thy.2011.0014

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Pathology, Lady Hardinge Medical College, New Delhi, India

    Md Ali Osama

  2. Department of Cytopathology, Sir Gangaram Hospital, Old Rajinder Nagar, New Delhi, 110060, India

    Pooja Bakshi & Kusum Verma

  3. Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India

    Ajit Yadav

Authors
  1. Md Ali Osama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pooja Bakshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kusum Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ajit Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pooja Bakshi.

Ethics declarations

Ethics Approval and Consent to Participate

All procedures performed in the current study were approved by the Ethics Committee of Sir Ganga Ram Hospital, New Delhi, India (EC/10/17/1283). Informed consent was waived by the Institutional Review Board. The authors certify that they have obtained the appropriate consent from the patients. The patients have given their consent for the images and other clinical information to be reported in the journal. The patients understand that the name and initials will not be published, and due efforts have been made to conceal the same.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Osama, M.A., Bakshi, P., Verma, K. et al. Utility of Liquid-Based Cytology and Conventional Smears in Fine Needle Aspirates of Thyroid Lesions: A Comparative Study. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-02018-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13193-024-02018-5

Keywords

Search

Navigation