Skip to main content
SpringerLink
Log in

Diagnostic assessment of intraoperative cytology for papillary thyroid carcinoma: using a decision tree analysis

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to elucidate the cytological characteristics and the diagnostic usefulness of intraoperative cytology (IOC) for papillary thyroid carcinoma (PTC). In addition, using decision tree analysis, effective features for accurate cytological diagnosis were sought.

Methods

We investigated cellularity, cytological features and diagnosis based on the Bethesda System for Reporting Thyroid Cytopathology in IOC of 240 conventional PTCs. The cytological features were evaluated in terms of nuclear score with nuclear features, and additional figures such as presence of swirling sheets, psammoma bodies, and multinucleated giant cells. The nuclear score (range 0–7) was made via seven nuclear features, including (1) enlarged, (2) oval or irregularly shaped nuclei, (3) longitudinal nuclear grooves, (4) intranuclear cytoplasmic pseudoinclusion, (5) pale nuclei with powdery chromatin, (6) nuclear membrane thickening, and (7) marginally placed micronucleoli.

Results

Nuclear scores in PTC, suspicious for malignancy, and atypia of undetermined significance cases were 6.18 ± 0.80, 4.48 ± 0.82, and 3.15 ± 0.67, respectively. Additional figures more frequent in PTC than in other diagnostic categories were identified. Cellularity of IOC significantly correlated with tumor size, nuclear score, and presence of additional figures. Also, IOCs with higher nuclear scores (4–7) significantly correlated with larger tumor size and presence of additional figures. In decision tree analysis, IOCs with nuclear score >5 and swirling sheets could be considered diagnostic for PTCs.

Conclusions

Our study suggests that IOCs using nuclear features and additional figures could be useful with decreasing the likelihood of inconclusive results.

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

Access this article

Log in via an institution

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

References

  1. Pyo JS, Kang G, Kim DH et al (2013) Activation of nuclear factor-κB contributes to growth and aggressiveness of papillary thyroid carcinoma. Pathol Res Pract 209:228–232

    Article  CAS  PubMed  Google Scholar 

  2. Agretti P, Niccolai F, Rago T (2014) BRAF mutation analysis in thyroid nodules with indeterminate cytology: our experience on surgical management of patients with thyroid nodules from an area of borderline iodine deficiency. J Endocrinol Invest 37:1009–1014

    Article  CAS  PubMed  Google Scholar 

  3. Pacini F, Brianzoni E, Durante C et al (2016) Recommendations for post-surgical thyroid ablation in differentiated thyroid cancer: a 2015 position statement of the Italian society of endocrinology. J Endocrinol Invest 39:341–347

    Article  CAS  PubMed  Google Scholar 

  4. Ali SZ, Cibas ES (2009) The Bethesda system for reporting thyroid cytopathology. Thyroid 19:1159–1165

    Article  PubMed  Google Scholar 

  5. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  Google Scholar 

  6. Gharib H, Papini E, Paschke R et al (2010) American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Invest 33:51–56

    Article  CAS  PubMed  Google Scholar 

  7. Nardi F, Basolo F, Crescenzi A et al (2014) Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Invest 37:593–599

    Article  PubMed  Google Scholar 

  8. Degirmenci B, Haktanir A, Albayrak R et al (2007) Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material. Clin Radiol 62:798–803

    Article  CAS  PubMed  Google Scholar 

  9. Nayar R, Ivanovic M (2009) The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute thyroid fine needle aspiration state of the science conference. Cancer Cytopathol 117:195–202

    Article  Google Scholar 

  10. Yassa L, Cibas ES, Benson CB et al (2007) Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer Cytopathol 111:508–516

    Article  Google Scholar 

  11. Chehrei A, Ahmadinejad M, Tabatabaee SA et al (2012) Touch imprint and crash preparation intra operative cytology versus frozen section in thyroid nodule. J Res Med Sci 17:475–480

    PubMed  PubMed Central  Google Scholar 

  12. Anila KR, Krishna G (2014) Role of imprint cytology in intra operative diagnosis of thyroid lesions. Gulf J Oncol 1:73–78

    CAS  Google Scholar 

  13. Hothorn Torsten, Hornik Kurt, Zeileis Achim (2006) Unbiased recursive partitioning: a conditional inference framework. J Comput Gr Stat 15:651–674

    Article  Google Scholar 

  14. Choi SH, Baek JH, Lee JH et al (2014) Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration. Eur Radiol 24:2819–2826

    Article  PubMed  Google Scholar 

  15. Na DG, Kim JH, Sung JY et al (2012) Core needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid 22:468–475

    Article  PubMed  Google Scholar 

  16. Park KT, Ahn SH, Mo JH et al (2011) Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 33:160–165

    Article  PubMed  Google Scholar 

  17. Samir AE, Vij A, Seale MK et al (2012) Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 22:461–467

    Article  PubMed  PubMed Central  Google Scholar 

  18. Basolo F, Ugolini C, Proietti A et al (2007) Role of frozen section associated with intraoperative cytology in comparison to FNA and FS alone in the management of thyroid nodules. Eur J Surg Oncol 33:769–775

    Article  CAS  PubMed  Google Scholar 

  19. Tworek JA, Giordano TJ, Michael CW (1998) Comparison of intraoperative cytology with frozen sections in the diagnosis of thyroid lesions. Am J Clin Pathol 110:456–461

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Eulji University Hospital, Daejeon, Republic of Korea

    J.-S. Pyo

  2. Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunanro, Jongno-gu, Seoul, 03181, Republic of Korea

    J. H. Sohn

  3. Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea

    G. Kang

Authors
  1. J.-S. Pyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. H. Sohn.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

All of the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pyo, JS., Sohn, J.H. & Kang, G. Diagnostic assessment of intraoperative cytology for papillary thyroid carcinoma: using a decision tree analysis. J Endocrinol Invest 40, 305–311 (2017). https://doi.org/10.1007/s40618-016-0563-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-016-0563-0

Keywords

Search

Navigation