[421] Minimizing the Diagnosis of Follicular Lesion of Undetermined Significance and Identifying Predictive Features for Neoplasia

X Jing, M Roh, SM Knoepp, L Zhao, CW Michael. University of Michigan, Ann Arbor, MI

Background: The diagnosis of follicular lesion of undetermined significance is problematic and frequently results in unnecessary surgery. The objectives of this study are: 1) assessing whether the undetermined diagnoses can be minimized by using standard morphologic criteria 2) identifying predictive features for neoplastic nodules.
Design: A retrospective blinded review was perofrmed by 4 pathologists who agreed upon standard morphologic criteria for the diagnosis. Images illustrating the criteria were circulated. The group reviewed a total of 123 thyroid FNAs with a previous undetermined diagnosis and surgical follow-up. The reviewers assessed a total of 25 features semi-quantatively and rendered a diagnosis. The latter were correlated with histologic diagnoses. Logistic regression was perofrmed to identify predictive features for neoplasia (including adenoma).
Results:

CORRELATION OF CYTOLOGIC AND HISTOLOGIC DIAGNOSES
HistologicDiagnosis
Cytologic DiagnosisNonneoplasiaFollicular adenomaFollicular carcinomaPapillary carcinomaParathyroid adenomaTotal
Nonneoplasia47952164
Undetermined21911-32
Follicular neoplasm9913-22
Papillary carcinoma3--2-5
Total8027781123




PREDICTIVE CYTOLOGIC FEATURES FOR NEOPLASIA
FeaturesOR (95% CI)P
Cellularity1.73 (0.95, 3.15)0.07
Syncytium1.64 (1.11, 2.42)0.01
Scattered microfollicules1.82 (1.20, 2.75)0.005
Follicles with scalloped borders1.78 (1.02, 3.10)0.04
Scant cytoplasm2.08 (1.26, 3.44)0.004
Irregular nuclear membranes1.69 (1.00, 2.84)0.05
Nuclear overlapping1.47 (1.01, 2.16)0.04
Coarse chromatin2.56 (1.34, 4.97)0.004
Honeycombing0.59 (0.41, 0.85)0.004
Colloid0.49 (0.29, 0.81)0.005
Histiocytes0.57 (0.35, 0.94)0.03



Conclusions: Using standard criteria to assess undetermined follicular lesions: 1) provides a better stratification of cytologic diagnoses and a diagnostic accuacy of 68.1% is achieved. 2) Neoplasia is positively correlated with cellularity and presence of syncytium, scattered microfollicles, follicles with scalloped borders, scant cytoplasm, irregular nuclear membranes, nuclear overlapping, and coarse chromatin. 3) Neoplasia is negatively correlated with presence of honeycombing, colloid and histiocyte.
Category: Cytopathology

Tuesday, March 23, 2010 1:15 PM

Platform Session: Section D, Tuesday Afternoon

 

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