Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? Experience of over 18000 FNAs reported at the same institution during 1998-2007

S. Piana, A. Frasoldati, M. Ferrari, R. Valcavi, E. Froio, V. Barbieri, C. Pedroni, G. Gardini

Research output: Contribution to journalArticle

Abstract

Objective: Fine needle aspiration (FNA) has long been recognized as an essential technique for the evaluation of thyroid nodules. Although specific cytological patterns have been recognized, a wide variety of reporting schemes for thyroid FNA results have been adopted. This study reports our experience with a five-category reporting scheme developed in-house based on a numeric score and applied to a large series of consecutive thyroid FNAs. It focuses mainly on the accuracy of thyroid FNA as a preoperative test in a large subset of histologically distinct thyroid lesions. Methods: During the 1998-2007 period, 18359 thyroid ultrasound-guided FNAs were performed on 15269 patients; FNA reports were classified according to a C1-C5 reporting scheme: non-diagnostic (C1), benign (C2), indeterminate (C3), suspicious (C4), and malignant (C5). Results: Non-diagnostic (C1) and indeterminate (C3) FNA results totalled 2230 (12.1%) and 1461 (7.9%), respectively, while suspicious (C4) and malignant (C5) results totalled 238 (1.3%) and 531 (2.9%), respectively. Histological results were available in 2047 patients, with thyroid malignancy detected in 840. Positive predictive value of FNA was 98.1% with a 49.0 likelihood ratio (LR) of malignancy in patients with a C4/C5 FNA report. Conclusions: This five-category scheme for thyroid FNA is accurate in discriminating between the virtual certainty of malignancy associated with C5, a high rate (92%) of malignancy associated with C4, and a 98% probability of a histological benign diagnosis associated with C2. Further sub-classifications of C3 may improve the accuracy of the diagnostic scheme and may help in recognizing patients eligible for a 'wait and see' management.

Original languageEnglish
Pages (from-to)164-173
Number of pages10
JournalCytopathology
Volume22
Issue number3
DOIs
Publication statusPublished - Jun 2011

Keywords

  • Accuracy
  • Classification
  • Fine needle aspiration cytology
  • Thyroid tumours
  • Ultrasound-guided FNA

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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