Morphology combined with ancillary techniques: An algorithm approach for thyroid nodules

E. D. Rossi, M. Martini, S. Capodimonti, T. Cenci, M. Bilotta, F. Pierconti, A. Pontecorvi, Celestino Pio Lombardi, G. Fadda, L. M. Larocca

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Several authors have underlined the limits of morphological analysis mostly in the diagnosis of follicular neoplasms (FN). The application of ancillary techniques, including immunocytochemistry (ICC) and molecular testing, contributes to a better definition of the risk of malignancy (ROM) and management of FN. According to literature, the application of models, including the evaluation of ICC, somatic mutations (ie, BRAFV 600E), micro RNA analysis is proposed for FNs. This study discusses the validation of a diagnostic algorithm in FN with a special focus on the role of morphology then followed by ancillary techniques. Methods: From June 2014 to January 2016, we enrolled 37 FNs with histological follow-up. In the same reference period, 20 benign nodules and 20 positive for malignancy were selected as control. ICC, BRAFV 600E mutation and miR-375 were carried out on LBC. Results: The 37 FNs included 14 atypia of undetermined significance/follicular lesion of undetermined significance and 23 FN. Specifically, atypia of undetermined significance/follicular lesion of undetermined significance resulted in three goitres, 10 follicular adenomas and one NIFTP whereas FN/suspicious for FN by seven follicular adenomas and 16 malignancies (nine non-invasive follicular thyroid neoplasms with papillary-like nuclear features, two invasive follicular variant of papillary thyroid carcinoma [PTC] and five PTC). The 20 positive for malignancy samples included two invasive follicular variant of PTC, 16 PTCs and two medullary carcinomas. The morphological features of BRAFV 600E mutation (nuclear features of PTC and moderate/abundant eosinophilic cytoplasms) were associated with 100% ROM. In the wild type cases, ROM was 83.3% in presence of a concordant positive ICC panel whilst significantly lower (10.5%) in a negative concordant ICC. High expression values of MirR-375 provided 100% ROM. Conclusions: The adoption of an algorithm might represent the best choice for the correct diagnosis of FNs. The morphological detection of BRAFV 600E represents the first step for the identification of malignant FNs. A significant reduction of unnecessary thyroidectomies is the goal of this application.

Original languageEnglish
Pages (from-to)418-427
Number of pages10
JournalCytopathology
Volume29
Issue number5
DOIs
Publication statusPublished - Oct 1 2018

Keywords

  • BRAF mutation
  • immunocytochemistry
  • molecular testing
  • plump cells
  • thyroid malignancies
  • thyroid nodules

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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