Distinguishing Parathyroid and Thyroid Lesions on Ultrasound-Guided Fine-Needle Aspiration: A Correlation of Clinical Data, Ancillary Studies, and Molecular Analysis
Distinguishing Parathyroid and Thyroid Lesions on Ultrasound-Guided Fine-Needle Aspiration: A Correlation of Clinical Data, Ancillary Studies, and Molecular Analysis
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DOI：
10.1002/cncy.21888
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发表时间：
2017-09-01
影响因子：
3.4
通讯作者：
Levine, Pascale
中科院分区：
文献类型：
--
作者：
Cho, Margaret;Oweity, Thaira;Levine, Pascale
背景：甲状旁腺和甲状腺病变的鉴别可能具有挑战性，因为它们在形态上有相当大的重叠和解剖上的相似性。因此，作者试图确定特征性的形态模式和有用的辅助测试来区分这两个实体。方法：在研究机构数据库中搜索2000年至2016年临床不确定的甲状腺结节，重点是确诊的甲状旁腺结节。检索病理报告、幻灯片、辅助研究、分子分析以及临床和放射学数据。结果：共确诊143例临床不明的甲状腺结节，其中34例确诊为甲状旁腺结节。细胞学分三种类型：嗜酸性细胞型(9例，26%)，意义不明的滤泡病变样/乳头状型(14例，41%)，非特异性内分泌细胞团(11例，32%)。可见裸露的卵圆形核(100%)、核重叠(88%)、密集片状核(88%)和胞浆内空泡(62%)。甲状旁腺激素(PTH)阳性10例(29%)，甲状旁腺激素(PTH)阳性7例(21%)，ThyroSeq v.2甲状旁腺激素阳性9例(26%)。其余8例形态不明或提示甲状旁腺起源。细胞学诊断经临床(20例)或手术(14例)证实。8例最初诊断为甲状腺组织，辅助检查后修正为甲状旁腺病变，其中5例仅根据ThyroSeq v.2检查结果。结论：滤泡病变样或嗜酸细胞性病变易误诊。目前的研究在甲状旁腺病变中发现了不同的细胞学模式，提示甲状旁腺起源，结合甲状旁腺激素免疫染色或化验、分子研究或甲状旁腺扫描，有助于区分甲状旁腺和甲状腺病变。(C)2017年美国癌症协会。
BACKGROUND: Differentiating parathyroid and thyroid lesions can be challenging because of considerable morphologic overlap and anatomic proximity. Therefore, the authors sought to identify characteristic morphologic patterns and useful adjunct tests to distinguish these 2 entities. METHODS: A search was conducted in the study institution database for clinically indeterminate thyroid nodules from 2000 through 2016 with an emphasis on confirmed parathyroid nodules. Pathology reports, slides, ancillary studies, molecular analysis, and clinical and radiologic data were retrieved. RESULTS: A total of 143 cases of clinically indeterminate thyroid nodules were identified; 34 of these were confirmed parathyroid nodules. Three cytologic patterns were identified: 1) oncocytic cell pattern (9 cases; 26%); 2) follicular lesion of undetermined significance-like/papillary-like pattern (14 cases; 41%); and 3) nonspecific endocrine cell clusters (11 cases; 32%). Bare oval nuclei (100%), nuclear overlap (88%), crowded sheets (88%), and intracytoplasmic vacuoles (62%) were observed. Ten cases (29%) demonstrated positive immunostaining for parathyroid hormone (PTH), 7 cases (21%) demonstrated a positive PTH assay, and 9 cases (26%) had PTH detected by ThyroSeq v.2. The remaining 8 cases were morphologically either indeterminate or suggestive of parathyroid origin. The cytologic diagnosis was confirmed clinically (20 cases) or surgically (14 cases). Based on cytology alone, 8 cases initially were diagnosed as thyroid tissue and amended to parathyroid lesion after ancillary studies were performed, including 5 cases based on ThyroSeq v.2 results alone. CONCLUSIONS: Lesions with follicular lesion of undetermined significance-like or oncocytic features are prone to misdiagnosis. The current study identified distinct cytologic patterns in parathyroid lesions suggestive of parathyroid origin, which, together with PTH immunostains or assay, molecular studies, or sestamibi scans, aid in distinguishing parathyroid from thyroid lesions. (c) 2017 American Cancer Society.