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Processing the entire capsule in thyroid follicular lesions improves diagnostic accuracy
Ameer Hamza1, Sidrah Khawar1, Ahmed Alrajjal1
1St. John Hospital and Medical Center, Detroit, MI, USA.
Annals of Diagnostic Pathology
|January 2, 2019
Summary
Submitting the entire capsule of thyroid follicular lesions aids diagnosis in a small percentage of cases, but incurs significant costs. Thin slicing may be a more practical approach for larger lesions.
Area of Science:
- Endocrinology
- Surgical Pathology
- Thyroid Neoplasms
Background:
- Diagnostic challenges exist for thyroid follicular lesions.
- Pathologic evaluation necessitates complete capsule submission, which is difficult for large lesions.
Purpose of the Study:
- To assess the diagnostic impact of submitting the entire capsule versus representative sections for thyroid follicular lesions.
- To evaluate the cost-effectiveness of complete capsule submission.
Main Methods:
- Retrospective review of 80 thyroid follicular lesion cases.
- Comparison of diagnoses between initial representative section submission and subsequent entire capsule submission.
- Analysis of section numbers and processing costs.
Main Results:
- Complete capsule submission changed the diagnosis in 3.8% of cases by identifying capsular microinvasion.
- No significant difference in section requirements between residents and pathologist assistants.
- Additional processing costs for entire capsule submission totaled $4143.
Conclusions:
- Complete capsule processing for thyroid follicular lesions offers a diagnostic yield but is costly.
- Thin slicing and gross examination for abnormalities like "mushrooming" may be more practical, especially for larger lesions.
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