[Puncture biopsy in the diagnosis of papillary epitheliomas of the thyroid]

In this study of the cytological appearances of papillary adenocarcinoma of the thyroid after fine needle aspiration biopsy, the authors have brought together 60 examinations of thyroid nodules and 10 indicant ganglial metastases. They isolate three significant aspects. type I (25 cases) is notable for the dense cellular desquamation in papillary clusters with angular contours, numerous calcospherites and, above all, the presence of intranucleaur pseudo-inclusion bodies (PI) which are clearly visible after coloring with May Grunwald stain. Type II (17 cases) was mainly observed in cystic lesions (8 cases) and metastatic ganglia (6 cases). It shows thick clusters of necrotic cells, few PI, barely visible against a background preparation of lysated hemates, polynuclear cells and macrophages. Type III (19 cases) consists of layers of cells poor in cytonuclear anomalies. The presence of PI is both a prerequisite and sufficent arounds for a diagnosis of papillary carcinoma of the thyroid, which will always be confirmed by subsequent histopathological examinations. The absence of PI leads to a false negative result. Better knowledge of cytological aspects specific to papillary tumors of the thyroid improves the quality of the diagnosis, not in terms of the percentage of carcinomas identified, which rises from 75.6 to 77% at a second reading, but in the specification of the papillary type, which rises from 38.5 to 64.2%. In the absence of PI and cytonuclear anomalies, non-identification of the carcinoma (22.8%) results from uninterpretable smears (5.7%) and false negatives (17.1%). There were no false positives. Cytological examination after fine needle aspiration biopsy should be included in the preoperative examinations of all thyroid nodules, as well as in the exploration of cervical ganglia likely to host an indicant or delayed metastasis.