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Hyperthyroidism-Related Epithelial Hyperplasia as a Potential Pitfall of Thyroid Cytology: Institutional
Eliisa Eveliina Viljanen1,2, Lotta Virtanen1, David Kalfert3
1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Insights
Distinguishing epithelial hyperplasia from papillary thyroid carcinoma (PTC) in thyroid cytology is crucial. Nuclear features are key differentiators, aiding accurate diagnosis in hyperthyroidism cases.
Area of Science:
- Cytopathology
- Endocrinology
- Oncology
Background:
- Epithelial hyperplasia in hyperthyroidism is an underrecognized diagnostic challenge in thyroid fine-needle aspiration (FNA).
- Distinguishing this benign condition from papillary thyroid carcinoma (PTC) is critical for appropriate patient management.
- This study investigates the cytomorphological features differentiating these entities.
Purpose of the Study:
- To identify and compare cytomorphological characteristics of hyperthyroidism-related epithelial hyperplasia and papillary thyroid carcinoma (PTC).
- To establish criteria for differentiating benign hyperplasia from malignant PTC in thyroid FNA specimens.
Main Methods:
- Quantitative evaluation of 48 cytomorphological features in 133 FNA specimens from 76 patients with hyperthyroidism-related epithelial hyperplasia.
- Comparison with 21 FNA specimens histologically verified as PTC.
- Statistical analysis to identify significant differentiating features.
Main Results:
- Significant architectural, cellular, and nuclear differences were observed between epithelial hyperplasia and PTC.
- Nuclear features, including elongation, grooves, irregular nuclear membranes, pseudoinclusions, and nucleoli presence, were significantly more common in PTC.
- These nuclear characteristics are crucial for differentiating benign hyperplasia from PTC.
Conclusions:
- Cytomorphological analysis, particularly of nuclear features, can effectively differentiate hyperthyroidism-related epithelial hyperplasia from PTC.
- Integrating clinical data and thyroid function tests with cytological findings improves diagnostic accuracy.
- This approach can reduce the misclassification of benign hyperplasia as malignant, minimizing unnecessary procedures.
Introduction:
Hyperthyroidism-related epithelial hyperplasia is seldomly listed as a pitfall in thyroid cytology. Therefore, we focused on the cytomorphological characteristics of epithelial hyperplasia and compared these features with papillary thyroid carcinoma (PTC).
Methods:
Study group consisted of 76 patients (133 FNA specimens) histologically diagnosed with hyperthyroidism-related epithelial hyperplasia without a concomitant malignancy. The control group contained 21 histologically verified FNAs of PTCs. A total of 48 cytomorphological features were quantitatively evaluated.
Results:
Statistically significant differences between the study groups were discovered on the architectural, cellular, and nuclear levels. Nuclear features varied most: nuclear elongation, grooves, irregular nuclear membrane, pseudoinclusions, the presence of nucleoli or small eccentric nucleoli were clearly more common in PTC group.
Conclusion:
Fine-needle aspiration referrals with clinical data and thyroid function test results can facilitate the interpretation of cytomorphological features and reduce the use of undetermined categories in cases of hyperthyroidism-related epithelial hyperplasia.
