Diagnostic value of AgNOR method in thyroid cytopathology: correlation with morphometric measurements

Role of Multiparameter Analysis of AgNORs in FNA Smears of Thyroid Swellings in Differentiating Benign and Malignant Lesions

Background. The aim of this study is to assess the role of multiparameter analysis of silver (Ag)-stained nucleolar organizer regions (AgNORs) technique on aspiration smears of thyroid swellings to distinguish between benign and malignant lesions. Materials and Methods. Aspiration smears from 166 cases of thyroid swellings were examined. Diagnosis was confirmed by histology in 61 cases. AgNOR staining was done on FNA smears according to silver-staining protocol proposed by the International Committee for AgNOR quantification. Multiparameter analysis of AgNORs such as mAgNOR, pAgNOR, and AgNOR size grade was done on 50–100 cells under oil immersion lens. Results. AgNOR parameter of benign and malignant thyroid lesions was compared and was found to be statistically significant. Out of 157 satisfactory AgNOR stained cases, 148 (94.3%) were benign lesions and 9 (5.7%) cases were malignant lesions. In AgNOR analysis, sensitivity was found to be 83.33%, specificity 100%, PPV 100%, NPV 98.21%, and accuracy was 98.36%. Conclusions. AgNOR analysis in the FNA smears is a simple, sensitive, and cost-effective method for differentiating benign from malignant thyroid swellings.

Fine needle aspiration cytology in non-neoplastic non-toxic recurrent nodular goitre

The aim of the study was to examine whether evaluation of anisokaryosis is helpful in the cytological diagnosis of focal lesions in non-toxic recurrent goitre (NRG) after thyroidectomy for non-malignant goitre. Karyometric analysis was performed in routine cytological smears obtained from 80 females: 40 with focal lesions in non-toxic primary goitre (NPG) and 40 with NRG (postoperative histopathological examination revealed nodular goitre in both groups in all cases). We found that the level of anisokaryosis was significantly (P<0.005) higher in NRG than in NPG. There were no significant differences between the two lesions, in cellular composition or thyroid follicular cell arrangement. Thus, isolated anisokaryosis, a feature of malignancy in patients without a prior thyroidectomy, has limited diagnostic value in recurrent goitre.

Usefulness of computer-aided karyometric examination in preoperative differentiation of Hürthle cell lesions

We have previously reported that there is a significant difference in the mean size of thyrocyte nuclei among patients with nodular goiter, follicular adenoma, and follicular carcinoma. In the present study, we have examined karyometric parameters of Hürthle cells in smears collected from 41 patients with Hürthle cells adenomas, Hürthle cells carcinomas, nodular goiter, and lymphocytic thyroiditis. The karyometric evaluation was performed with the image analysis computer system-Karyometry Manager 1.2. We measured the mean volume, the mean intersection area, and the mean perimeter of 100 nuclei in each routine smear. We found that the sizes of Hürthle cell nuclei could be arranged in the ascending order from the nodular goiter, through lymphocytic thyroiditis to Hürthle cell neoplasms, but those differences did not reach a border of statistical significance.