Cytopathology and AgNOR counts in fine-needle aspiration cytology smears of thyroid lesions

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.

Management of nodular goiters and their operative indications

It remains controversial whether or not nodular goiters should be treated surgically or conservatively. This report reviews our 9-year experience of treating nodular goiters in 334 patients, 44 of whom underwent surgery, and compares the methods of treatment employed from 1990 to 1999 with those employed from 1971 to 1989 when 171 operations were carried out. In accordance with diagnoses made using fine-needle aspiration biopsy (FNAB) and ultrasonography, patients were treated as follows. Those with cysts were given percutaneous ethanol injection therapy (PEIT), and those with solid tumors underwent surgery if cancer of >class 3 was suspected or if the tumors were >3 cm. Consequently, 44 patients with solid tumors underwent surgery and 72 with cysts were treated by PEIT. The number of operations performed annually decreased to half of the pre-1990 figure. During the follow-up of those patients who did not undergo surgery, four with solid tumors and two with cysts later required surgery due to suspected carcinoma of >class 3 in 3 patients or as a result of personal choice in 3 patients. The growth of solid tumors was not able to be measured in most cases. These results indicate that the number of operations performed for nodular goiters can be reduced by PEIT. An accurate cytological diagnosis supports this therapeutic strategy.