Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases

Diagn Cytopathol. 1993;9(3):345-50. doi: 10.1002/dc.2840090320.


To determine the diagnostic pitfalls of thyroid fine-needle aspiration (FNA), we reviewed 394 thyroid aspirates obtained between January 1986 and December 1990. Surgical follow-up was available for 150 aspirations. The cytologic diagnoses were categorized into four groups: benign, 57; indeterminate, 51; malignant, 33; and nondiagnostic specimen, nine. There were three false negative diagnoses (3%), which upon review were judged to be inadequate specimens. Three false positive diagnoses (7%) were identified: in the first two cases, follicular adenomas were mistaken for papillary carcinoma; in the third case, atypical Hürthle cells were mistaken for a Hürthle cell carcinoma. Our results showed a sensitivity of 93% and a specificity of 91% for the detection of malignancy. If indeterminate cases were considered positive, the specificity decreased to 50%, while the sensitivity increased to 97%. We conclude that: 1) certain follicular adenomas may display cytologic features mimicking papillary carcinoma; 2) as in follicular neoplasms, aspirates of Hürthle cell adenomas cannot be differentiated from Hürthle cell carcinomas; 3) with adequate sampling, false negative results can be markedly reduced.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle*
  • Cytodiagnosis / standards
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Thyroid Diseases / diagnosis*
  • Thyroid Diseases / pathology
  • Thyroid Neoplasms / diagnosis*
  • Thyroid Neoplasms / pathology