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Invited Critique
October 1, 2006

When Fine-Needle Aspiration Biopsy Cannot Exclude Papillary Thyroid Cancer—Invited Critique

Arch Surg. 2006;141(10):966. doi:10.1001/archsurg.141.10.966

It is important for surgeons to be cognizant that suspicious thyroid fine-needle aspiration (FNA) cytology reports do not follow a script. In other words, an FNA specimen that is “suspicious for papillary thyroid cancer” (PTC) is not always indicative of PTC, its follicular variant (FVPTC), or a benign tumor on final histopathologic examination. Conversely, a “follicular neoplasm” on an FNA specimen does not necessarily represent a follicular cancer, FVPTC, or follicular adenoma, nor does “Hürthle cell neoplasm” always represent Hürthle cell cancer or Hürthle cell adenoma. A follicular neoplasm can be indicative of PTC, lymphocytic thyroiditis, or Hürthle cell tumor, and similarly, a lesion suspicious for PTC can represent lymphocytic thyroiditis or Hürthle cell tumor. Importantly, an FNA specimen that is suspicious for PTC can also represent a follicular adenoma or follicular cancer.

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