Abstract
Background:Differential diagnosis of thyroid lesions with predominantly follicular pattern is one of the most common problems in thyroid pathology. Development of more objective and reproducible tools for diagnosis is needed. This work is aimed at studying the role of nuclear morphometry in differential diagnosis of different thyroid lesions having predominant follicular pattern.Material and methods:Semiautomatic image analysis system was used to measure a total of 8 nuclear parameters in 48 thyroid lesions including seven nodular goiter (NG), 14 follicular adenoma (FA), 14 follicular carcinoma (FC) and 13 follicular variant papillary carcinoma (FVPC).Results:The parameters related to nuclear size (area, perimeter, MaxD, MinD, nuclear size) and shape (L/S ratio, Form_AR) were significantly higher in neoplastic group (FA, FC, FVPC) when compared to non-neoplastic group (NG) P<0.05. The perimeter was the most reliable parameter (area under the cure (AUC)=97%) followed by area, MaxD, and size (all have AUC= 96%) then form-AR (90%), LS ratio (86%) and the least reliable was Min D (79%). Within the neoplastic group, most parameters related to size and shape of the nuclei was significantly higher in FVPC than in FA and FC (p ≤ 0.05). Nuclear area and size (AUC 77%) were the most reliable parameters for differentiation between FVPC and FA. The best cut off values for diagnosing FVPC are nuclear area ≥39.9μm2 and nuclear size ≥27.7μm2. However, there was no quantitative difference between FC and FA.Conclusion:Nuclear morphometric parameters may help in the differentiation between neoplastic and non-neoplastic thyroid lesions and between FVPC and follicular neoplasms (FC and FA) but they have no value in the differentiation between FC and FA.
Highlights
Differential diagnosis of thyroid lesions with predominantly follicular pattern is one of the most common problems in thyroid pathology
The parameters related to nuclear size and shape (L/S ratio, Form_AR) were significantly higher in neoplastic group (FA, follicular carcinomas (FC), follicular variant of papillary thyroid carcinoma (FVPC)) when compared to non-neoplastic group (NG) P
Most parameters related to size and shape of the nuclei was significantly higher in FVPC than in follicular adenomas (FA) and FC (p ≤ 0.05)
Summary
Differential diagnosis of thyroid lesions with predominantly follicular pattern is one of the most common problems in thyroid pathology [1,2]. Histopathological diagnosis of the encapsulated FVPC remains one of the most difficult and controversial areas in thyroid surgical pathology [1]. Correct diagnosis in such cases is important since FVPC has the potential for lymphatic and distant metastases [13]. Misdiagnosis of an FA as an FVPC will expose the patient to unnecessary aggressive surgical intervention
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