Journal of Cytology
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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 28  |  Issue : 3  |  Page : 98-102
Morphology to morphometry in cytological evaluation of thyroid lesions


Department of Pathology, Sri Ramachandra Medical College & Research Institute, Chennai, India

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Date of Web Publication4-Aug-2011
 

   Abstract 

Aim: To evaluate the cytomorphometric features in fine needle aspiration cytology (FNAC) of thyroid lesions.
Materials and Methods: FNAC of 36 thyroid cases was reviewed. The study included 10 cases each of follicular lesion, adenomatous goiter, papillary carcinoma, 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma. Their ages ranged from 28 to 50 years, and there were nine females and one male. Morphometric analysis was done on aspiration smears from 36 thyroid lesions. Hematoxylin and Eosin stained smears were examined using image analyzer Proplus V software. Morphological parameters measured included mean nuclear diameter, mean nuclear perimeter, mean nuclear area, circular rate, largest to smallest dimension ratio (LS ratio) and coefficient of variation of nuclear area (NACV).
Statistical Analysis: Statistical evaluation was carried out using the analysis of variance (ANOVA) test for the five variables, both within the group and in between the groups. The result was considered significant when P < 0.05.
Results: The follicular carcinomas had higher LS ratio than patients with adenomatous goiters. Mean nuclear diameter and the mean nuclear perimeter were higher in anaplastic carcinomas when compared to other subtypes and were the least for follicular neoplasms.
Conclusion: When correctly applied, quantitative estimation of cytological nuclear features can play an important role in preoperative assessment and can complement morphological features in thyroid lesions.

Keywords: Fine needle aspiration cytology; morphometry; thyroid lesions

How to cite this article:
Priya S S, Sundaram S. Morphology to morphometry in cytological evaluation of thyroid lesions. J Cytol 2011;28:98-102

How to cite this URL:
Priya S S, Sundaram S. Morphology to morphometry in cytological evaluation of thyroid lesions. J Cytol [serial online] 2011 [cited 2020 Feb 21];28:98-102. Available from: http://www.jcytol.org/text.asp?2011/28/3/98/83462



   Introduction Top


Fine needle aspiration cytology (FNAC) has been applied routinely as a useful and indispensable method to diagnose thyroid lesions. However, it is still quite difficult to establish a precise diagnosis of follicular lesions of the thyroid preoperatively by cytology. The present study was undertaken to analyse the usefulness of quantitative estimations of various cytological nuclear features in specimens obtained by preoperative FNAC that were confirmed by histopathological examination.


   Materials and Methods Top


The study was conducted on 36 patients who presented to the surgical outpatient department with thyroid lesions. All 36 cases were subjected to fine needle aspiration (FNA) and tissue sections were obtained subsequently. A concise clinical history, examination, and details of relevant investigations were also obtained. These were helpful in reaching a probable clinical diagnosis as well as in cytohistological evaluation and formulations of the pathological diagnosis. The data included 10 cases each of adenomatoid goiter, follicular neoplasm, papillary carcinoma, 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma. Their ages ranged from 28 to 50 years (average 45 years), and there were nine females and one male. The mean maximum tumor dimension was 2.5 cm (range 1.5-3 cm). FNA smears were stained with Hematoxylin and Eosin. The stained smears were examined with a standard microscope connected to a computerised video system and analyzed with image analyzer Proplus V software. Using 200× magnifications, three to five fields of vision were sampled randomly and a minimum of 10 nuclei per case were measured automatically and calculated. Care was taken to ensure that only individual cells were selected. Overlapping of the cells, oddly shaped nuclei and degenerative cells were excluded from the study. The mean nuclear area and the mean nuclear perimeter [Figure 1] were measured by the calculations of pixels corresponding to the nuclei for the evaluation of the nuclear size in each case. To determine the variation in shape, the circular rate and the largest to the smallest dimension ratio of the nuclei (LS ratio) were calculated [Figure 2]. In a round circle, the values of the circular rate and the LS ratio correspond to 1. If the object is elliptical, the circular rate becomes <1; in contrast, the LS ratio is higher than 1. The coefficient of variation of the nuclear area (NACV) was calculated by expressing the variation in size in an individual case. Statistical differences were determined by the analysis of variance (ANOVA) test, both within the group and in between the groups. P values <0.05 were considered statistically significant.
Figure 1: Aspirate showing thyroid follicular epithelial cells highlighting nuclear perimeter (H and E, × 200)

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Figure 2: Aspirate showing thyroid follicular epithelial cells highlighting the largest to smallest (L/S) ratio (H and E, × 200)

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   Results Top


The study examined 10 cases each of adenomatoid goiter, follicular neoplasm, papillary carcinoma, 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma. The clinical data for each histopathology group are shown in [Table 1]. All clinical data, including the patient's age, gender and tumor size, revealed no statistically significant difference among the five groups. Among the parameters for the quantitative morphometrics of nuclei, the mean nuclear diameter and the perimeter were higher in anaplastic carcinomas and were the least for follicular neoplasms. The circular rate was significantly higher in the group with adenomatous goiter than with follicular neoplasm (P < 0.05). The circular rate was also higher in papillary carcinoma when compared to medullary carcinoma. The adenomatous goiter patients had a higher LS ratio than the patients with follicular neoplasm (P<0.05). The NACV value was 44.24 ± 7.76% in adenomatous goiter, 24.02 ± 4.11% in follicular neoplasm and 66.17 ± 13.88% in papillary carcinoma which showed significant differences between all the groups (P<0.0001). The data of the nuclear parameters are shown in [Table 2] and [Table 3] and [Figure 3], [Figure 4], [Figure 5] and [Figure 6].
Figure 3: Chart depicting nuclear area among variants (AG - Adenomatoid goiter; FN - Follicular neoplasm; PC - Papillary carcinoma; MC - Medullary carcinoma; AC - Anaplastic carcinoma)

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Figure 4: Chart depicting perimeter among variants (AG - Adenomatoid goiter; FN - Follicular neoplasm; PC - Papillary carcinoma; MC - Medullary carcinoma; AC - Anaplastic carcinoma)

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Figure 5: Chart depicting circular rate among variants (AG - Adenomatoid goiter; FN - Follicular neoplasm; PC - Papillary carcinoma)

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Figure 6: Chart depicting (L/S) largest to smallest ratio among variants (AG - Adenomatoid goiter; FN - Follicular neoplasm; PC - Papillary carcinoma; MC - Medullary carcinoma; AC - Anaplastic carcinoma)

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Table 1: Clinical characteristics of patients

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Table 2: Data analysis

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Table 3: Analysis of variance

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   Discussion Top


FNAC is routinely used to diagnose thyroid lesions. However, it is difficult to establish a precise diagnosis of follicular lesions of thyroid preoperatively by cytology. Morphometry may complement cytological diagnosis and provide useful information. The potential significance of this technique is to distinguish between benign, borderline and malignant lesions, for objective grading of invasive tumors, prediction of prognosis and therapeutic response. Morphometry has been described for more than a century because the histological characteristics of normal and abnormal cells have been used as a measure of prognosis and as a way of predicting the cause of the disease. While adaptation of quantitative morphometric analysis as a clinical tool has been discussed in the literature for over 30 years, the usefulness of this approach has helped in cytological grading of breast lesions, but has not yet received widespread acceptance in thyroid lesions owing to limited references and subjectivity. [1],[2],[3],[4],[5],[6] Rajesh et al.[7] studied histopathologically proven 19 cases of lobular carcinoma, 30 cases of ductal carcinoma, 10 cases of borderline lesions and 20 cases of benign breast lesions. ANOVA showed that morphometric data may be useful in distinguishing invasive lobular carcinoma from infiltrating ductal carcinoma on cytological smears. However, data were not helpful in distinguishing benign and borderline lesions from invasive lobular carcinoma. They also studied 70 breast cancer patients treated with preoperative chemotherapy. Nuclear area (NA) and NACV were compared with prognostic factors and this analysis reflected the chemosensitivity and the risk of recurrence. There are studies where morphometry has been applied to other organs like nasopharynx, skin, urinary bladder and colon. [8] In our study, we evaluated 10 cases each of adenomatoid goiter, follicular neoplasm, papillary carcinoma, 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma. The circular rate was significantly higher in the group with adenomatous goiter than with follicular neoplasm. The NACV value was higher in adenomatous goiter than in follicular neoplasm. Kaur et al.[9] also reported that nuclear features were not helpful in differentiation of follicular carcinomas from adenomas. Nagashima et al.[1],[2] also evaluated variation in nuclear size by using NACV which showed significant differences among follicular carcinomas, adenomas and adenomatous goiters. In our study, the circular rate was higher in papillary carcinoma when compared to medullary carcinoma, which was not documented in any of the studies. Fernandez-Lopez et al.[10] evaluated in their study, the prognostic value of the colorectal cancer in 90 patients. It was noticed that the patients with greater nuclear diameters also had a significant poor prognosis than the patients with cells of smaller diameter. This study asserted that the variations could be related to the survival of these patients. Similar studies were also done by Ikeguchi et al. [11] Reifen et al.[12] studied the morphometry and the stereology in nasopharyngeal carcinoma. Moro-Rodríguez et al.[13] analyzed nuclear parameters like nuclear area, axis minor, diameter minor, radius minor, perimeter area in oligodendroglioma and found it to be statistically significant with regard to grading of oligodendrogliomas. Bektas et al.[8] analyzed morphometry with respect to renal carcinomas for diagnostic and prognostic purpose. The limitation of our study was small sample size. Studies including larger series of cases investigating detailed nuclear morphometric analysis of subtypes of thyroid carcinoma with longer periods of observation are required in order to demonstrate the association between clinical outcome and morphometric parameters and in order to standardize the morphometric method by giving a suitable cut-off value of NACV in thyroid lesions.


   Conclusions Top


When correctly applied with appropriate cutoffs, morphometry can help in preoperative assessment and may act as an adjunct to morphological features in thyroid lesions.

 
   References Top

1.Nagashima T, Suzuki M, Oshida M, Hashimoto H, Yagata H, Shishikura T, et al. Morphometry in the cytologic evaluation of thyroid follicular lesions. Cancer 1998;84:115-8.  Back to cited text no. 1
    
2.NagashimaT, Suzuki M, Nakajima N. Cytologic morphometric approach for the prediction of lymph node involvement in papillary thyroid cancer. Anal Quant Cytol Histol 1997;19:49-54.  Back to cited text no. 2
    
3.Dina R, Capitanio A, Damiani S. A morphometric analysis of cytological features of tall cell variant and classical papillary carcinoma of the thyroid. Cytopathology 2000;11:124-8.  Back to cited text no. 3
    
4.Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of "follicular neoplasm": A gray zone in needle aspiration cytology. Diagn cytopathol 2002;26:41-4.  Back to cited text no. 4
    
5.Sakamoto A, Kasai N, Sugano H. Poorly differentiated carcinoma of the thyroid: A clinic pathologic entity for a high risk group of papillary and follicular carcinomas. Cancer 1983;52:1849-55.  Back to cited text no. 5
    
6.Slowinska-Klencha D, Klenchi M, Sporny S, Lewinski A. Size of thyrocyte nuclei in aspirates from follicular adenomas: Correlation with patients, ages. Acta Cytol 1996;40:414-6.  Back to cited text no. 6
    
7.Rajesh L, Dey P, Joshi K. Automated image morphometry of lobular breast carcinoma. Anal Quant Cytol Histol 2002;24:81-4.  Back to cited text no. 7
    
8.Bektas S, Barut F, Kertis G, Bahadir B, Gun BD, Kandemir NO, et al. Concordance of nuclear morphometric analysis with Fuhrman nuclear grade and pathologic stage in conventional renal cell carcinoma. Turk Patoloji Derg 2008;24:14-8.  Back to cited text no. 8
    
9.Kaur A, Jayaram G. Thyroid tumors: Cytomorphology of follicular neoplasms. Diagn Cytopathol 1991;7:469-72.  Back to cited text no. 9
    
10.Fernandez-Lopez F, Paredes-Cotore JP, Cadarso-Suarez C, Forteza-Villa J, Puente-Dominquez JL, Potel-Lesquereux J. Prognostic value of nuclear morphometry in colorectal cancer. Dis Colon Rectum 1999;386-92.  Back to cited text no. 10
    
11.Ikeguchi M, Sakatani T, Endo K, Makino M. Kaibara computerised nuclear morphometry is a useful technique for evaluating the high metastatic potential of colorectal adenocarcinoma. Cancer 1999;86:1944-51.  Back to cited text no. 11
    
12.Reifen E, Noyek AM, Mullen BM. Nuclear morphometry and stereology in nasopharyngeal carcinoma. Laryngoscope 1992;102:53-5.  Back to cited text no. 12
    
13.Moro-Rodríguez E, Figols J, Alvira M, Uranga-Ocio JA, García-Poblete E. GFAP and alpha1a-AR staining and nuclear morphometry of oligodendrogliomas by confocal microscope and image analysis. Diagn Pathol 2008;3:S26.  Back to cited text no. 13
    

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Correspondence Address:
S Shanmuga Priya
Department of Pathology, Sri Ramachandra Medical College & Research Institute, Chennai - 600 116
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.83462

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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