Thyroid puncture biopsy pathology report - interpretation of common terms!

Author: Zhang Jinxia, ​​Chief Physician, Peking University Shougang Hospital

Reviewer: Wu Xueyan, Chief Physician, Peking Union Medical College Hospital

Thyroid puncture biopsy is a commonly used pathological examination method in clinical practice. Many patients and their families feel confused when faced with the unfamiliar terms on the report form. Today we will introduce several common terms.

Only blood or serous components are seen, and the specimen is unsatisfactory:

This means that the biopsy specimens sent are mainly blood and serous fluid, and no cells that can be used for diagnosis are seen. Generally speaking, a qualified biopsy specimen should have at least six or seven clusters of follicular epithelial cells. If no cells are seen, and only some serous fluid and blood are seen, then no diagnosis can be made.

In this case, if the B-ultrasound examination shows that the tumor is a cyst and only blood and cystic fluid are seen, it may be benign and the patient does not need to undergo re-puncture to obtain samples. He can follow the doctor's advice for regular follow-up visits and go home to observe.

If the B-ultrasound examination shows a nodule with some cystic material inside, and only blood and cystic fluid are found in the specimen without many follicular cells, it may be a nodular goiter and can be further observed. Nodular goiter generally requires surgery only when it grows particularly large and causes neck compression symptoms.

However, if the B-ultrasound indicates signs of malignancy, for example, if the nodule has some tiny gravel-like calcifications, or the boundaries are unclear and extend to the surrounding like burrs, or it is a solid tumor with low echoes in the middle, or the tumor is rich in blood vessels, these are all indications of malignancy. If no cells are obtained from the specimen, re-puncture and sampling will be required.

Atypical cytopathy of undetermined significance:

This refers to the cells seen in the smear, which may be follicular epithelial cells, lymphocytes, or inflammatory cells. These cells are not completely benign cells, but cannot be clearly diagnosed as malignant cells.

For example, thyroiditis, nodular goiter, hyperthyroidism, thyroid cyst, adenoma, follicular carcinoma, and papillary carcinoma can all occur. It is a very vague term, which means that this lesion can occur in many diseases.

Figure 1 Original copyright image, no permission to reprint

This situation needs to be handled in combination with ultrasound, clinical examination, and patient presentation. If ultrasound shows a cyst or nodular goiter, observe first; if ultrasound shows diffuse thyroid hardening, or if many lymphocytes are seen under the microscope, it may be lymphocytic thyroiditis; some patients may have received radiotherapy before, and these atypical cells of unclear significance appear again, which may be a reactive change to radiotherapy.

Therefore, this lesion should be analyzed in combination with comprehensive clinical analysis to rule out the possibility of a tumor. Only when clinical B-ultrasound suspects that it is a follicular tumor or there are signs of malignancy, it is recommended to observe for a period of time before puncture.

Follicular neoplasms, suspected follicular neoplasms:

Follicular neoplasms and suspected follicular neoplasms include follicular adenoma, follicular carcinoma, and follicular variant of papillary carcinoma.

This type of follicular tumor and suspected follicular tumor cannot be qualitatively identified by puncture, and it is also difficult to identify by freezing during surgery. Generally, a large pathological examination is required after the tumor is removed for comprehensive evaluation. Why? We can explain this with a picture.

Figure 2 Original copyright image, no permission to reprint

In the above picture, for example, red represents the tumor, and yellow represents a capsule around it. Most of the tumor grows in the capsule. If the tumor breaks through the capsule and grows obviously outside the capsule, protruding like a mushroom, or if it has tumor thrombi in the capsule blood vessels and the blood vessels outside the capsule, it can be diagnosed as malignant.

Therefore, when fine needle aspiration is used to diagnose follicular tumors or suspected follicular tumors, there are surgical indications. Whether it is benign or malignant, a postoperative pathological examination is required for comprehensive evaluation and diagnosis.

If fine needle aspiration can provide a clear diagnosis, there will generally be a clear diagnosis report on the report form, such as clearly indicating that it is papillary thyroid cancer, anaplastic thyroid cancer, medullary thyroid cancer, etc.

When you are not sure, it may be papillary thyroid cancer, medullary thyroid cancer, anaplastic thyroid cancer, etc.

Of course, sometimes it may indicate that the malignant tumor may have metastasized, because malignant tumors in the lungs, ovaries and other parts of the body can metastasize to the thyroid gland.