[Puncture biopsy in the diagnosis of papillary epitheliomas of the thyroid]. / Apport de la cytoponction dans le diagnostic des épithéliomas papillaires de la thyroïde.

In this study of the cytological appearances of papillary adenocarcinoma of the thyroid after fine needle aspiration biopsy, the authors have brought together 60 examinations of thyroid nodules and 10 indicant ganglial metastases. They isolate three significant aspects. type I (25 cases) is notable for the dense cellular desquamation in papillary clusters with angular contours, numerous calcospherites and, above all, the presence of intranucleaur pseudo-inclusion bodies (PI) which are clearly visible after coloring with May Grunwald stain. Type II (17 cases) was mainly observed in cystic lesions (8 cases) and metastatic ganglia (6 cases). It shows thick clusters of necrotic cells, few PI, barely visible against a background preparation of lysated hemates, polynuclear cells and macrophages. Type III (19 cases) consists of layers of cells poor in cytonuclear anomalies. The presence of PI is both a prerequisite and sufficent arounds for a diagnosis of papillary carcinoma of the thyroid, which will always be confirmed by subsequent histopathological examinations. The absence of PI leads to a false negative result. Better knowledge of cytological aspects specific to papillary tumors of the thyroid improves the quality of the diagnosis, not in terms of the percentage of carcinomas identified, which rises from 75.6 to 77% at a second reading, but in the specification of the papillary type, which rises from 38.5 to 64.2%. In the absence of PI and cytonuclear anomalies, non-identification of the carcinoma (22.8%) results from uninterpretable smears (5.7%) and false negatives (17.1%). There were no false positives. Cytological examination after fine needle aspiration biopsy should be included in the preoperative examinations of all thyroid nodules, as well as in the exploration of cervical ganglia likely to host an indicant or delayed metastasis.

[Cytological diagnosis by punction of thyroid lesions. Histopathological correlations. Benign lesions (600 cases) (author's transl)]. / La cyto-ponction des lésions thyroïdiennes. Confrontations anatomo-pathologiques. Lésions bénignes (600 observations).

Because of its important and its soft consistency, the thyroid is not always convenient for punction. Many smears cannot be classified, others are disappointing. The analysis of 2,300 punctions of thyroid lesions, allowed the authors to realise 900 comparisons between histopathological and cytological results. Among 300 histological malignant lesions, 89 unknown cancers were found, 40 of which gave haemorragic smears. The real false diagnosis were especially linked to vesicular and papillary carcinomas. On the other hand, undifferentiated carcinomas and lymphomas usually led to a correct interpretation. A correct diagnosis was made in 70% of all smears and in 81% of interpretable smears. The best results are found in benign lesions. The interpretation is correct in 94% of 600 punctions. A false diagnosis of malignancy is made in 6.1% of cases. So, this method fails to recognize an important number of cancers. It is not sufficient to assert the diagnosis and must be followed by an histopathological per-operatoire study. On the other hand a cytological diagnosis of cancer is reliable as long as the cytologist is not impressed by some cellular changes which are not so significant, as far as thyroid lesions are concerned, as in other fields of cytology.

[Correlation between histology, cytology and clinical examination]. / Corrélations entre l'histologie, la cytologie et la clinique

There exist, very frequently, an excellent correlation between cytology, histology and clinical examination in breast diseases. Combination of different methods reduce the risk of false diagnosis.