Intranuclear cytoplasmic inclusions and nuclear grooves in fine needle aspiration smears of papillary thyroid carcinoma and its variants: advantage of the count under an oil-immersion objective over a high-power objective

Das, D.K.; Sharma, P.N.

Analytical and Quantitative Cytology and Histology 27(2): 83-94

2005


PMID: 15913201
Accession: 012232176

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Abstract
OBJECTIVE: To determine the advantage of examining fine needle aspiration (FNA) smears of papillary thyroid carcinoma (PTC) tinder a 100x oil-immersion objective, which is capable of optically sectioning the cells.STUDY DESIGN: Two hundred neoplastic cells were counted under a high-power (40x) objective as well as oil-immersion (100x) objective in 54 PTC cases classified into variants: 14 follicular neoplasms, 8 Hurthle cell neoplasms, 5 medullary thyroid carcinomas and 9 hyperplastic lesions. The counts of cells with 2 important diagnostic features of PTC, intranuclear cytoplasmic inclusions (INCIs) and grooved nuclei, were compared between various groups and between high-power and oil-immersion objectives in each group.RESULTS: Cytomorphologic features, such as INCI and nuclear grooves, were visible usually tinder 2 or 3 focal planes under the oil-immersion objective as opposed to a single plane under the high-power objective. In PTC cases, the mean cell count, 10.1 (+/- 1.75 SE) with INCIs, under the oil-immersion objective was significantly higher than the count, 6.1 (+/- 1.32 SE), tinder the high-power objective (p=0.023). INCIs were not observed under the high-power objectives in 11 (20.4%) PTC cases, but in 5 (45.5%) of these they were visible tinder the oil-immersion objective. In PTC the mean cell count, 88.0 (+/- 4.96 SE), with grooved nuclei tinder the oil-immersion objective was also significantly higher than the count, 69.5 (+/- 4.87 SE), tinder the high-power objective (p=0.010). Under the high-power objective, < 20.0% of cells with grooved nuclei were observed in 12 (22.2%) cases of PTC. However, examination under the oil-immersion objective revealed >= 20.0% cells with grooved nuclei in 9 (75%) of these. In PTC the mean cell counts with INCIs as well as grooved nuclei tinder the oil-immersion objective were significantly higher than those of follicular neoplasms, Hurthle cell neoplasms, medullary carcinoma and hyperplastic lesions.CONCLUSION: In PTC, examination of FNA smears for INCIs and grooved nuclei under an oil-immersion objective was diagnostically more useful as compared to a high-power objective.