Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma

Ricardo V. Lloyd, Lori A. Erickson, Mary B. Casey, King Y. Lam, Christine M. Lohse, Sylvia L. Asa, John K.C. Chan, Ronald A. DeLellis, H. Ruben Harach, Kennichi Kakudo, Virginia A. LiVolsi, Juan Rosai, Thomas J. Sebo, Manuel Sobrinho-Simoes, Bruce M. Wenig, Marick E. Lae

Research output: Contribution to journalReview article

340 Scopus citations

Abstract

The histopathologic diagnosis of follicular variant of papillary thyroid carcinoma (FVPCA) can be difficult. Recent reports have suggested that this neoplasm may be frequently overdiagnosed by pathologists. We examined the observer variation in the diagnosis of FVPCA in 87 tumors by 10 experienced thyroid pathologists. The criteria that the reviewers considered most helpful for making a diagnosis of FVPCA were also assessed. A concordant diagnosis of FVPCA was made by all 10 reviewers with a cumulative frequency of 39%. In this series, 24.1% of the patients had metastatic disease (n = 21). In the cases with metastatic disease, a diagnosis of FVPCA was made by all 10 reviewers with a cumulative frequency of 66.7%, and 7 of the reviewers made a diagnosis of FVPCA with a cumulative frequency of 100%. The most important criteria used to diagnose FVPCA included the presence of cytoplasmic invaginations into the nucleus (pseudo-inclusions), abundant nuclear grooves, and ground glass nuclei. These results suggest that although the diagnosis of FVPCA is variable even among experienced thyroid pathologists, most reviewers agreed on this diagnosis for patients with metastatic disease. The use of well-defined histopathologic features should improve the consistency in diagnosing FVPCA. Since most cases with metastatic disease had obvious invasion, caution should be used in making a diagnosis of FVPCA in the absence of the major histopathologic features or clear-cut invasive growth.

Original languageEnglish (US)
Pages (from-to)1336-1340
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume28
Issue number10
DOIs
StatePublished - Oct 1 2004

Keywords

  • Follicular variant of papillary carcinoma
  • Observer variation
  • Thyroid

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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    Lloyd, R. V., Erickson, L. A., Casey, M. B., Lam, K. Y., Lohse, C. M., Asa, S. L., Chan, J. K. C., DeLellis, R. A., Harach, H. R., Kakudo, K., LiVolsi, V. A., Rosai, J., Sebo, T. J., Sobrinho-Simoes, M., Wenig, B. M., & Lae, M. E. (2004). Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma. American Journal of Surgical Pathology, 28(10), 1336-1340. https://doi.org/10.1097/01.pas.0000135519.34847.f6