Preoperative cytologic morphometry may assist in predicting patient outcome after surgery in papillary thyroid cancer

OBJECTIVE: To evaluate the quantitative estimations of various cytologic nuclear features on smears obtained by preoperative fine-needle aspiration and to examine their correlation with patient outcome after surgery for papillary thyroid cancer. STUDY DESIGN: The subjects consisted of 142 patients with common type papillary thyroid cancer. The aspirated smears were examined quantitatively with a standard microscope connected to a computerized video system, and the mean nuclear area, nuclear perimeter, form factor (FF) and the coefficient of variation of the nuclear area (NACV) were measured and calculated. All of the surgically treated patients were followed through serial clinical evaluations, and correlations between the cytologic parameters and patient outcomes were analyzed. RESULTS: Local relapses or distant metastases were identified in 13 (9.2%) of the 142 patients in the median follow-up period of 160 (range, 108-234) months. Recurred cases had higher FF values than disease-free cases (p = 0.0017), especially in local relapse (p = 0.0015). Distant metastases were frequently observed in the cases with a high NACV value (p = 0.0020). CONCLUSION: Preoperative quantitative estimations of cytologic nuclear features provide preoperative clinical information that may predict patient outcome and be useful for designing individual protocols.