What is it about?
The tall cell variant (TCV) of papillary thyroid carcinoma (PTC) is a rare but very aggressive variant. It is defined by the World Health Organization as a tumor consisting of at least 30% of epithelial cells that are 2-3 times taller than they are wide, but this percentage differs among studies and ranges from 10-75%. TCV also show an abundant eosinophilic cytoplasm. Scanning for these taller epithelial cells is a difficult and time-consuming task. Thus, in practice, the reporting of the amount of these cells relies on subjective estimations. In our study, we estimate the percentage of tall cells in digitally scanned histological samples. Also, we study the correlation between this composition and outcome of patients in a case-control cohort consisting of patients with an aggressive disease, and with patients who had completely recovered.
Featured Image
Why is it important?
The percentage of tall cells needed for a papillary thyroid carcinoma (PTC) to be regarded as a tall cell variant (TCV) is being debated. In the present study we estimate the tall cell composition and look at how it correlates to an adverse outcome in a cohort consisting of 34 patients with an aggressive disease and 31 patients who recovered completely. The cases were matched by age (within 10 years), gender, time of primary operation (within 10 years), T stage, N stage, tumour size and any radioactive iodine ablation (yes/no). Furthermore, the estimation of tall cell composition is relying on subjective estimations and new diagnostic methods are needed. Here, we scan the tumors for tall cells in digitally scanned histological H&E glass slides. This digitisation of the slides offers a more convenient way to scan the tumors for tall cells. Having the slides in a digital format also improves reproducibility of studies and makes it possible to gather material for a multi-center study in the future, which is recommended.
Perspectives
In the present study, we try to tackle an important problem in diagnosing tall cell varant of papillary thyroid carcinoma. Our aim was to verify results of previous projects showing a correlation between an aggressive disease and a minor tall cell component. The most important limitation of the study was our cohort size of 65 patients. However, these patients were carefully picked and matched by age (within 10 years), gender, time of primary operation (within 10 years), T stage, N stage, tumour size and any radioactive iodine ablation (yes/no). Also, the follow-up of our cohort was long with a median of 22 years, also accounting for later events of the disease. Our method was also different from other studies, and to our knowledge, has not been used in scanning thyroid tumors for tall cells. However, even with this method, our kappa value was lower than expected, and only moderate agreement between the two investigators independently scanning for tall cells could be reached. This results proves that subjectivity plays a big role in estimating the tall cell composition and better diagnostic methods are needed.
Sebastian Emil Stenman
Institute for Molecular Medicine Finland: FIMM
Read the Original
This page is a summary of: The prognostic significance of tall cells in papillary thyroid carcinoma: A case-control study, Tumor Biology, July 2018, SAGE Publications,
DOI: 10.1177/1010428318787720.
You can read the full text:
Contributors
The following have contributed to this page
