2010, Number 6
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ABSTRACTBackground: Thyroid cancer presents as nodules. Thyroid nodules are frequent, but only 5-30% are malignant. Fine needle aspiration biopsy (FNAB) is useful for initial evaluation; nevertheless, malignancy is uncertain when follicular neoplasm is reported. Some factors can be associated with malignancy. Therefore, we analyzed our follicular neoplasms in order to identify those factors associated with a higher risk of malignancy.
Methods: We analyzed the clinical files of consecutive patients with cytological diagnoses of follicular neoplasm.
Results: From 1,005 cases of thyroid nodules, 121 were follicular neoplasms according to cytology. Of these, 75 were surgically treated. Definitive report showed 45 benign (60%) and 30 malignant (40%) cases. Benign cases included 29 goiters, 11 follicular adenomas, and 5 cases of thyroiditis. Malignant cases were comprised of 12 papillary carcinomas, 4 follicular carcinomas, 3 papillary carcinomas-follicular variant, 1 lymphoma, 1 teratoma, 5 medullary carcinomas, 2 insular carcinomas, 1 anaplastic carcinoma and 1 metastatic breast carcinoma. Tumor size of benign lesions was 3.43 ± 2.04 cm, and 4.67 ± 2.78 (p = 0.049) for malignant lesions. Age was 46.95 ± 15.39 years for benign lesions and 48.67 ± 17.28 for malignant lesions (p = 0.66). Fifty percent of males showed malignancy vs. 37.7% of females (p ‹0.005).
Conclusions: Our results suggest that size and gender, but not age, are associated with cytological pattern. Ultrasonographic characteristics may be useful discriminating patients with a higher risk of malignancy. FNAB is a useful tool for initial evaluation of thyroid nodules, but clinical evaluation can enhance predictive value.
Basolo F, Ugolini C, Proietti A, Iacconi P, Berti P, Miccoli P. Role of frozen section associated with intraoperative cytology in comparison to FNA and FS alone in the management of thyroid nodules. Eur J Surg Oncol 2007;33:769-775.
Bakhos R, Selvaggi S, DeJong S. Fine-needle aspiration of the thyroid: rate and causes of cytohistopathologic discordance. Diagn Cytopathol 2000;23:233-237.
Centro Nacional de Vigilancia Epidemiológica y Control de Enfermedades, Dirección General de Epidemiología. Compendio de cáncer 2002. Registro histopatológico de las neoplasias malignas en México, 2002. México: SSA; 2002. pp. 3, 5.
St Louis JD, Leight GS, Tyler DS. Follicular neoplasms: the role of observation, fine needle aspiration biopsy, thyroid suppression, and surgery. Semin Surg Oncol 1999;16:5-11.
Kimoto T, Suemitsu K, Eda I, Shimizu T, Ohtani M, Nabika T. The efficiency of performing ultrasound-guided fine-needle aspiration biopsy following mass screening for thyroid tumors to avoid unnecessary surgery. Surg Today 1999;29:880-883.
Rosen JE, Stone MD. Contemporary diagnostic approach to the thyroid nodule. J Surg Oncol 2006;94:649-661.
Prim MP, Diego JI, Hardisson D, Madrid R, Gavilan J. Factors related to nerve injury and hypocalcemia in thyroid gland surgery. Otolaryngol Head Neck Surg 2001;124:111-114.
Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 2003;133:180-185.
Galera-Davidson H. Diagnostic problems in thyroid FNAs. Diagn Cytopathol 1997;17:422-428.
Berner A, Sigstad E, Pradhan M, Groholt KK, Davidson B. Fineneedle aspiration cytology of the thyroid gland: comparative analysis of experience at three hospitals. Diagn Cytopathol 2006;34:97-100.
Logani S, Gupta PK, LiVolsi VA, Mandel S, Baloch ZW. Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: follow-up and management. Diagn Cytopathol 2000;23:380-385.
Henry JF, Denizot A, Porcelli A. Thyroperoxidase immunodetection for the diagnosis of malignancy on fine-needle aspiration of the thyroid nodules. World J Surg 1994;18:529-534.
Wu HH, Jones JN, Osman J. Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital. Diagn Cytopathol 2006;34:93-96.
Kovacevic DO, Skurla MS. Sonographic diagnosis of thyroid nodules: correlation with the results of sonographically guided fine-needle aspiration biopsy. J Clin Ultrasound 2007;35:63-67.
Gardner HA, Ducatman BS, Wang HH. Predictive value of fineneedle aspiration of the thyroid in the classification of follicular lesions. Cancer 1993;71:2598-2603.
Lin JD, Huang BY, Weng HF, Jeng LB, Hsueh C. Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer. J Clin Ultrasound 1997;25:111-118.
Gharib H. Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations and effect. Mayo Clin Proc 1994;69:44-49.
Kingston GW, Bugis SP, Davis N. Role of frozen section and clinical parameters in distinguishing benign from malignant follicular neoplasm of the thyroid. Am J Surg 1992;164:603-605.
Baloch ZW, Fleisher S, LiVolsi V, Gupta PK. Diagnosis of “follicular neoplasms”: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol 2002;26:41-44.
Elisei R, Bottici V, Luchetti F, Di Coscio G, Romei C, Grasso L, et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 2004;89:163-168.
Saggiorato E, De Pompa R, Volante M. Characterization of thyroid “follicular neoplasms” in fine-needle aspiration cytological specimens using a panel of immunohistochemical markers: a proposal for clinical application. Endocr Relat Cancer 2005;12:305-317.
Hurtado-López LM, Arellano-Montaño S, Torres-Acosta EM. Combined use of fine-needle aspiration biopsy, MIBI scans and frozen section biopsy offers the best diagnostic accuracy in the assessment of the hypofunctioning solitary thyroid nodule. Eur J Nucl Med Mol Imaging 2004;31:1273-1279.
De Geus-Oei LF, Pieters GF, Bonekamp JJ. 18F-FDG PET reduces unnecessary hemithyroidectomy for thyroid nodules with inconclusive cytologic results. J Nucl Med 2006;47:770-775.