>Year 2001, Issue 3
Hurtado LMN, Zaldivar RFR, Basurto KE
Therapeutic decision for a follicular tumor
Cir Gen 2001; 23 (3)
PDF: 4. Kb.
Objective: To determine whether fine needle aspiration biopsy (FNAB) and the transoperative study by freezing (TSF) are reliable to decide to operate and to determine the surgical extension for a follicular tumor.
Setting: Third level health care hospital.
Method: Transversal, retrospective, comparative study during a 5-years period (1993-1998) in patients subjected to surgery to resolve thyroid nodules and in whom “follicular tumor” was reported by either of the diagnostic studies performed (FNAB, TSF) and compared with the definitive histopathologic study.
Results: A total of 61 patients were studied (60 women and 1 man), average age of 40.1 years. From the 26 follicular tumors confirmed by the histopathologic study, four corresponded to follicular cancer (15.4%) and 22 to adenomas (84.6%).
FNAB had a sensitivity of 65%, specificity of 44%, positive predictive value (PV+) of 75% and negative predictive value (PV-) of 33%.
TSF had a sensitivity of 71%, specificity of 4%, PV+ 48%, and PV-11%. Combining FANB and TSF yielded a sensitivity of 60%, specificity of 33%, PV+ 60% and PV-33%.
Conclusion: Discrepancies exist between FNAB/ TSF and the definite histopathologic diagnosis in the presence of a follicular tumor; therefore, for any thyroid nodule diagnosed as “follicular tumor” through FNAB it is advised not to make the TSF and to await for the definite histopathologic diagnosis to norm the action to be taken. If no FNAB is available, but a “follicular tumor” has been diagnosed through TSF, the definite histopathologic diagnosis must be awaited to decide on the final action to be taken.
||Thyroid, follicular neoplasm, thyroid nodule, thyroidectomy.
Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993; 328: 553-9.
Rojeski MT, Gharib H. Nodular thyroid disease: evaluation and management. N Engl J Med 1985; 313: 428-36.
Davis NI, Gordon M, Germann E, Robins E, McGregor GI. Clinical parameters predictive of malignancy of thyroid follicular neoplasms. Am J Surg 1991; 161: 567-9.
LiVolsi Va. Current concepts in follicular tumors of the thyroid. Monogr Pathol 1994; 35: 118-37.
Zaldivar-Ramírez FR, Hurtado-López LM, López-López JA, Pulido-Cejudo A, Campos-Castillo C, Basurto-Kuba E. Nódulo tiroideo: incidencia de malignidad. Cir Gen 1999; 21(4)supl 1:30.
Wingo PA, Tong T, Bolden S. Cancer statistics. CA Cancer Clin J 1995; 45: 8.
Grant CS, Hay ID, Gough IR, McCarthy PM, Goellner JR. Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses. Surgery 1989; 106: 980-5; discussion 985-6.
Roque L, Castedo S, Gomes P, Soares P, Clode A, Soares J. Cytogenic findings in 18 follicular thyroid adenomas. Cancer Genet Cytogenet 1993; 67: 1-6.
van Heerden JA, Hay ID, Goellner JR, Salomao D, Ebersold JR, Bergstralh EJ, et al. Follicular thyroid carcinoma with capsular invasion alone: a nonthreatening malignancy. Surgery 1992; 112: 1130.
Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118: 282-9.
Gardner HAR, Ducatman BS, Wang HH. Predictive value of fine-needle aspiration biopsy of the thyroid in the classification of follicular lesions. Cancer 1993; 71: 2598-603.
Kingston GW, Bugis SP, Davis N. Role of frozen section and clinical parameters in distinguishing benign from malignant follicular neoplasms of the thyroid. Am J Surg 1992; 164: 603-5.
Kraemer BB. Frozen section and the thyroid. Semin Diagn Pathol 1987; 4: 169-89.
Hamming JF, Goslings BM, van Steenis GJ, van Ravenswaary Claasen H, Hermans J, van de Velde CJ. The value of fine-needle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds. Arch Intern Med 1990; 150: 113-6.
Reverter JL, Lucas A, Salinas I, Audi L, Foz M, Sanmarti A. Suppressive therapy with levothyroxine for solitary nodules. Clin Endocrinol 1992; 36: 25-8.
LiVolsi VA, Asa SL. The demise of follicular carcinoma of the thyroid gland. Thyroid 1994; 4: 233-6.
Hamburger JI, Hamburger SW. Declining role of frozen section in surgical planning for thyroid nodules. Surgery 1985; 98: 307-12.
>Year 2001, Issue 3