Clinical Features Associated with an Increased Risk of Thyroid Malignancy in Patients with Follicular Neoplasia by Fine-Needle Aspiration

Abstract

The application of fine-needle aspiration (FNA) to the evaluation of the thyroid nodule has greatly enhanced the ability of the clinician to appropriately select patients for thyroidectomy. However, despite extensive experience with thyroid FNA, the cytological distinction of benign from malignant follicular neoplasia remains problematic. As a result, most patients with FNA findings of a follicular neoplasm are referred for thyroidectomy. The goal of the present study was to develop clinical criteria capable of predicting malignancy in patients with an FNA diagnosis of follicular neoplasm. Among 1121 patients undergoing thyroid FNA at two large teaching centers during the period 1990 to 1995, 149 patients had cytological findings consistent with a follicular neoplasm. Among 103 patients referred for thyroidectomy, 22 (21%) were found to have a malignancy in the biopsied nodule. Among patients subjected to thyroidectomy, the risk of malignancy was significantly higher when follicular neoplasia was present in a male (43% vs. 16% for females, p = 0.007), when the nodule was greater than 4 cm to palpation (40% vs. 13% for nodules less than 4 cm, p = 0.03), or when the nodule was judged to be solitary by palpation (25% vs. 6% for a dominant nodule in a multinodular goiter, p = 0.02). Bayesian analysis of the data reveals that after an FNA showing a follicular neoplasm, the risk of malignancy in males with large nodules was nearly 80%, compared with a rate of only 3% in females with small nodules. These results suggest that clinical features including gender, nodule size, and character of the gland by palpation can be systematically integrated into the decision analysis, thereby improving the selection of patients for surgical referral.

Diagnostic and extent of disease multigene assay for malignant thyroid neoplasms

“…[7][8][9][10] Many prognostic scoring systems ( [EORTC]) have been used to estimate diseasefree survival and cause-specific mortality in patients with thyroid cancer. [11][12][13][14] The main use of these risk classification systems is to identify patients with a poor prognosis, to ensure that they receive additional treatment such as radioiodine ablation, and to achieve closer follow-up monitoring.…”

Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland

“…1,2 In addition, clinical predictors of malignancy in patients with follicular neoplasms and HCN have been intensely studied, with varied results. [3][4][5][6][7][8] The cytomorphologic features of Hurthle cell nodules of the thyroid in FNAB have been described by multiple investigators, but there is limited agreement regarding the usefulness of specific features for the cytologic diagnosis of HCN. 9 -19 Kini et al 13 described a set of widely used criteria for the cytologic diagnosis of HCN that include cytoarchitecture, monomorphism, and macronucleoli.…”

Predictive Factors of Malignancy in Thyroid Nodules Diagnosed as Follicular Neoplasm or Hürthle Cell Neoplasm on FNA

“…(16,18,19,25,26) According to the ATA guideline, initial total thyroidectomy is recommended in patients with indeterminate nodules who have large tumors (＞4 cm) due to an increased risk for malignancy. Taneri et al (26) found in HCN that there was no malignancy among the tumors less than 1 cm diameter.…”