Diagnostic performance of thyroid ultrasound in Hürthle cell carcinomas

Santana, Nathalie Oliveira de; Freitas, Ricardo Miguel Costa de; Marcos, Vinícius Neves; Chammas, Maria Cristina; Camargo, Rosalinda; Schmerling, Cláudia Kliemann; Vanderlei, Felipe Augusto Brasileiro; Hoff, Ana O.; Marui, Suemi; Danilovic, Débora Lucia Seguro

doi:10.20945/2359-3997000000131

Cited by 11 publications

(18 citation statements)

References 27 publications

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“…The only published study dedicated to the assessment of the performance of U-RSS in nodules with predominant HC referred to ACR-TIRADS. Santana et al (2019) did not confirm the usefulness of that system in distinguishing benign and malignant HN [ 30 ]. They evaluated 24 HTC and 27 HTA and indicated that similar percentages of carcinomas and adenomas (58% and 48%) were classified as ACR-TIRADS categories four or five.…”

Section: Discussionmentioning

confidence: 99%

Usability of EU-TIRADS in the Diagnostics of Hürthle Cell Thyroid Nodules with Equivocal Cytology

Słowińska-Klencka

Wysocka-Konieczna

Klencki

et al. 2020

JCM

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The aim of this study was to compare the diagnostic effectiveness of EU-TIRADS in two groups of nodules with equivocal cytology (categories III-V of Bethesda system), with and without Hürthle cells (HC and non-HC). The study included 162 HC and 378 non-HC nodules with determined histopathological diagnosis (17.9% and 15.6% cancers). In both groups calculated and expected risk of malignancy (RoM) for high, intermediate and benign risk categories of EU-TIRADS were concordant. RoM for low risk category was higher than expected in both groups, but especially in HC (HC: 13.9%, non-HC: 7.0%, expected: 2–4%). The majority of cancers in HC of that category were follicular thyroid carcinomas (FTC) and Hürthle cell thyroid carcinoma (HTC) (60.0% vs. non-HC: 16.7%). The diagnostic efficacy of EU-TIRADS was lower in HC (the area under the receiver operating characteristics curve (AUC): 0.621, sensitivity (SEN): 44.8%, specificity (SPC): 78.9% for high risk threshold) than in non-HC (AUC: 0.711, SEN: 61.0%, SPC: 77.7%). AUC was the highest for category V (AUC > 0.8, both groups) and the lowest for category IV (inefficient, both group). If intermediate risk category was interpreted as an indication for surgery, 25% of cancers from category III and 21.4% from category IV would not be treated in the HC group (0.0% and 7.4% from non-HC group, respectively). EU-TIRADS does not aid making clinical decisions in patients with cytologically equivocal HC nodules, particularly those classified into category IV of Bethesda System for Reporting Thyroid Cytopathology (BSRTC).

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Section: Discussionmentioning

confidence: 99%

Usability of EU-TIRADS in the Diagnostics of Hürthle Cell Thyroid Nodules with Equivocal Cytology

Słowińska-Klencka

Wysocka-Konieczna

Klencki

et al. 2020

JCM

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“…HCC is more often observed in females, and the reported female to male ratio of HCC is 1.6-4.8:1 [4,[16][17][18]. The affected age range is 54-62 years old [4,17,[19][20][21][22].…”

Section: Demographic Featuresmentioning

confidence: 99%

“…Preoperative diagnosis by ultrasound is challenging. In ultrasounds, HCC shows a range of sonographic appearances from predominantly hypoechoic to hyperechoic lesions, and no preoperative features can differentiate HCC from adenoma [18,27]. Several attempts have been made to predict HCC before the operation.…”

Section: Ultrasoundsmentioning

confidence: 99%

Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features

Kure

Ohashi

2020

Cancers

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Hürthle cell carcinoma (HCC) represents 3–4% of thyroid carcinoma cases. It is considered to be more aggressive than non-oncocytic thyroid carcinomas. However, due to its rarity, the pathological characteristics and biological behavior of HCC remain to be elucidated. The Hürthle cell is characterized cytologically as a large cell with abundant eosinophilic, granular cytoplasm, and a large hyperchromatic nucleus with a prominent nucleolus. Cytoplasmic granularity is due to the presence of numerous mitochondria. These mitochondria display packed stacking cristae and are arranged in the center. HCC is more often observed in females in their 50–60s. Preoperative diagnosis is challenging, but indicators of malignancy are male, older age, tumor size > 4 cm, a solid nodule with an irregular border, or the presence of psammoma calcifications according to ultrasound. Thyroid lobectomy alone is sufficient treatment for small, unifocal, intrathyroidal carcinomas, or clinically detectable cervical nodal metastases, but total thyroidectomy is recommended for tumors larger than 4 cm. The effectiveness of radioactive iodine is still debated. Molecular changes involve cellular signaling pathways and mitochondria-related DNA. Current knowledge of Hürthle cell carcinoma, including clinical, pathological, and molecular features, with the aim of improving clinical management, is reviewed.

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“…8,12,13,15,17,18 TI-RADS has emerged as a radiographic scoring system developed by the American College of Radiology 19 that is valuable in evaluating thyroid nodules 20 ; however, it has poor performance in differentiating Hürthle cell carcinoma (HCC) from adenoma. 21 Genomic studies have suggested HCC is genetically unique, 22,23 and sequencing has been used with some success to improve the specificity of FNA. 24 We sought to perform a retrospective analysis of patients seen at our institution to determine if final pathologic diagnosis was consistent with published rates.…”

mentioning

confidence: 99%

“…al. who found that TI-RADS 4 or 5 had a specificity of only 51.8% and a likelihood ratio of 1.21 for HCC in 101 patients with HCN 21. While TI-RADS may have limited utility in predicting malignancy of HCN lesions, other sonographic features such as solid (rather than cystic) appearance, hypoechoic echogenicity, absence of calcifications,…”

mentioning

confidence: 99%

Hürthle cell neoplasms of the thyroid: Pathologic outcomes and ultrasonographic analysis

Shin

Rabbani

Murthy

et al. 2020

Laryngoscope Investig Oto

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Background: Fine-needle aspiration (FNA) of thyroid nodules suspicious for Hürthle cell neoplasms (HCN) have uncertain rate of malignancy. We aim to characterize rate and predictors of malignancy at our institution and compare these findings with established literature to help guide management. Methods: Single tertiary-referral center, retrospective study of 166 adults who underwent hemithyroidectomy or total thyroidectomy following FNA suspicious for HCN from 1998-2018. Demographic information and surgical histopathologic results were collected. Preoperative ultrasonography was independently scored on the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) by a board-certified head and neck radiologist. Results: There were 39 males and 127 females. Overall, 25 (15.1%) patients had carcinoma, with 15 (9%) being Hürthle cell carcinoma (HCC). Men had higher incidence of carcinoma (25.6% v. 11.8%, P = .035), and especially older males. Contralateral carcinoma was seen in 3 of 13 (23.1%) patients that underwent completion thyroidectomy. Patients with carcinoma had larger nodules (average diameter 3.3 cm versus 2.5 cm, respectively, P = .01), but no association with TI-RADS. Conclusion: Adults with nodules suspicious for HCN have significant risk of malignancy consistent with prior studies. Older males and larger nodule diameter are associated with malignancy in this cohort, but TI-RADS grade is not. These findings provide a framework for management and counseling for lesions suspicious for HCN.

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Diagnostic performance of thyroid ultrasound in Hürthle cell carcinomas

Cited by 11 publications

References 27 publications

Usability of EU-TIRADS in the Diagnostics of Hürthle Cell Thyroid Nodules with Equivocal Cytology

Usability of EU-TIRADS in the Diagnostics of Hürthle Cell Thyroid Nodules with Equivocal Cytology

Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features

Hürthle cell neoplasms of the thyroid: Pathologic outcomes and ultrasonographic analysis

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