Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine‐needle aspiration?

Abstract

Thyroid fine-needle aspiration (FNA) is a standard procedure for the clinical triage of thyroid nodules. The diagnosis of an adequately sampled thyroid FNA is generally grouped into three categories: benign, malignant, and indeterminate. The latter group usually includes follicular neoplasm, follicular lesion, and sometimes a more specific diagnosis such as Hurthle cell neoplasm or follicular lesion/neoplasm with Hurthle cell change. Whether a FNA diagnosis of Hurthle cell lesion/neoplasm (HLN) denotes a worse clinical outcome than follicular lesion/neoplasm (FLN) remains controversial. A cohort of 303 thyroid FNA cases with follow-up thyroidectomy in our institutes was identified, with the follow-up excision diagnosis compared to the FNA diagnosis in order to address this issue. Of this cohort, 87 cases had an FNA diagnosis of HLN while 216 cases had a diagnosis of FLN. Upon excision, the FNA diagnosis of HLN group had 14 cases of goiter/nodular hyperplasia (16%), 46 cases of adenoma (12 follicular adenoma (14%) and 34 cases of Hurthle cell adenoma (39%)), and 27 cases of carcinoma (31%, 12 papillary carcinoma and 15 Hurthle cell carcinoma). The FLN group had 74 cases of goiter/nodular hyperplasia (34.3%), 8 cases of Hashimoto thyroiditis (3.7%), 73 cases of follicular adenoma (33.8%), one case of granular cell tumor, and 60 cases of carcinoma (27.8%, 46 papillary carcinoma, 12 follicular carcinoma, and 1 Hurthle cell carcinoma and 1 parathyroid carcinoma) upon excision. There is no significant difference in predicting cancer between the two cytology diagnosis groups (HLN versus FLN, 31% versus 27.8%, P = 0.5771). When sorting all the cases by the surgical diagnosis, while comparable for age at diagnosis, the cancer group having the higher proportion of male patients than the non-cancer group (28.7% versus 16.7%, P = 0.0259). Hurthle cell carcinoma patients are typically older than patients with other cancer diagnoses (59 versus 44, P = 0.0077). Our results suggest that an FNA diagnosis of HLN does not predict more malignancy than FLN. Males and older patients with a HLN FNA diagnosis carry a higher risk of Hurthle cell carcinoma upon thyroidectomy.

The cytologic category of oncocytic (Hurthle) cell neoplasm mostly includes low-risk lesions at histology: an institutional experience

“…In conclusion, the 'nightmare' of OCN ought to be regarded similarly as indeterminate proliferations linked to a low malignant rate and handled with less aggressive surgical treatment as also stated in several papers (13,42,43,44,45). Our final suggestion, based on the inter-observer variability on oncocytic/Hurthle cells, is to perform a second FNAC after a period of 6 months if any of the additional morphological features are not present.…”

The atypical thyroid fine‐needle aspiration: Past, present, and future

“…Aspirates with this pattern are better placed in the AUS/FLUS category, and patients may benefit from a repeat FNA performed within 3 to 6 months. 23,24 Another pattern is the cellular aspirate comprised exclusively or nearly exclusively of oncocytes in a patient with chronic lymphocytic thyroiditis (HT) (Fig. 3C) or multinodular hyperplasia (MNH).…”

Carcinoma de células de Hürthle. Análisis cooperativo de los dos hospitales oncológicos de la Ciudad de Buenos Aires

“…Debido a que el diagnóstico de CCH implica confirmar la presencia de invasión vascular o capsular o de ambas, la PAAF evidencia limitaciones en esta patología 9,15 . En la serie analizada, como es esperable, el 70% de las PAAF correspondieron a la categoría IV del sistema de Bethesda.…”

“…Las mutaciones de RAS se observan en el 11% de los casos de CCH, comparado con el 45% del carcinoma folicular 2 . La congelación intraoperatoria, en la práctica, no suele contribuir a confirmar el diagnóstico, ya que requiere entre 15 y 20 cortes para discriminar benigno y maligno 15,17 . De modo similar, en el presente trabajo se diagnosticó CCH por biopsia intraoperatoria en menos de la cuarta parte de los casos, en los que se pudo confirmar ruptura capsular y extensión extratiroidea.…”