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Yim, Kim, Kim, Kim, Gong, Hong, Kim, and Shong: Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hürthle Cell Neoplasm and the Risk of Malignancy
Original Article
Endocrinology and Metabolism

Endocrinology and Metabolism 2010; 25(4): 316-320.

Published online: 31 December 2010

DOI: https://doi.org/10.3803/EnM.2010.25.4.316

Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hürthle Cell Neoplasm and the Risk of Malignancy

Ji Hye Yim, Eui Young Kim, Won Gu Kim, Tae Yong Kim, Gyungyup Gong1, Suck Joon Hong2, Won Bae Kim, Young Kee Shong

Department of Endocrinology & Metabolism, Asan Medical Center, Unversity of Ulsan College of Medicine, Seoul, Korea.

1Department of Pathology, Asan Medical Center, Unversity of Ulsan College of Medicine, Seoul, Korea.

2Department of Surgery, Asan Medical Center, Unversity of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Won Bae Kim. Department of Endocrinology & Metabolism, Asan Meical Center, University of Ulasn College of Medicin, 388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3240, Fax: +82-2-3010-6962, kimwb@amc.seoul.kr

Received 11 May 2010       Accepted 26 September 2010

Copyright © 2010 Korean Endocrine Society

Abstract

Background

Follicular neoplasm (FN) or Hürthle cell neoplasm (HN) is a less well understood pitfall when evaluating thyroid nodule with fine-needle aspiration (FNA). This study aimed to determine the rates of malignancy and the predictive factors for malignancy in thyroid nodules with a cytological diagnosis of FN or HN.

Methods

The patients who were cytologically diagnosed as having FN or HN after FNA between 1995 and 2004 at Asan Medical Center were included in this study. We collected the pathology data until 2009 and we analyzed the clinical characteristics associated with malignancy.

Results

A total 478 patients were cytologically diagnosed as having FN or HN during the study period and 327 (68%) among them underwent thyroid surgery. Thyroid malignancy was confirmed in 157 (48%) of 327 patients. Malignancy was confirmed in 124 patients with FN (124/253, 49%). They were 48 papillary, 65 follicular, 7 Hürthle cell and 3 medullary carcinomas and 1 anaplastic carcinoma. The malignancy in the cases of HN (33/71, 44.6%) was 9 papillary, 4 follicular and 20 Hürthle cell carcinomas. The risk of malignancy was not associated with male gender, a larger tumor size (> 4 cm) or the diagnosis of HN. However, an age below 20 years (RR 3.6, P = 0.03) and above 60 years (RR 2.3, P = 0.04) was associated with an increased risk of malignancy.

Conclusion

About half of the patients with FN or HN on FNA cytology were diagnosed as having thyroid cancer after surgery. The malignancy rate for the cytologic diagnosis of HN was similar to that for FN. Thyroid surgery should be recommended for this situation, and especially for patients younger than 20 years or older than 60 years.

Keywords: Cytology, Follicular neoplasm, Hürthle cell neoplasm, Thyroid cancer

Figures and Tables

Table 1
Clinical features of patients with follicular neoplasm and Hürthle cell neoplasm on fine needle aspiration cytology
enm-25-316-i001

Percentages or range in parentheses.

Follow up duration: Between cytologic diagnosis and surgical treatment.

FN, follicular neoplasm; HN, Hürthle cell neoplasm.

Table 2
Pathological diagnosis of patients with follicular neoplasm or Hürthle cell neoplasm on fine needle aspiration cytology
enm-25-316-i002

Percentages or range in parentheses.

FN, follicular neoplasm; HN, Hürthle cell neoplasm; PTC, papillary thyroid cancer; FTC, follicular thyroid cancer.

Table 3
Clinical features of patients with follicular neoplasm or Hürthle cell neoplasm on fine needle aspiration cytology according to pathological diagnosis of malignancy after surgery
enm-25-316-i003

Percentages in parentheses.

*Follow up duration: Between cytologic diagnosis and surgical treatment.

Table 4
Clinicopathologic parameters associated with malignant pathology in patients with follicular neoplasm and Hürthle cell neoplasm on cytology
enm-25-316-i004

References

1. Suk JH, Kim TY, Kim MK, Kim WB, Kim HK, Jeon SH, Shong YK. Prevalence of ultrasonographically-detected thyroid nodules in adults without previous history of thyroid disease. J Korean Endocr Soc. 2006. 21:389–393.
2. Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK. Fine-needle aspiration of thyroid: an institutional experience. Thyroid. 1998. 8:565–569.
3. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ. Cancer statistics, 2008. CA Cancer J Clin. 2008. 58:71–96.
4. Caraway NP, Sneige N, Samaan NA. Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases. Diagn Cytopathol. 1993. 9:345–350.
5. Elliott DD, Pitman MB, Bloom L, Faquin WC. Fine-needle aspiration biopsy of Hurthle cell lesions of the thyroid gland: a cytomorphologic study of 139 cases with statistical analysis. Cancer. 2006. 108:102–109.
6. Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of "follicular neoplas": a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol. 2002. 26:41–44.
7. Wu HH, Clouse J, Ren R. Fine-needle aspiration cytology of Hürthle cell carcinoma of the thyroid. Diagn Cytopathol. 2008. 36:149–154.
8. Greaves TS, Olvera M, Florentine BD, Raza AS, Cobb CJ, Tsao-Wei DD, Groshen S, Singer P, Lopresti J, Martin SE. Follicular lesions of thyroid: a 5-year fine-needle aspiration experience. Cancer. 2000. 90:335–341.
9. Nguyen GK, Husain M, Akin MR. Cytodiagnosis of benign and malignant Hürthle cell lesions of the thyroid by fine-needle aspiration biopsy. Diagn Cytopathol. 1999. 20:261–265.
10. Renshaw AA. Fine-needle aspiration of Hurthle cell lesions: making the best of what consumers want. Diagn Cytopathol. 2003. 29:183–184.
11. Saggiorato E, De Pompa R, Volante M, Cappia S, Arecco F, Dei Tos AP, Orlandi F, Papotti 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.
12. Sorrenti S, Trimboli P, Catania A, Ulisse S, De Antoni E, D'Armiento M. Comparison of malignancy rate in thyroid nodules with cytology of indeterminate follicular or indeterminate Hürthle cell neoplasm. Thyroid. 2009. 19:355–360.
13. Pu RT, Yang J, Wasserman PG, Bhuiya T, Griffith KA, Michael CW. Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? Diagn Cytopathol. 2006. 34:330–334.
14. Giorgadze T, Rossi ED, Fadda G, Gupta PK, LiVolsi VA, Baloch Z. Does the fine-needle aspiration diagnosis of "Hürthle-cell neoplasm/follicular neoplasm with oncocytic features" denote increased risk of malignancy? Diagn Cytopathol. 2004. 31:307–312.
15. Kim ES, Nam-Goong IS, Gong G, Hong SJ, Kim WB, Shong YK. Postoperative findings and risk for malignancy in thyroid nodules with cytological diagnosis of the so-called "follicular neoplasm". Korean J Intern Med. 2003. 18:94–97.
16. Máximo V, Sobrinho-Simões M. Hürthle cell tumours of the thyroid. A review with emphasis on mitochondrial abnormalities with clinical relevance. Virchows Arch. 2000. 437:107–115.
17. Yutan E, Clark OH. Hürthle cell carcinoma. Curr Treat Options Oncol. 2001. 2:331–335.
18. Sobrinho-Simões M, Máximo V, Castro IV, Fonseca E, Soares P, Garcia-Rostan G, Oliveira MC. Hürthle (oncocytic) cell tumors of thyroid: etiopathogenesis, diagnosis and clinical significance. Int J Surg Pathol. 2005. 13:29–35.
19. Asari R, Koperek O, Scheuba C, Riss P, Kaserer K, Hoffmann M, Niederle B. Follicular thyroid carcinoma in an iodine-replete endemic goiter region: a prospectively collected, retrospectively analyzed clinical trial. Ann Surg. 2009. 249:1023–1031.
20. Gharib H, Goellner JR, Zinsmeister AR, Grant CS, Van Heerden JA. Fine-needle aspiration biopsy of the thyroid. The problem of suspicious cytologic findings. Ann Intern Med. 1984. 101:25–28.
21. Evans HL, Vassilopoulou-Sellin R. Follicular and Hurthle cell carcinomas of the thyroid: a comparative study. Am J Surg Pathol. 1998. 22:1512–1520.
22. Carcangiu ML, Bianchi S, Savino D, Voynick IM, Rosai J. Follicular Hurthle cell tumors of the thyroid gland. Cancer. 1991. 68:1944–1953.
23. Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordoñez NG, Sherman SI. Prognostic factors in patients with Hürthle cell neoplasms of the thyroid. Cancer. 2003. 97:1186–1194.
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