Elastosonographical characteristics, cytological results and histopathological features of nodules in patients with hurthle cells
D. Tuzun1, R. Ersoy2, A. Kilicyazgan1, A. Oguz1, G. Kiyak1, G. Guler2 & B. Cakir2
Objective: In this study, we aimed to evaluate ultrasonographical and elastosonographical characteristics, cytological results and histopathological features of nodules in patients with Hurthle cells in cytological examination and operated for various reasons.
Method:57 patients and 57 nodules detected to have Hurthle cells in thyroid fine needle aspiration biopsy (FNAB) were included in the study.
Results: Among 57 nodules with Hurthle cells in cytological examination, 49 (86%) were classified as Bethesda 1 and 8 (14%) were classified as Bethesda 3. Histopathologically, 45 (78.9%) nodules were benign and 12 (21.1%) were malignant. When nodules were grouped according to Bethesda results, nodule volume, ultrasonographic features in gray-scale and vascularization pattern were similar in two groups. There was no signicant difference in terms of elastosonographic scoring and mean strain index (SI) between groups. Elastosonography scores determined in transverse axis were found to be more predictive for malignancy compared to scores determined in longitudinal axis (P=0.023 and P=0.867, respectively). However, mean SI values in longitudinal axis were significantly higher than mean SI values in transverse axis (P<0.05). Hurthle cells were significantly higher in Bethesda 3 nodules compared to Bethesda 1 nodules (P<0.01). Cytological features were compared in histopathologically benign and malignant nodules. Nuclear groove, transgressing blood vessel (TBV) and absence of colloid were observed with a higher frequency in malignant nodules compared to benign nodules (P<0.05).
Conclusion: Nuclear groove, TBV and absence of colloid in cytomorphological evaluation seem to be the features that support malignancy in nodules including Hurthle cells cytologically. Higher SI values obtained during elastosonographical examination in malignant nodules compared to benign nodules suggest that SI might be used as a parameter to predict malignancy. Since malignancy rate in our patient group was 21.1%, we think total or near total thyroidectomy should be preferred in nodules with Hurthle cells in cytological examination.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector