Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2007) 13 P314

SFEBES2007 Poster Presentations Thyroid (51 abstracts)

Only one in four patients with suspicious thyroid cytology (THY3) has a thyroid carcinoma

Radu Mihai 1 , Kenny Chin 1 , Andrew Parker 2 , Derek Roskell 2 & Greg Sadler 1


1Dept Surgery, John Radcliffe Hospital, Oxford, United Kingdom; 2Dept Histopathology, John Radcliffe Hospital, Oxford, United Kingdom.


Background: Fine needle aspiration biopsy (FNA) is the cornerstone of assessment of thyroid nodules. Cytological criteria for benign (THY2) and malignant (THY5) nodules are well-established and reliable. In a minority of patients cytology raises the possibility of a neoplasm (THY3) and only formal histological assesment can differentiate between benign and malignant lesions.

Method: Retrospective review of histological and clinical data in a cohort of patients with thyroid nodules with cytological diagnosis of follicular neoplasm (THY3).

Results: Between Jan 2000 and October 2006, out of a total of 2078 patients who underwent thyroid FNAs, there were 89 THY3 reports (approx 1:20). There were 19 men and 70 women, aged 17–76 years. Thyroid lobectomy was performed in 82 patients and total thyroidectomy in 7 patients.

Histology demonstrated a thyroid carcinoma in 24 patients (15 follicular, 4 medullary, 3 papillary, 1 Hurthle cell and 1 poorly differentiated).

Benign changes were found in 65 patients (40 follicular adenomas, 10 Hurthle adenomas, 6 multinodular goitres, 4 adenomatoid nodules, 2 Hashimoto thyroiditis 1 colloid nodule).

Malignancy was more common in women (20/70 vs. 4/19, P<0.001 chi test) in younger patients (median age 31 vs. 50 yrs) and in larger nodules (median 31 mm vs. 28 mm).

Some 8/17 nodules over 40 mm in diameter were carcinomas, compared with only 12/53 in nodules under 40 mm (P<0.01, chi test).

Conclusion: Only one in four patients with cytological features of a follicular neoplasm has a thyroid carcinoma. A large nodule (>4 cm) in a young patient has a high likelihood of being a cancer and arguably such patients could be offered total thyroidectomy rather than diagnostic lobectomy.

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