Endocrine Abstracts (2009) 20 P106

The ratio of malignancy in patients who underwent thyroidectomy due to follicular lesion/neoplasia

Kamile Gul1, Didem Ozdemir Sen1, Husniye Baser1, Ali Erkan2, Reyhan Ersoy1 & Bekir Cakir1

1Department of Endocrinology and Metabolism, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 2Department of 2. General Surgery, Ankara Ataturk Education and Research Hospital, Ankara, Turkey.

Objective: We aimed to evaluate the frequency of malignancy in patients with follicular lesion or follicular neoplasia in cytological examination.

Method: About 29 patients who had follicular neoplasia or follicular lesion in cytological examination after ultrasound guided thyroid fine needle aspiration biopsy (FNAB) were included in the study. Histopathologic results were evaluated after thyroidectomy in all patients.

Results: There were 28 female and one male patient. Ten of the patients had nodular, 18 had multinodular and one had recurrent multinodular goiter preoperatively. One of the nodules was infracentrimetric, 28 were supracentrimetric. Mean age was 42.27±11.06 (21–65). Postoperatively, thyroid malignancy was determined in 12 patients in histopathologic examination. Therefore, the frequency of thyroid malignancy in patients with follicular lesion/neoplasia was found to be 41.4%. All of malign nodules, except one, was supracentrimetric. Six of the patients had nodular and 6 had multinodular goiter. The distribution of thyroid cancer was as follows; 3 follicular thyroid carcinoma, 7 papillary thyroid carcinoma and 2 follicular variant of papillary carcinoma. Three of the histopathologically benign cases had hashimoto’s thyroiditis, 2 had hurthle cell adenoma, 2 had follicular adenoma and 10 had nodular hyperplasia.

Conclusion: It is difficult to differentiate follicular and hurthle cell carcinoma from follicular and hurthle cell adenoma cytologically. These nodules are diagnosed as carcinoma if vascular and capsular invasion is seen histopathologically. Studies showed no benefit of frozen sections on differential diagnosis. In the literature the rate of malignancy in follicular neoplasia/lesion is 6–47%. In our study, we found 41.4% malignancy rate in patients who underwent surgery due to follicular lesion or neoplasia. About 75% of the malignant cases were papillary carcinoma. We accept this group of patients as malignant and suggest that total /near total thyroidectomy should be performed.

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