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Clinical Presentation of Patients with a Thyroid Follicular Neoplasm: Are there Preoperative Predictors of Malignancy?

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Studies examining differences in presentation of patients with benign [follicular adenoma (FA)] and malignant follicular thyroid neoplasms [follicular thyroid carcinoma (FTC) or follicular variant papillary thyroid carcinoma (FVPTC)] include only one or two of these subtypes, and none has considered clinical, cytological, and sonographic features together. We therefore examined presenting clinical features of all benign and malignant follicular neoplasm subtypes in an attempt to identify predictors of malignancy.

Methods

Consecutive patients with a surgically resected follicular thyroid neoplasm at a tertiary hospital from 2005 to 2013 were reviewed. Age, gender, symptoms, history, physical findings, nodule size, sonographic, cytologic, and final pathologic results were recorded. Multivariate logistic regression was used to determine variables that contributed to a diagnosis of malignant follicular neoplasm.

Results

A total of 616 patients (163 males, 453 females) presented with 441 FAs, 17 FTCs, and 158 FVPTCs. On multivariate analysis, male sex [odds ratio (OR) 1.87, p = 0.008], family history of thyroid cancer (OR 5.16, p < 0.001), and history of head and neck radiation (OR 2.01, p = 0.04) were associated with an increased odds of malignancy; age >45 (OR 2.03, p = 0.001), dysphagia (OR 3.48, p = 0.001) or pressure sensation (OR 3.00, p = 003), concomitant hyperthyroidism (OR 4.76, p = 0.01), nodules ≥4 cm (OR 3.68, p < 0.001), and multinodularity on physical examination (OR 1.93, p = 0.004) were associated with an increased odds of a benign lesion.

Conclusions

Independent clinical predictors exist that might be helpful in preoperative differentiation of benign and malignant follicular neoplasms. A combination of these predictors with both FNA and molecular results may help us to improve the clinical management of patients with follicular thyroid lesions.

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References

  1. Polyzos SA, Kita M, Avramidis A. Thyroid nodules - stepwise diagnosis and management. Horm. 2007;6(2):101–19.

    Article  Google Scholar 

  2. Suster S. Thyroid tumors with a follicular growth pattern: problems in differential diagnosis. Arch Pathol Lab Med. 2006;130(7):984–8.

    PubMed  Google Scholar 

  3. Banks ND, Kowalski J, Tsai H-L, et al. A diagnostic predictor model for indeterminate or suspicious thyroid FNA samples. Thyroid. 2008;18(9):933–41.

    Article  CAS  PubMed  Google Scholar 

  4. Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pr. 2011;17(3):456–520.

    Article  Google Scholar 

  5. Asa SL, Mete O. Thyroid neoplasms of follicular cell derivation: a simplified approach. Semin Diagn Pathol. 2013;30(3):178–85.

    Article  PubMed  Google Scholar 

  6. Lin HS, Komisar A, Opher E, Blaugrund SM. Follicular variant of papillary carcinoma: the diagnostic limitations of preoperative fine-needle aspiration and intraoperative frozen section evaluation. Laryngoscope. 2000;110(9):1431–6.

    Article  CAS  PubMed  Google Scholar 

  7. Najafian A, Zeiger MA. The role of molecular diagnostic markers in the management of indeterminate and suspicious thyroid nodules. Int J Endocr Oncol. 2014;1(1):49–57.

    Article  CAS  Google Scholar 

  8. Boonyaarunnate T, Olson MT, Ali SZ. “Suspicious for a follicular neoplasm” before and after the Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology. Acta Cytol. 2013;57(5):455–63.

    Article  PubMed  Google Scholar 

  9. Olson MT, Clark DP, Erozan YS, Ali SZ. Spectrum of risk of malignancy in subcategories of “atypia of undetermined significance.” Acta Cytol. 2011;55(6):518–25.

    Article  PubMed  Google Scholar 

  10. Olson MT, Boonyaarunnate T, Aragon Han P, Umbricht CB, Ali SZ, Zeiger M. A tertiary center’s experience with second review of 3885 thyroid cytopathology specimens. J Clin Endocrinol Metab. 2013;98(4):1450–7.

    Article  CAS  PubMed  Google Scholar 

  11. Mathur A, Najafian A, Zeiger MA, Olson MT, Schneider EB. Malignancy risk and reproducibility in atypia of undetermined significance on thyroid cytology. Surgery. 2014;156(6):1471–6.

    Article  PubMed  Google Scholar 

  12. Umbricht CB, Saji M, Westra WH, Udelsman R, Zeiger MA, Sukumar S. Telomerase activity: a marker to distinguish follicular thyroid adenoma from carcinoma. Cancer Res. 1997;57(11):2144–7.

    CAS  PubMed  Google Scholar 

  13. Baloch ZW, Cibas ES, Clark DP, et al. The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation. Cytojournal. 2008;5:6.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306–15.

    Article  PubMed  Google Scholar 

  15. Mathur A, Olson MT, Zeiger MA. Follicular lesions of the thyroid. Surg Clin North Am. 2014;94(3):499–513.

    Article  PubMed  Google Scholar 

  16. Yoon JH, Kim E, Hong SW, Kwak JY, Kim MJ. Sonographic features of the follicular variant of papillary.J Ultrasound Med. 2008;27(10):1431-7.

    PubMed  Google Scholar 

  17. Sillery JC, Reading CC, Charboneau JW, Henrichsen TL, Hay ID, Mandrekar JN. Thyroid follicular carcinoma: sonographic features of 50 cases. AJR Am J Roentgenol. 2010;194(1):44–54.

    Article  PubMed  Google Scholar 

  18. Rago T, Fiore E, Scutari M, et al. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol. 2010;162(4):763–70.

    Article  CAS  PubMed  Google Scholar 

  19. Przybylik-Mazurek E. Positive family history of thyroid disease as a risk factor for differentiated thyroid carcinoma. Pol Arch Med Wewn. 2011;121(12):441–6.

    PubMed  Google Scholar 

  20. Xu L, Li G, Wei Q, El-Naggar AK, Sturgis EM. Family history of cancer and risk of sporadic differentiated thyroid carcinoma. Cancer. 2012;118(5):1228–35.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Auguste LJ, Sako K. Radiation and thyroid carcinoma: radiotherapy, head and neck regions, thyroid carcinoma. Head Neck Surg. 1985;7(3):217-24.

    Article  CAS  PubMed  Google Scholar 

  22. Boaventura P, Soares P, Pereira D, Teixeira-Gomes J, Sobrinho-Simões M. Head and neck lesions in a cohort irradiated in childhood for tinea capitis treatment. Lancet Infect Dis. 2011;11(3):163–4.

    Article  PubMed  Google Scholar 

  23. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US features of thyroid malignancy: pearls and pitfalls. RadioGraphics. 2007;27(3):847–60.

    Article  PubMed  Google Scholar 

  24. Gulcelik N, Gulcelik M, Kuru B. Risk of malignancy in patients with follicular neoplasm: Predictive value of clinical and ultrasonographic features. Arch Otolaryngol Neck Surg. 2008;134(12):1312–5.

    Article  Google Scholar 

  25. Lee SH, Baek JS, Lee JY, et al. Predictive factors of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. Endocr Pathol. 2013;24(4):177–83.

    Article  PubMed  Google Scholar 

  26. Rago T, Di Coscio G, Basolo F, et al. Combined clinical, thyroid ultrasound and cytological features help to predict thyroid malignancy in follicular and Hupsilonrthle cell thyroid lesions: results from a series of 505 consecutive patients. Clin Endocrinol (Oxf). 2007;66(1):13–20.

    CAS  PubMed  Google Scholar 

  27. Raber W, Kaserer K, Niederle B, Vierhapper H. Risk factors for malignancy of thyroid nodules initially identified as follicular neoplasia by fine-needle aspiration: results of a prospective study of one hundred twenty patients. Thyroid. 2000;10(8):709–12.

    Article  CAS  PubMed  Google Scholar 

  28. Schlinkert RT, Van Heerden JA, Goellner JR, et al. Factors that predict malignant thyroid lesions when fine-needle aspiration is “suspicious for follicular neoplasm.” Mayo Clin Proc. 1997;72(10):913–6.

    Article  CAS  PubMed  Google Scholar 

  29. Jeong SH, Hong HS, Lee EH, Cha JG, Park JS, Kwak JJ. Outcome of thyroid nodules characterized as atypia of undetermined significance or follicular lesion of undetermined significance and correlation with Ultrasound features and BRAF(V600E) mutation analysis. AJR Am J Roentgenol. 2013;201(6):W854–60.

    Article  PubMed  Google Scholar 

  30. Lubitz CC, Faquin WC, Yang J, et al. Clinical and cytological features predictive of malignancy in thyroid follicular neoplasms. Thyroid. 2010;20(1):25–31.

    Article  PubMed  Google Scholar 

  31. David E, Rosen IB, Bain J, James J, Kirsh JC. Management of the hot thyroid nodule. Am J Surg. 1995;170(5):481–3.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alireza Najafian MD, Eric B. Schneider PhD & Martha A. Zeiger MD

  2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Matthew T. Olson MD

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  1. Alireza Najafian MD
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  2. Matthew T. Olson MD
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  3. Eric B. Schneider PhD
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  4. Martha A. Zeiger MD
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Correspondence to Martha A. Zeiger MD.

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Najafian, A., Olson, M.T., Schneider, E.B. et al. Clinical Presentation of Patients with a Thyroid Follicular Neoplasm: Are there Preoperative Predictors of Malignancy?. Ann Surg Oncol 22, 3007–3013 (2015). https://doi.org/10.1245/s10434-014-4324-z

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  • DOI: https://doi.org/10.1245/s10434-014-4324-z

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