Abstract
Follicular lesions account for 4–6% of all thyroid fine-needle aspiration (FNA) cytologies. To date, no cytological criteria exist to distinguish follicular adenoma from carcinoma. For this purpose, histological evaluation after surgical exeresis is required. From 1993 to 2000 we performed 1238 US-assisted FNA biopsies in patients admitted to our unit for uni-or multi-nodular goiters. In the latter goiters, FNA was performed in the dominant nodule. Cytological examination revealed a follicular lesion in 71 patients (5.7%). All patients came from regions of Northern Italy with moderate iodine deficiency. In 48%, the lesion presented as a solitary nodule, while in the other 52% it occurred in the context of a multinodular goiter. Surgical exeresis of the neoplasm was recommended in all cases. Sixty-three patients (89%) underwent surgery (Group 1) while the other 8 patients (11%) opted for follow-up (Group 2). In Group 2, the mean nodule volume (3.2±0.5 ml) at baseline was slightly smaller (p=0.08) than that found in Group 1 (5.4±0.7 ml). In Group 1, histological examination after surgery showed a follicular adenoma in 52 patients (83%) and a colloid goiter in the others (17%). No malignancy was detected. Group 2 underwent a median follow-up of 46 months (range 24–96 months) on L-thyroxine suppressive regimen (dose range 75–125 μg/day), with TSH levels ranging from 0.1 to 0.3 mIU/l. Throughout the follow-up, no patient developed clinical or ultrasonographic features that could be considered worrisome for malignancy; thus, no further biopsy was performed. However, an overall slight increase (median +5.2%) in nodular volume in respect to baseline was observed. Although institutional and cytological bias cannot be ruled out, our data do not confirm the reported incidence of malignancy in histological specimens of follicular lesions diagnosed on FNA cytology, and prompt us to suggest a less aggressive first-step approach (i.e. careful clinical and instrumental evaluation, and suppressive LT4 therapy) for these lesions, unless anamnestic reports or clinical and ultrasonographic features of the nodules suggest malignancy.
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References
Wiest P.W., Hartshorne M.F., Inskip P.D. et al. Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. Ultrasound Med. 1998, 17: 487–496.
Gutman P.D., Henry M. Fine needle aspiration cytology of the thyroid. Clin. Lab. Med. 1998, 18: 461–482.
Tollin S.R., Mery G.M., Jelveh N. et al. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with multinodular goiter. Thyroid 2000, 10: 235–241.
Ortiz R., Hupart K.H., De Fesi C., Surks M.I. Effect of early referral to an endocrinologist on efficiency and cost of evaluation and development of treatment plan in patients with thyroid nodules. J. Clin. Endocrinol. Metab. 1998, 83: 3803–3807.
Rago T., Vitti P., Chiovato L. et al. Role of conventional ultrasonography and color flow-doppler sonography in predicting malignancy in “cold” thyroid nodules. Eur. J. Endocrinol. 1998, 138: 41–46.
Burguera B., Gharib H. Thyroid incidentalomas. Prevalence, diagnosis, significance, and management. Endocrinol. Metab. Clin. North Am. 2000, 29: 187–203.
Peccin S., de Castro J.A.S., Furlanetto T.W., Furtado A.P.A., Brasil B.A., Czepielewski M.A. Ultrasonography: is it useful in the diagnosis of cancer in throid nodules? J.Endocrinol. Invest. 2002, 25: 39–43.
Gharib H., Goellner J.R. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann. Intern. Med. 1993, 118: 282–289.
Gharib H. Fine-needle aspiration of thyroid nodules: advantages, limitations and effects. Mayo Clin. Proc. 1994, 69: 44–49.
Burch H.B. Evaluation and management of the solitary thyroid nodule. Endocrinol. Metab. Clin. North Am. 1995, 24: 663–670.
Bennedbaek F.N., Perrild H., Hegedus L. Diagnosis and treatment of the solitary thyroid nodule. Result of a European survey. Clin. Endocrinol. 1999, 50: 357–363.
Bennedbaek F.N., Hegedus L. Management of the solitary nodule: results of a North American survey. J. Clin. Endocrinol. Metab. 2000, 85: 2493–2498.
Poller D.N., Ibrahim A.K., Cummings M.H., Mikel J.J., Boote D., Perry M. Fine needle aspiration of the thyroid. Importance of an indeterminate diagnostic category. Cancer (Cancer Cytopathol.) 2000, 90: 239–244.
Greaves T.S., Olvera M., Florentine B.D. et al. Follicular lesions of thyroid. A 5-year fine needle aspiration experience. Cancer (Cancer Cytopathol) 2000, 90: 335–341.
Hagag P., Strauss S., Weiss M. Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid 1998, 8: 989–995.
De May R.M. Follicular lesions of the thyroid. Wh(i)ther follicular carcinoma. Am. J. Clin. Pathol. 2000, 114: 681–683.
Giuffrida D., Gharib H. Controversies in the management of cold, hot and occult thyroid nodules. Am. J. Med. 1995, 99: 642–650.
Daniels GH. Thyroid nodules and nodular thyroids: a clinical overview. Comp. Ther. 1996, 22: 239–250.
Rojieski M.T., Gharib H. Nodular thyroid disease: evaluation and management. N.Engl. J. Med. 1985, 313: 428–436.
Schlinkert RT., van Heerden J.A., Goellner J.R. et al. Factors that predict malignant thyroid lesions when fineneedle aspiration is “suspicious for follicular neoplasm”. Mayo Clin. Proc. 1997, 72: 913–916.
Danese D., Schiacchitano S., Farsetti A., Andreoli M., Pontecorvi A. Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules. Thyroid 1998, 8: 15–21.
Rosai J., Carcangiu M.L., DeLellis R.A. Atlas of tumor pathology (third series). Tumors of the thyroid gland. Armed Forces Institute of Pathology, Washington, D.C., 1992, p. 21–60.
Carpi A., Nicolini A., Sagripanti A. Protocols for the preoperative selection of palpable thyroid nodules: review and progress. Am. J. Clin. Oncol. 1999, 22: 499–504.
Gardner H.A.R., Chir B., Ducatman B.S., Wang H.H. Predictive values of fine-needle aspiration of the thyroid in the classification of follicular lesions. Cancer 1993, 71: 2598–2603.
De May R.M. Follicular lesions. In: De May R.M. (Eds.), The art and science of cytopathology. Aspiration cytology, american society of clinical pathologists, ASCP Press, Chicago, USA, 1996, p.722.
Goodel W.M., Hossein Saboorian M., Ashfaq R. Fine-needle aspiration diagnosis of the follicular variant of papillary carcinoma. Cancer (Cancer Cytopathology) 1998, 84: 349–354.
Tancredi M., Foppiani L., Giordano G.D. et al. Magnetic resonance imaging: A complementary tool in the evaluation of thyroid nodules? J. Endocrinol. Invest. 2001, 24: 384–385.
Baloch Z.W., Sack M.J., Yu G.H., Livolsi V.A., Gupta P.K. Fine-needle aspiration of thyroid: An institutional experience. Thyroid 1998, 8: 565–569.
Sidawy M.K., Del Vecchio D.M., Knoll S.M. Fine-needle aspiration of thyroid nodules. Cancer (Cancer Cytopathol.) 1997, 81: 253–259.
Gharib H., Goellner J.R., Zinsmeister A.R., Grant C.S., Van Heerden J.A. Fine-needle aspiration biopsy of the thyroid. Ann. Int. Med. 1984, 101: 25–28.
Kini S.R., Miller J.M., Hamburger J.I., Smith-Purslow M.J. Cytopathology of follicular lesions of the thyroid gland. Diagn. Cytopathol. 1985, 2: 123–32.
Raber W., Kaserer K., Niederle B., Vierhapper H. Risk factors for malignancy of thyroid nodules initially identified a follicular neoplasia by fine-needle aspiration: results of a prospective study of one hundred twenty patients. Thyroid 2000, 10: 709–712.
Piromalli D., Martelli G., Del Prato I., Collini P., Pilotti S. The role of fine needle aspiration in the diagnosis of thyroid nodules: analysis of 795 consecutive cases. Surg. Onc. 1992, 50: 247–250.
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Foppiani, L., Tancredi, M., Ansaldo, G.L. et al. Absence of histological malignancy in a patient cohort with follicular lesions on fine-needle aspiration. J Endocrinol Invest 26, 29–34 (2003). https://doi.org/10.1007/BF03345119
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DOI: https://doi.org/10.1007/BF03345119