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Malignancy risk in indeterminate thyroid nodules with Hürthle cells: role of autoimmune thyroiditis

Abstract

Introduction

Hürthle cells are modified follicular thyroid cells, whose development and proliferation have been related to different stimuli inducing cellular stress. Most thyroid aspirates containing Hürthle cells are classified as indeterminate, although the specific risk of malignancy for this subtype of atypia remains unclear. The aim of our study was to assess if the presence of Hürthle cells in indeterminate thyroid nodules correlates with the risk of malignancy. We further evaluated if this risk can be modified by the presence of an underlying Hashimoto’s thyroiditis.

Materials and methods

We retrospectively analyzed all indeterminate thyroid nodules that were surgically treated at our institution between January 2010 and March 2019. For each nodule, we inferred the presence of Hürthle cells in the cytological report. Cytological findings were then correlated with histological reports.

Results

354 indeterminate thyroid nodules were included in the study. The rate of malignancy resulted significantly lower in nodules exhibiting Hürthle cells compared to those negative for this cellular pattern (11.4% vs 22.5%, p = 0.01). Although there was no difference in the rate of malignancy in the whole population according to the presence or absence of Hashimoto’s thyroiditis (21.5 vs 18.5%, p = 0.63), the significantly lower prevalence of malignant lesions in nodules with Hürthle cells was confirmed only in the presence of a histologically documented Hashimoto’s thyroiditis (6.2% vs 32%, p = 0.005).

Conclusions

The finding of Hürthle cells in indeterminate thyroid nodules is associated with a low risk of malignancy in patients with an underlying Hashimoto’s thyroiditis. The clinical management of these lesions may therefore be more conservative.

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Fig. 1

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Trimboli, P., Crescenzi, A., Giovanella, L.: Performance of Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) in discriminating indeterminate lesions at low and high risk of malignancy. A systematic review and meta-analysis. Endocrine. (2018). https://doi.org/10.1007/s12020-017-1382-6

  2. Cibas, E.S., Ali, S.Z.: The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. (2017). https://doi.org/10.1089/thy.2017.0500

  3. Nardi, F., Basolo, F., Crescenzi, A., Fadda, G., Frasoldati, A., Orlandi, F., Palombini, L., Papini, E., Zini, M., Pontecorvi, A., Vitti, P.: Italian consensus for the classification and reporting of thyroid cytology. J. Endocrinol. Investig. (2014). https://doi.org/10.1007/s40618-014-0062-0

  4. Straccia, P., Santoro, A., Rossi, E.D., Brunelli, C., Mosseri, C., Musarra, T., Pontecorvi, A., Lombardi, C.P., Fadda, G.: Incidence, malignancy rates of diagnoses and cyto-histological correlations in the new Italian Reporting System for Thyroid Cytology: An institutional experience. Cytopathology (2017). https://doi.org/10.1111/cyt.12455

  5. Renshaw, A.A.: Should “atypical follicular cells” in thyroid fine-needle aspirates be subclassified? Cancer Cytopathol. (2010). https://doi.org/10.1002/cncy.20091

  6. T.S. Greaves, M. Olvera, B.D. Florentine, A.S. Raza, C.J. Cobb, D.D. Tsao-Wei, S. Groshen, P. Singer, J. Lopresti, S.E. Martin, Follicular lesions of thyroid: A 5-year fine-needle aspiration experience. Cancer 90, 335–341 (2000).

    CAS  Article  Google Scholar 

  7. Sclabas, G., Staerkel, G., Shapiro, S., Fornage, B., Sherman, S., Vassillopoulou-Sellin, R., Lee, J., Evans, D.: Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients. Am. J. Surg. (2003). https://doi.org/10.1016/j.amjsurg.2003.08.015

  8. Sobrinho-Simões, M., Máximo, V., Vieira de Castro, I., Fonseca, E., Soares, P., Garcia-Rostan, G., Cardoso de Oliveira, M.: Hürthle (oncocytic) cell tumors of thyroid: Etiopathogenesis, diagnosis and clinical significance. Int. J. Surg. Pathol. (2005). https://doi.org/10.1177/106689690501300104

  9. Pu, R., Yang, J., Wasserman, P., Bhuiya, T., Griffith, K., Michael, C.: Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration? Diagn. Cytopathol. (2006). https://doi.org/10.1002/dc.20440

  10. Cannon, J.: The significance of Hurthle cells in thyroid disease. Oncologist. (2011). https://doi.org/10.1634/theoncologist.2010-0253

  11. Auger, M.: Hürthle cells in fine-needle aspirates of the thyroid: a review of their diagnostic criteria and significance. Cancer Cytopathol. (2014). https://doi.org/10.1002/cncy.21391

  12. Sparano, C., Parenti, G., Cilotti, A., Bencini, L., Calistri, M., Mannucci, E., Biagini, C., Vezzosi, V., Mannelli, M., Forti, G., Pertrone, L.: Clinical impact of the new SIAPEC-IAP classification on the indeterminate category of thyroid nodules. J. Endocrinol. Invest. (2019). https://doi.org/10.1007/s40618-018-0871-7

  13. Haugen, B.R., Alexander, E.K., Bible, K.C., Doherty, G.M., Mandel, S.J., Nikiforov, Y.E., Pacini, F., Randolph, G.W., Sawka, A.M., Schlumberger, M., Schuff, K.G., Sherman, S.I., Sosa, J.A., Steward, D.L., Tuttle R.M., Wartofsky, L.: 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid (2016). https://doi.org/10.1089/thy.2015.0020

  14. Durante, C., Grani, G., Lamartina, L., Filetti, S., Mandel, S.J., Cooper, D.S. The diagnosis and management of thyroid nodules: a review. JAMA. (2018). https://doi.org/10.1001/jama.2018.0898

  15. Lim, H., Devesa, S.S., Sosa, J.A., Check, D., Kitahara, C.M. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA. (2017). https://doi.org/10.1001/jama.2017.2719

  16. Krauss, E., Mahon, M., Fede, J., Zhang, L.: Application of the Bethesda classification for thyroid fine-needle aspiration institutional experience and meta-analysis. Arch. Pathol. Lab. Med. (2016). https://doi.org/10.5858/arpa.2015-0154-SA

  17. Giorgadze, T., Rossi, E.D., Fadda, G., Gupta, P.K., Livolsi, V.A., Baloch, Z.: Does the fine-needle aspiration diagnosis of “Hürthle-cell neoplasm/follicular neoplasm with oncocytic features” denote increased risk of malignancy? Diagn. Cytopathol. (2004). https://doi.org/10.1002/dc.20132

  18. Ren, Y., Kyriazidis, N., Faquin, W.C., Soylu, S., Kamani, D., Saade, R., Torchia, N., Lubitz, C., Davies, L., Stathatos, N., Stephen A.E., Randolph, G.W.: The Presence of Hurthle Cells Does Not Increase the Risk of Malignancy in Most Bethesda Categories in Thyroid Fine-Needle Aspirates. Thyroid. (2020). https://doi.org/10.1089/thy.2019.0190

  19. Ruggeri, R.M., Campennì, A., Giuffrida, G., Casciaro, M., Barbalace, M.C., Hrelia, S., Trimarchi, F., Cannavò, S., Gangemi, S. Oxidative stress as a key feature of autoimmune thyroiditis: an update. Minerva Endocrinol. (2020). https://doi.org/10.23736/S0391-1977.20.03268-X

  20. Roh, M.H., Jo, V.Y., Stelow, E.B., Faquin, W.C., Zou, K.H., Alexander, E.K., Larsen, P.R., Marqusee, E., Benson, C.B., Frates, M.C., Gawande, A., Moore Jr F.D., Cibas, E.S.: The predictive value of the fine-needle aspiration diagnosis “suspicious for a follicular neoplasm, Hurthle cell type” in patients with Hashimoto thyroiditis. Am. J. Clin. Pathol. (2011) https://doi.org/10.1309/AJCP0RW2WMDUAKGK

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Correspondence to Francesca Perticone.

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The authors declare no competing interests.

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The local Ethic Committee (San Raffaele Scientific Institute in Milan – Italy) approved the study protocol and written informed consent was obtained from each patient.

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Perticone, F., Maggiore, R., Mari, G. et al. Malignancy risk in indeterminate thyroid nodules with Hürthle cells: role of autoimmune thyroiditis. Endocrine 75, 823–828 (2022). https://doi.org/10.1007/s12020-021-02932-6

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  • DOI: https://doi.org/10.1007/s12020-021-02932-6

Keywords

  • Thyroid cancer
  • Indeterminate thyroid nodules
  • Malignancy risk
  • Hürthle cells