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Tumor Size Predicts Malignant Potential in Hürthle Cell Neoplasms of the Thyroid

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Abstract

Background

A fine needle aspiration (FNA) diagnosis of a Hürthle cell neoplasm is associated with a 20% risk of malignancy. We sought to determine if the primary tumor size correlated with the risk of malignancy in patients with a preoperative FNA diagnosis of a Hürthle cell neoplasm.

Methods

Between January 2000 and November 2006, 57 patients underwent a thyroidectomy with a preoperative FNA diagnosis of a Hürthle cell neoplasm. Patient histories, FNA reports, operative notes, and pathology reports were retrospectively reviewed. Statistical analysis was performed.

Results

The overall rate of malignancy in patients with Hürthle cell neoplasms was 21%. The average tumor size was 3.2 cm, with malignant tumors being significantly larger than benign tumors (5.0 vs. 2.7 cm, p < 0.01). The risk of malignancy directly correlated with tumor size. No malignancies were seen in tumors 2 cm or smaller (0/15). The risk of malignancy was only 13% (6/46) in tumors 4 cm or smaller and increased to 55% (6/11) in tumors larger than 4 cm. All tumors larger than 6 cm were malignant (4/4).

Conclusions

Tumor size correlates directly with malignant potential in patients with Hürthle cell neoplasms of the thyroid. Among our patients, malignancy was not present in any tumors 2 cm or smaller and was present in all tumors larger than 6 cm. Because the risk of malignancy is greater than 50% in patients with a tumor larger than 4 cm, consideration should be given for an initial total thyroidectomy in these patients.

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Authors and Affiliations

  1. Department of Surgery, University of California San Francisco and the UCSF Comprehensive Cancer Center at Mount Zion, San Francisco, CA, 94143, USA

    Rebecca S. Sippel, Dina M. Elaraj, Rasa Zarnegar, Electron Kebebew, Quan-Yang Duh & Orlo H. Clark

  2. Department of Pathology, University of California San Francisco and the UCSF Comprehensive Cancer Center at Mount Zion, San Francisco, CA, 94143, USA

    Elham Khanafshar

  3. Department of Surgery, University of Wisconsin-Madison, H4/710 CSC, 600 Highland Ave, Madison, WI, 53792, USA

    Rebecca S. Sippel

Authors
  1. Rebecca S. Sippel
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  2. Dina M. Elaraj
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  3. Elham Khanafshar
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  4. Rasa Zarnegar
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  5. Electron Kebebew
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  6. Quan-Yang Duh
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  7. Orlo H. Clark
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Corresponding author

Correspondence to Rebecca S. Sippel.

Additional information

This work was supported in part by Friends of Endocrinology, The Gerald Heller Family Foundation, The Helen and Sanford Diller Foundation, and the Bell Charitable Trust.

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Sippel, R.S., Elaraj, D.M., Khanafshar, E. et al. Tumor Size Predicts Malignant Potential in Hürthle Cell Neoplasms of the Thyroid. World J Surg 32, 702–707 (2008). https://doi.org/10.1007/s00268-007-9416-5

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  • DOI: https://doi.org/10.1007/s00268-007-9416-5

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