title: Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration?
abstract: Thyroid fine-needle aspiration (FNA) is a standard procedure for the clinical triage of thyroid nodules. The diagnosis of an adequately sampled thyroid FNA is generally grouped into three categories: benign, malignant, and indeterminate. The latter group usually includes follicular neoplasm, follicular lesion, and sometimes a more specific diagnosis such as Hurthle cell neoplasm or follicular lesion/neoplasm with Hurthle cell change. Whether a FNA diagnosis of Hurthle cell lesion/neoplasm (HLN) denotes a worse clinical outcome than follicular lesion/neoplasm (FLN) remains controversial. A cohort of 303 thyroid FNA cases with follow-up thyroidectomy in our institutes was identified, with the follow-up excision diagnosis compared to the FNA diagnosis in order to address this issue. Of this cohort, 87 cases had an FNA diagnosis of HLN while 216 cases had a diagnosis of FLN. Upon excision, the FNA diagnosis of HLN group had 14 cases of goiter/nodular hyperplasia (16%), 46 cases of adenoma (12 follicular adenoma (14%) and 34 cases of Hurthle cell adenoma (39%)), and 27 cases of carcinoma (31%, 12 papillary carcinoma and 15 Hurthle cell carcinoma). The FLN group had 74 cases of goiter/nodular hyperplasia (34.3%), 8 cases of Hashimoto thyroiditis (3.7%), 73 cases of follicular adenoma (33.8%), one case of granular cell tumor, and 60 cases of carcinoma (27.8%, 46 papillary carcinoma, 12 follicular carcinoma, and 1 Hurthle cell carcinoma and 1 parathyroid carcinoma) upon excision. There is no significant difference in predicting cancer between the two cytology diagnosis groups (HLN versus FLN, 31% versus 27.8%, P = 0.5771). When sorting all the cases by the surgical diagnosis, while comparable for age at diagnosis, the cancer group having the higher proportion of male patients than the non-cancer group (28.7% versus 16.7%, P = 0.0259). Hurthle cell carcinoma patients are typically older than patients with other cancer diagnoses (59 versus 44, P = 0.0077). Our results suggest that an FNA diagnosis of HLN does not predict more malignancy than FLN. Males and older patients with a HLN FNA diagnosis carry a higher risk of Hurthle cell carcinoma upon thyroidectomy.
authors.affiliation: Department of Pathology, Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA. robertpu@umich.edu
authors.forename: Robert T
authors.initials: RT
authors.lastname: Pu
authors.forename: Jack
authors.initials: J
authors.lastname: Yang
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Wasserman
authors.forename: Tawfiqul
authors.initials: T
authors.lastname: Bhuiya
authors.forename: Kent A
authors.initials: KA
authors.lastname: Griffith
authors.forename: Claire W
authors.initials: CW
authors.lastname: Michael
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000473:pathology* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D018249:Adenoma, Oxyphilic / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006044:Goiter, Nodular / Q000473:pathology / Q000601:surgery; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D024862:Oxyphil Cells / Q000473:pathology*; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy