title: Predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm of thyroid nodules.
abstract: BACKGROUND
  Our aim was to evaluate predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm (HCN) of thyroid nodules.
  
  
  METHODS
  We searched cases with cytologically suspicious for HCN from 11,569 ultrasound-guided fine-needle aspirations (US-FNA) performed at our institution. Nodules that were confirmed surgically or followed-up for at least 2 years were compared with respect to age, gender, tumor size, US diagnosis, and US findings to predict malignancy.
  
  
  RESULTS
  The incidence of cases with cytologically suspicious for HCN was 1.2% (143 of 11,569). Of 75 nodules that underwent sufficient follow-up or surgery, malignancies were found in 11 (14.7%). Malignant histological examination revealed oncocytic variants of papillary thyroid carcinoma (PTC) in 3 cases, classic PTC in 1, Hurthle cell carcinoma in 3, follicular carcinoma in 3 and an unclassified carcinoma in 1. In univariate analysis, tumor size was significantly larger in malignant nodules compared to benign nodules (p = 0.026). The best cut-off value of tumor size in predicting malignancy was 2.5 cm. (p = 0.006, sensitivity: 63.6%, specificity: 79.7%). The incidences of hypoechogenicity and malignant US diagnoses were higher in malignant nodules than in benign nodules (p < 0.001). In multivariate analysis, tumor size was an independent factor in predicting malignancies. (p = 0.037, odd ratio: 2.09, confidence interval: 1.046-4.161).
  
  
  CONCLUSIONS
  Preoperative US provides predictive factors of malignancy in thyroid nodules with cytologically suspicious for HCN. Predictive factors include tumor size of 2.5 cm or greater, hypoechoic nodule and malignant US diagnosis.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University, College of Medicine, 1435 Jwa-dong, Haeundae-gu, Busan 612-030, Republic of Korea.
authors.forename: Kwang Hwi
authors.initials: KH
authors.lastname: Lee
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Shin
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Ko
authors.forename: Soo Yeon
authors.initials: SY
authors.lastname: Hahn
authors.forename: Jee Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Jung-Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Lyun
authors.initials: YL
authors.lastname: Oh
mesh_terms: D018249:Adenoma, Oxyphilic; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D014463:Ultrasonography
keywords: Diagnosis; Hurthle cell neoplasm; Predictive factor; Thyroid nodule; Ultrasonography