Research Article| Volume 116, ISSUE 6, P1054-1060, December 1994

Indeterminate fine-needle aspiration biopsy of the thyroid: Identification of subgroups at high risk for invasive carcinoma

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      Background. We examined the various cytologic features of indeterminate thyroid fine-needle aspirates along with known clinical and radiologic risk factors to determine whether any parameters were predictive of malignancy.
      Methods. Indeterminate fine-needle aspirates were prospectively categorized into four subgroups: (1) suspicious for papillary carcinoma, (2) follicular neoplasm, (3) Hürthle cell neoplasm, and (4) hypercellular follicular aspirates with colloid. Several clinical risk factors were examined, and subgroup comparisons were performed with Fisher's exact test.
      Results. Of 571 fine-needle aspirate cytologic findings 104 were interpreted as indeterminate for malignancy, and 81 patients underwent thyroidectomy. Invasive cancer was diagnosed in 9 of 10 lesions cytologically suspicious for papillary -arcinoma, 8 of 43 follicular neoplasms, 5 of 18 Hürthle cell neoplasms, and 0 of 10 hypercellular aspirates. Cytologic subgroup (p < 0.0001) and age of 50 years or older (p = 0.008) were the only significant predictors of malignancy. When used together, age of 50 years or older and a cytologic diagnosis of follicular or Hürthle cell neoplasm also identified a subgroup of patients at high risk (9 of 20) of invasive malignancy (P = 0.01).
      Conclusions. The majority of invasive cancers (18 of 22, 82%) were found in patients whose lesions were suspicious for papillary carcinoma or in patients 50 years or older with follicular or Hürthle cell neoplasms. The risk of carcinoma in these combined subgroups (18 of 30, 60%) warrants early surgical intervention.
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        • Gharib H.
        • Goellner J.R.
        Fine-needle aspiration biopsy of the thyroid: an appraisal.
        Ann Intern Med. 1993; 118: 282-289
        • Hamming J.F.
        • Goslings B.M.
        • van Sternis G.J.
        • van Ravenswaay Claasen H.
        • Hermans J.
        • van de Velde C.J.H.
        The value of fineneedle aspiration biopsy in patients with nodular thyroid disease divided into groups of suspicion of malignant neoplasms on clinical grounds.
        Arch Intern Med. 1990; 150: 113-116
        • Layfield L.J.
        • Reichman A.
        • Bottles K.
        • Gioliano A.
        Clinical determinants for the management of thyroid nodules by fine-needle aspiration cytology.
        Arch Otolaryngol Head Neck Surg. 1992; 118: 717-721
        • Mazzaferri E.L.
        Management of a solitary thyroid nodule.
        N Engl J Med. 1993; 328: 553-559
        • Gharib H.
        Fine-needle aspiration biopsy of thyroid nodules: advantages, limitations, and effect.
        in: 2nd ed. Mayo Clin Proc. 69. 1994: 44-49
        • Dwarakanathan A.A.
        • Ryan W.G.
        • Staten E.D.
        • Martirano M.
        • Economou S.G.
        Fine-needle aspiration biopsy of the thyroid.
        Arch Intern Med. 1989; 149: 2007-2009
        • Caraway N.P.
        • Sneige N.
        • Samaan N.A.
        Diagnostic pitfalls in thyroid fine-needle aspiration: a review of 394 cases.
        Diagn Cytopathol. 1993; 9: 345-350
        • Bloch M.A.
        • Dailey G.E.
        • Muchmore D.
        Avoiding reoperation for indeterminate thyroid nodules identified as malignant after surgery.
        Arch Surg. 1991; 126: 598-602
        • Cersosimo E.
        • Gharib H.
        • Suman V.J.
        • Goellner J.R.
        “Suspicious” thyroid cytologic findings: outcome in patients without immediate surgical treatment.
        in: 2nd ed. Mayo Clin Proc. 68. 1993: 343-348
        • Grant C.S.
        • Hay I.D.
        • Gough I.R.
        • McCarthy P.M.
        • Goellner J.R.
        Long-term follow-up of patients with benign thyroid fine-needle aspiration cytologic diagnoses.
        Surgery. 1989; 106: 980-986
        • Kini S.K.
        Guides to clinical aspiration biopsy of the thyroid.
        in: Igaku-Shoin, New York1987: 121-187
        • Hall T.L.
        • Layfield L.J.
        • Philippe A.
        • Rosenthal D.L.
        Sources of diagnostic error in fine needle aspiration of the thyroid.
        Cancer. 1989; 63: 718-725
        • McHenry C.R.
        • Rosen I.B.
        • Walfish P.G.
        • Bedard Y.
        Influence of fine-needle aspiration biopsy and frozen section examination on the management of thyroid cancer.
        Am J Surg. 1993; 166: 353-356
        • Cady B.
        • Rossi R.
        An expanded view of risk-group definition in differentiated thyroid carcinoma.
        Surgery. 1988; 104: 947-953
        • DeGroot L.J.
        • Kaplan E.L.
        • McCormick M.
        • Straus F.J.
        Natural history, treatment, and course of papillary thyroid carcinoma.
        J Clin Endocrinol Metab. 1990; 71: 414-424
        • Samaan N.A.
        • Schultz P.N.
        • Hickey R.C.
        • et al.
        The results of various modalities of treatment of well differentiated thyroid carcinoma: a retrospective review of 1599 patients.
        J Clin Endocrinol Metab. 1992; 75: 714-720
        • Mazzaferri E.L.
        • Young R.L.
        Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients.
        Am J Med. 1981; 70: 511-518
        • Hay I.D.
        • Bergstralh E.J.
        • Goellner J.R.
        • Ebersold J.R.
        • Grant C.S.
        Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated one institution during 1940 through 1989.
        Surgery. 1993; 114: 1050-1058
        • Hay I.D.
        • Grant C.S.
        • Taylor W.F.
        • McConahey W.M.
        Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system.
        Surgery. 1987; 102: 1088-1095
        • Grant C.S.
        • Hay I.D.
        • Gough I.R.
        • et al.
        Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important?.
        Surgery. 1988; 104: 954-962
        • Hamburger J.I.
        • Hamburger S.W.
        Declining role of frozen section in surgical planning for thyroid nodules.
        Surgery. 1985; 98: 307-312
        • Levin K.E.
        • Clark A.H.
        • Duh Q.
        • Demeure M.
        • Siperstein A.E.
        • Clark O.H.
        Original communications. Reoperative thyroid surgery.
        Surgery. 1992; 111: 604-609
        • Harness J.K.
        • Thompson N.W.
        • McLeod M.K.
        • Eckhauser F.E.
        • Lloyd R.V.
        Follicular carcinoma of the thyroid gland: trends and treatment.
        Surgery. 1984; 96: 972-980
        • van Heerden J.A.
        • Hay I.D.
        • Goellner J.R.
        • et al.
        Follicular thyroid carcinoma with capsular invasion alone: a nonthreatening malignancy.
        Surgery. 1992; 112: 1130-1138