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Beheshti Firoozabadi J, Mahdavi R, Shamsi K, Ataee H, Shafiee A, Ebrahiminik H, Chegini H, Hoseinpour P, Moradi A, Yousefpour N, Aghaei F, Fardoost A, Ghelichli A, Mokhtari Dowlatabad H, Hajighasemi F, Sami N, Rouhollah Miri S, Akbari ME, Abdolahad M. Intraoperative Assessment of High-Risk Thyroid Nodules Based on Electrical Impedance Measurements: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12122950. [PMID: 36552958 PMCID: PMC9776834 DOI: 10.3390/diagnostics12122950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Precise diagnosis of thyroid nodules is challenging due to non-diagnostic/inconclusive results and uncertainties about the malignancy of follicular neoplasms (FNs), even in frozen-section pathology. Therefore, surgical management, especially in Bethesda III and IV categories, may be complicated, and sometimes a second surgery may be required. The Thyroid Nodule Impedance Measurement System (TN-IMS) consists of a metallic patch attached to submental skin and a G20 I.V. cannula inserted into the targeted nodules. Two impedance-based parameters named Z1kHz and impedance phase slope (IPS) in 100 kHz to 500 kHz of the thyroid nodules are recorded and compared with their histopathological results as the gold standard. TN-IMS was intra-surgically applied to 103 human thyroid nodules and normal thyroid tissues. A remarkable consistency between defined co-ranges of Z1kHz/IPS and the histopathological status of specimens was achieved (p < 0.001). Based on these measurements, it was concluded that intraoperative bioelectrical impedance scanning of thyroid nodules would be a helpful complementary approach to detecting high-risk excision-required thyroid nodules.
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Affiliation(s)
- Jalil Beheshti Firoozabadi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
| | - Reihane Mahdavi
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
| | - Khosro Shamsi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
| | - Hossein Ataee
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
- Department of Electrical Engineering, Amirkabir University of Technology, Tehran 15916-34311, Iran
| | - Abdollah Shafiee
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Department of Surgery, Farmanieh Hospital, Tehran 19537-34411, Iran
| | - Hojat Ebrahiminik
- Department of Internentional Radiology and Radiation Sciences Research Center, Aja University of Medical Sciences, Tehran 14117-18541, Iran
- Interventional Radiology Department, Tirad Imaging Institute, Tehran 15867-36513, Iran
| | - Hossein Chegini
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Interventional Radiology Department, Tirad Imaging Institute, Tehran 15867-36513, Iran
| | - Parisa Hoseinpour
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Department of Pathology, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran 15179-64311, Iran
| | - Afshin Moradi
- Department of Pathology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
| | - Narges Yousefpour
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
| | - Faeze Aghaei
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
| | - Ali Fardoost
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
| | - Alireza Ghelichli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
| | - Hadi Mokhtari Dowlatabad
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
| | - Farzane Hajighasemi
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
| | - Nafiseh Sami
- Department of Medicine, Islamic Azad University of Medical Sciences, Tehran 19395-1495, Iran
| | - Seyed Rouhollah Miri
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
- Department of Surgical Oncology, Tehran University of Medical Science, Tehran 14176-14411, Iran
- Cancer Institute, Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran 14166-34793, Iran
| | - Mohammad Esmaeil Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Correspondence: (M.E.A.); (M.A.)
| | - Mohammad Abdolahad
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 14166-34793, Iran
- Nano Bioelectronics Devices Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran 14399-57131, Iran
- Cancer Electronics Research Center, University of Tehran and Tehran University of Medical Sciences Imam Khomeini Hospital, Tehran 14197-33141, Iran
- Cancer Institute, Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran 14166-34793, Iran
- Correspondence: (M.E.A.); (M.A.)
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Kim MJ, Shin JH, Hahn SY, Oh YL, Kim SW, Kim TH, Lim Y, Lee S. Ultrasonographic characteristics of Hurthle cell: prediction of malignancy. Ultrasonography 2022; 41:689-697. [PMID: 36031766 PMCID: PMC9532204 DOI: 10.14366/usg.21264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study investigated the ultrasound (US) features of malignancy in patients with Hürthle cell neoplasms (HCNs) of the thyroid gland. Methods The present study included 139 HCNs that had undergone surgical excision at a single institution from 1996 to 2020 and had preoperative US images. The sonographic characteristics of HCNs were correlated with their pathological results. The US findings associated with malignancy were explored using logistic regression analysis, and the diagnostic performance and cutoff were assessed using receiver operating characteristic analysis. Results The most common US findings of HCNs were a solid content (76.3%), oval to round shape (100%), hypoechogenicity (70.5%), a smooth margin (95.0%), the halo sign (90.6%), and no calcifications (93.5%). HCNs were commonly smaller in pathologic measurements than in US measurements (smaller, same, and greater than US measurements in 60.4%, 21.6%, and 18.0% of HCNs, respectively; P<0.001). On US, malignant nodules were significantly larger than benign nodules (3.4±1.6 cm vs. 2.2±1.2 cm, P<0.001). Multiple logistic regression showed that the US tumor size was an independent predictor of malignancy (P=0.001; odds ratio, 1.730 for a 1-cm increase [95% confidence interval, 1.258 to 2.375]). The best cutoff US tumor size for predicting malignancy was 3.35 cm (sensitivity, 53.1%; specificity, 87.9%). Conclusion The US tumor size was found to be an independent predictor of malignancy in HCNs, and a US tumor size >3.35 cm might be used as a criterion to suggest malignancy. The size of HCNs often showed discrepancies between US and pathologic measurements.
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Affiliation(s)
- Min Je Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to: Jung Hee Shin, MD, PhD, Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2518 Fax. +82-2-3410-2559 E-mail:
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yaeji Lim
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Sanghyuk Lee
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
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Cytologic Diagnosis of Oncocytic Neoplasms of the Thyroid Gland: The Importance of the Clinical Scenario. Appl Immunohistochem Mol Morphol 2018; 27:726-731. [PMID: 30358610 DOI: 10.1097/pai.0000000000000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
It is a diagnostic challenge to differentiate benign and malignant thyroid neoplasms made up of Hürthle (or oncocytic) cells on cytologic material. They are large, polygonal cells with marked eosinophilic, granular cytoplasm reflective of overly abundant mitochondria. These cells commonly occur in nodular goiters and dominant adenomatous or hyperplastic nodules though they may also be the predominant component of neoplastic lesions. There are significant controversies concerning the optimal management of patients with oncocytic cell carcinoma. This review provides an overview of the most significant studies addressing the distinction between benign and malignant Hürthle cell lesions on cytology and histology.
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Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00187.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of the current study was to determine the risk of malignancy in patients with thyroid nodules with cytology of indeterminate follicular and indeterminate Hürthle cell neoplasm (HN). The cytologic diagnosis of follicular neoplasm (FN) or HN remains a diagnostic challenge. Often, surgery is recommended for such lesions. A retrospective analysis was performed on 80 patients who underwent thyroid surgery following a diagnosis of indeterminate FN and indeterminate HN in thyroid fine-needle aspiration biopsy. Sex; age; family history of thyroid cancer and radiation exposure; coexisting thyroid conditions, such as solitary nodule; multinodularity; cytologic diagnosis; sonographic features; type of surgical treatment; and histopathologic results were recorded. Of the 80 patients, 52 (65%) had FN on fine-needle aspiration biopsy cytology and 28 (35%) had HN. A total of 23 patients (28.7%) had primary thyroid cancers on surgical pathology, and 57 (71.3%) had benign diagnoses. Univariate analysis showed no differences between the benign and malignant groups by sex, nodule size, family history of thyroid cancer, history of radiation exposure, presence of solitary nodule or multinodularity in the nodular features. In multivariate binary logistic regression analysis, the factors that were statistically significant predictors of malignancy were microcalcification [odds ratio (OR), 10.9; 95% confidence interval (CI), 2.18–54.7; P = 0.004], being older than 45 years (OR, 4.2; 95% CI, 1.25–14.63; P = 0.02]. The independent predictors of malignancy in FN and HN are micorcalcification and being older than 45 years, the use of which may predict the risk of thyroid cancer.
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Liu C, Zhao Q, Zeng W, Chen C, Ming J, Wang S, Xiong Y, Zhang C, Chen T, Liu Z, Huang T. Do patients with oxyphilic cell papillary thyroid carcinoma have a poor prognosis? Analysis of the surveillance, epidemiology, and end results database 2004-2013 with propensity score matching. Oncotarget 2017; 8:77075-77085. [PMID: 29100371 PMCID: PMC5652765 DOI: 10.18632/oncotarget.20355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
The prognosis of oxyphilic cell papillary thyroid carcinoma (OCPTC) remains unclear. The aim of this study was to investigate the prognosis of OCPTC and provide a new perspective on treatment guidelines for these patients. We investigated a large cohort of DTC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013. Patient mortality was examined by Kaplan-Meier analyses with log-rank tests and Cox proportional hazards regression analyses. In the study cohort, the rate of cancer-specific mortality per 1000 person-years for OCPTC was lower than that for classic papillary thyroid cancer (CPTC) and follicular thyroid cancer (FTC). According to the multivariate Cox regression model, the cancer-specific and all-cause mortality rates of OCPTC were similar to that of CPTC and FTC. The cancer-specific survival rate in patients with OCPTC was higher than that in patients with FTC, but similar to patients with CPTC, after matching for influential factors using propensity score matching analysis. The unanticipated prognosis provided new implications for the treatment of patients with OCPTC.
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Affiliation(s)
- Chunping Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qiuyang Zhao
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Chen Chen
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shuntao Wang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yiquan Xiong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianwen Chen
- Department of Breast and Thyroid Surgery, Affiliated Nanshan Hospital, Guangdong Medical University, Shenzhen, China
| | - Zeming Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Kochummen E, Tong S, Umpaichitra V, Chin VL. A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent. Horm Res Paediatr 2017; 87:136-142. [PMID: 27467101 DOI: 10.1159/000448216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hürthle cell (HC) neoplasms are rare among pediatric thyroid cancers. HC adenomas (HCA) are typically benign and localized unilaterally without recurrence, and they are thus treated by hemithyroidectomy. HC carcinomas (HCC) can be bilateral and are more aggressive, necessitating total thyroidectomy. Diagnosis relies upon surgical histopathology demonstrating invasion for classification as HCC or lack of invasion in HCA, since fine needle aspiration fails to differentiate between the two. METHODS We report a case of a 14-year-old adolescent female with bilateral HCA. She had an initial left hemithyroidectomy for a large nodule measuring 2 × 1.5 × 1.2 cm3 in the left lobe, while smaller subcentimeter nodules remained under surveillance in the right. One year later, a nodule in the right lobe doubled in size, necessitating a right hemithyroidectomy which also revealed HCA. CONCLUSION To our knowledge, this is the first reported case of bilateral HCA in pediatrics. It highlights the importance of close surveillance of persistent small nodules, even in patients with previously documented benign lesions such as HCA, which are typically thought to be unilateral and localized. Both HCA and HCC remain unpredictable in behavior, and treatment of HCA should be individualized.
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Affiliation(s)
- Elna Kochummen
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, N.Y., USA
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Yazici P, Yilmaz B, Bozkurt E, Mihmanli M, Uludag M. Malignancy risk of oncocytic changes in thyroid nodules: who should we offer surgery to? Acta Chir Belg 2016; 116:30-5. [PMID: 27385138 DOI: 10.1080/00015458.2015.1136484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Oncocytic (Hürthle) cell in fine-needle aspiration biopsy (FNAB) remains challenging for surgeons. Surgical treatment is recommended for oncocytic change in FNAB, since it can sometimes be a struggle to determine the nature of thyroid nodules. We aimed to investigate the clinical significance of oncocytic changes in FNAB in terms of management of patients. Methods The FNAB samples of 172 patients with thyroid nodules were reviewed. Of these, 39 patients with cytologic findings of oncocytic changes on FNAB [POC: predominance of oncocytic cells; SFON-H: suspicious for follicular or oncocytic neoplasm (Hürthle cell type), SM-O: suspicious for malignancy-papillary or follicular carcinoma; oncocytic variant)] were included. Results FNAB demonstrated POC in 14 (35.8%), SFON-H in 15 (38.4%), and SM-O in 10 (25.6%) patients. The overall malignancy rate was 35.8% (n = 14). Clinical and laboratory data were not found to be associated with thyroid cancer while nodule size was significantly higher in patients with thyroid malignancy (15.2 versus 23.3 mm, p = 0.032). Regarding FNAB results including oncocytic changes, the rate of malignancy was significantly different and almost three-fold higher in nodules classified as SFON-H and SM-O [48% versus 14.2% with POC, p = 0.044]. Besides, there was a positive correlation between SFON-H and SM-O cytology and malignancy (p = 0.036, r = 0.337). Conclusions It is hard to discern the significance of oncocytic changes in FNAB report and to determine an optimal approach as a surgeon. We recommend surgery for the patients with an FNAB showing SFON-H and SM-O whereas POC should be better to be followed-up.
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Shawky M, Sakr M. Hurthle Cell Lesion: Controversies, Challenges, and Debates. Indian J Surg 2016; 78:41-8. [PMID: 27186039 PMCID: PMC4848220 DOI: 10.1007/s12262-015-1381-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/20/2015] [Indexed: 02/05/2023] Open
Abstract
Hurthle cell lesion is one of the most questionable clinico-pathological entities in most of its aspects. Literature has used the terms oncocytic, oxyphilic, Hurthle, and Ashkanazy interchangeably; what does each term denote? Who first described these cells? What is the cell of origin? How much Hurthle cells should be present to define the lesion as Hurthle cell one? Is it possible to differentiate hyperplastic from neoplastic and benign from malignant Hurthle cell lesion on a non-histopathologic ground? Does it belong to follicular or to papillary neoplasms or should it be classified separately? Can we anticipate its clinical behavior or predict its outcome? How can we manage? We will try to answer these questions in light of the ongoing relevant arguments with the aim of resolving some uncertainties and suggesting how to solve others.
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Affiliation(s)
- Michael Shawky
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Third Floor-Surgery Building, El Sultan Hussein St, Azarita, Alexandria, Egypt
| | - Mahmoud Sakr
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Third Floor-Surgery Building, El Sultan Hussein St, Azarita, Alexandria, Egypt
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Petric R, Besic H, Besic N. Preoperative serum thyroglobulin concentration as a predictive factor of malignancy in small follicular and Hürthle cell neoplasms of the thyroid gland. World J Surg Oncol 2014; 12:282. [PMID: 25213012 PMCID: PMC4168052 DOI: 10.1186/1477-7819-12-282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/02/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cytologic examination of a fine-needle aspiration biopsy specimen cannot distinguish between benign and malignant follicular or Hürthle cell neoplasms. Serum thyroglobulin (Tg) concentrations are higher in follicular and Hürthle cell carcinomas than in benign follicular or Hürthle cell tumors, but preoperative measurement of Tg is not recommended for initial evaluation of thyroid nodules. The aim of this study was to find out whether preoperative serum Tg concentration is a predictive factor of malignant disease in patients with a follicular or Hürthle cell neoplasm with a diameter of 2 cm or less. METHODS From 1988 to 2013, a total of 244 patients (214 female, 30 male, age range 9 to 82 years, median age 52 years) had a surgical procedure at our institute because of follicular or Hürthle cell neoplasms with a tumor diameter of 2 cm or less. In these patients a preoperative concentration of Tg was determined and Tg-autoantibodies were negative. The risk factors for malignancy were identified by a chi-square test and multivariate logistic regression. RESULTS The histopathologic diagnoses were carcinoma, adenoma, and benign goiter in 62 (25.5%), 115 (47%), and 67 (27.5%) patients, respectively. The median preoperative Tg concentration in benign tumors, papillary carcinomas, follicular carcinomas, and Hürthle cell carcinomas was 41, 87, 72, and 106 ng/ml (P = 0.05), respectively. The predictive factors for carcinoma shown by the chi-square test were: sex, thyroid volume, and preoperative Tg concentration. The independent predictors of malignancy as shown by multivariate logistic regression were: male sex (odds ratio, 2.57; P = 0.02), and a Tg concentration of more than 80 ng/ml (odds ratio, 2.35; P = 0.005). CONCLUSION The independent predictors of malignancy in follicular or Hürthle cell neoplasms are sex and preoperative Tg concentration.
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MESH Headings
- Adenocarcinoma/blood
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Follicular/blood
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adenoma/blood
- Adenoma/pathology
- Adenoma/surgery
- Adenoma, Oxyphilic
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Biopsy, Fine-Needle
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Child
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Neoplasm Staging
- Preoperative Care
- Prognosis
- Radioimmunoassay
- Retrospective Studies
- Thyroglobulin/blood
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/blood
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Thyroidectomy
- Young Adult
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Affiliation(s)
- Rok Petric
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Hana Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
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Giubbini R, Bertagna F. 99mTc-MIBI imaging in thyroid nodules: is it useful? Endocrine 2014; 46:1-2. [PMID: 24577805 DOI: 10.1007/s12020-013-0051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/28/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy,
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Abstract
Hürthle cells (HCs) and HC change, along with the frequently employed synonyms "oncocytes/oncocytic change" or "oxyphils/oxyphilic change," are not infrequently described on fine-needle aspiration biopsy (FNAB) reports of thyroid lesions. The description of HCs on FNAB reports may cause significant concern to the clinician; however, placing the finding in the appropriate clinical context may alleviate some anxiety. Not all oxyphilic cells are true HCs and not every aspirate containing HCs is or should be considered equivalent to an HC neoplasm (HCN). There are many benign thyroid lesions associated with HCs or HC change. For clinicians, it may be difficult to discern the significance of these findings and to determine an appropriate course of action. A skilled and experienced cytopathologist is invaluable in discriminating the subtle features that distinguish these lesions from those warranting a more aggressive approach. The diagnosis of HC carcinoma relies on histopathologic scrutiny and evidence of capsular and/or vascular invasion or metastasis to lymph nodes or distant organs. Many investigators have sought clinical, radiographic, cytological, genetic, and other factors to attempt to discriminate preoperatively between benign and malignant HCNs. To date, none have been definitively proven to be reliable. For now, because of the inability to determine the benign or malignant nature of such neoplasms based on cytology alone, a surgical approach is warranted.
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Affiliation(s)
- Jennifer Cannon
- Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Drive, Winston-Salem, North Carolina 27157, USA.
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Noordally SO, Sohawon S, Duttmann R, Spinato L, Kleynen P, Verougstraete G. A delayed fatal metastatic Hürthle cell carcinoma. ACTA MEDICA (HRADEC KRÁLOVÉ) 2011; 54:87-9. [PMID: 21842725 DOI: 10.14712/18059694.2016.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hürthle (oxyphilic or oncocytic) cell carcinoma is a variant of follicular cell carcinoma of thyroid. Although this entity of thyroid cancer is well known, its occurrence in young patients has scarcely been reported. We report a case of a 26 year-old male patient, at the time of diagnosis, of Turkish origin, who developed a tracheal, pulmonary and mediastinal metastatic Hürthle cell carcinoma with bilateral cervical and mediastinal lymphadenopathies. This case illustrates an aggressive and metastatic cancer at the time of diagnosis and resistant to all treatment options including surgery, chemotherapy and radioactive iodine.
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Affiliation(s)
- S Oaleed Noordally
- Department of Otolaryngology and Cervico-Facial Surgery, CHU Brugmann, Free University of Brussels, Brussels, Belgium.
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Kutun S, Turanli S, Kavlakoglu B, Cetin A. The predicting factors for clinical outcomes in patients with Hürthle cell carcinoma: how we do it. Clin Otolaryngol 2011; 36:73-7. [DOI: 10.1111/j.1749-4486.2011.02212.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Turanli S, Pirhan Y, Ozcelik CK, Cetin A. Predictors of Malignancy in Patients with a Thyroid Nodule That Contains Hürthle Cells. Otolaryngol Head Neck Surg 2011; 144:514-7. [DOI: 10.1177/0194599810394052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Fine needle aspiration cytology of a thyroid nodule with Hürthle cells can be present in both benign and malignant diseases of the thyroid. The aim of this study was to identify the factors that predict malignancy in patients who underwent thyroidectomy with a preoperative fine needle aspiration cytology that contains a predominance of Hürthle cells. Study Design. Retrospective data collection. Setting. Tertiary referral center. Subjects and Methods. Medical records of 70 consecutive patients were reviewed between March 2005 and August 2010. Predictive factors, as well as age, gender, preoperative serum thyroid-stimulating hormone level, the microscopic findings of fine needle aspiration, ultrasonographic appearance, and size and number of nodules in the pathology report, were correlated with final histopathologic diagnosis of benign or malignant disease. Results. Patients’ final pathology showed that 21 patients (30%) had malignant disease, of whom 15 patients (71.4%) had papillary carcinoma and 6 patients (28.6%) had Hürthle cell carcinoma. Forty-nine (70%) patients had benign disease (hyperplastic/adenomatoid nodule in 24 patients, Hashimoto thyroiditis in 18 patients, Hürthle cell adenoma in 5 patients, and follicular adenoma in 2 patients). The rate of malignancy was higher in male patients (42.9% vs 28.6%), with nodules measuring ≥2 cm (36.7% vs 25.0%), the presence of a solitary nodule (34.3% vs 27.7%), and the presence of metaplasia in fine needle aspiration (36.4% vs 27.1%), although none was found to be significant ( P > .05). Conclusion. Thyroid nodules that are reported in cytology as Hürthle cell lesions require surgery to differentiate benign from malignant disease.
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Affiliation(s)
- Sevim Turanli
- Department of General Surgery, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Yavuz Pirhan
- Department of General Surgery, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Caglar Kazim Ozcelik
- Department of General Surgery, Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Abdullah Cetin
- Department of General Surgery, Ankara Oncology Education and Research Hospital, Ankara, Turkey
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Localized advanced hürthle cell carcinoma with symptomatic intrathoracic goiter. Case Rep Surg 2011; 2011:623130. [PMID: 22606586 PMCID: PMC3350126 DOI: 10.1155/2011/623130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 08/08/2011] [Indexed: 11/22/2022] Open
Abstract
Intrathoracic goiters are divided into two categories: primary and secondary. Intrathoracic goiters (IG) can cause upper airway obstruction. The presence of obstructive symptoms secondary to increased thyroid growth and tracheal compression is major indication for surgery; however, goiters do not always require immediate surgical attention. In addition, although some diagnostic tests indicate upper airway obstruction, many patients remain asymptomatic. Surgeries to remove IG are performed routinely however, they are not without risk. In some cases, intrathoracic goiters present as thyroid cancers. Very rare cancers such as Hürthle cell carcinoma (HCC) can create a challenge for the surgeon when surgical intervention is vital.
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Kim TH, Lim JA, Ahn HY, Lee EK, Min HS, Won Kim K, Choi YH, Park YJ, Park DJ, Kim KH, Youn YK, Cho BY. Tumor size and age predict the risk of malignancy in Hürthle cell neoplasm of the thyroid and can therefore guide the extent of initial thyroid surgery. Thyroid 2010; 20:1229-34. [PMID: 20929403 DOI: 10.1089/thy.2009.0443] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The majority of patients having a diagnosis of Hürthle cell neoplasm (HCN) on fine-needle aspiration (FNA) of a thyroid nodule have a diagnostic thyroid lobectomy to make the final diagnosis. If the nodule is malignant, they require a completion thyroidectomy. The objective of this study was to devise a simple clinical scheme capable of predicting malignancy in patients with cytologic diagnosis of HCN and, therefore, guide the extent of initial thyroid surgery. METHODS A total of 57 patients who underwent thyroid surgery after an FNA diagnosis of HCN were retrospectively studied. The patients were examined for clinical features, preoperative imaging studies, and pathology reports. The risk of malignancy was calculated using a multiple logistic regression model. RESULTS The overall rate of malignancy in patients with HCN was 46% (26/57). The predictors of malignancy based on multiple logistic regression analysis were tumor size >1.5 cm (odds ratio [95% confidence interval] = 8.0 [1.9-33.4]) and patient age >45 years (odds ratio [95% confidence interval] = 2.3 [0.6-8.6]). In patients with nodules larger than 1.5 cm, the predicted probability of malignancy was greater in patients over 45 years than in younger patients (65% for >45 years vs. 44% for ≤45 years). In patients with a nodule 1.5 cm or less, the probability of malignancy was relatively low and not significantly different between the two age categories (18% for >45 years vs. 10% for ≤45 years). CONCLUSIONS This study suggests that tumor size and age can be integrated into decision making for patients with an FNA diagnosis of HCN to facilitate patient selection for surgical referral and, particularly, to determine in which patients a thyroidectomy rather than a lobectomy should be the initial surgery.
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Affiliation(s)
- Tae Hyuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Guerrero MA, Suh I, Vriens MR, Shen WT, Gosnell J, Kebebew E, Duh QY, Clark OH. Age and tumor size predicts lymph node involvement in Hürthle Cell Carcinoma. J Cancer 2010; 1:23-6. [PMID: 20842220 PMCID: PMC2931345 DOI: 10.7150/jca.1.23] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hürthle cell carcinoma (HCC) is a rare tumor that tends to metastasize to the lymph nodes. Some studies have correlated size of Hürthle cell tumors with the risk of malignancy. Whether the size of HCC correlates with the risk of lymph node (LN) metastases, to our knowledge has not been addressed. Methods: A retrospective analysis was performed on all patients diagnosed with HCC on final pathology between 1997 and 2008. The tumor size and lymph node status was obtained for each patient. The data were analyzed utilizing Student's t-test and the Fisher's exact test to calculate the two-tailed p-value. Results: Out of 39 patients diagnosed with HCC 3(8%) had LN metastases; 1 had ipsilateral central LN metastasis and 2 had ipsilateral central and lateral LN metastasis. LN dissection was performed in patients with known metastasis (2 were evident on preoperative ultrasound and 1 intraoperatively). Patients with LN metastasis were older than those without (mean age: 86.7 and 56.4 years, respectively), had larger tumors (mean size: 6 and 4 cm) and were commonly male (2 of 3). No tumor < 5cm presented with lymph node involvement (3/15 with >5cm cancer had node metastasis, 0/24 with <5cm cancer had node metastasis). Conclusions: Similar to what has been found in patients with papillary thyroid cancer, older male patients with Hürthle cell carcinomas greater than 5cm are more likely to have lymph node metastasis. Our data suggest that these patients may benefit from a prophylactic ipsilateral central neck dissection at the time of their initial operation.
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Affiliation(s)
- Marlon A Guerrero
- 1. Department of Surgery, University of Arizona, Tucson, AZ 85724-5131, USA
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Strazisar B, Petric R, Sesek M, Zgajnar J, Hocevar M, Besic N. Predictive factors of carcinoma in 279 patients with Hürthle cell neoplasm of the thyroid gland. J Surg Oncol 2010; 101:582-6. [DOI: 10.1002/jso.21526] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pisanu A, Di Chiara B, Reccia I, Uccheddu A. Oncocytic Cell Tumors of the Thyroid: Factors Predicting Malignancy and Influencing Prognosis, Treatment Decisions, and Outcomes. World J Surg 2009; 34:836-43. [DOI: 10.1007/s00268-009-0357-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Peng Y, Wang HH. A meta-analysis of comparing fine-needle aspiration and frozen section for evaluating thyroid nodules. Diagn Cytopathol 2009; 36:916-20. [PMID: 18855886 DOI: 10.1002/dc.20943] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The literature on comparing fine-needle aspiration (FNA) and frozen section for evaluating thyroid nodules was reviewed. Publications on this subject were divided into three groups (follicular lesions, non-follicular lesions and thyroid lesions, not otherwise specified). A meta-analysis was done to compare sensitivity, specificity, and positive and negative predictive values between FNA and frozen section diagnoses. For follicular lesions, FNA was much more sensitive but less specific, with lower positive predictive value than frozen section. FNA and frozen section are virtually identical in all parameters of accuracy in evaluating thyroid nodules that are not follicular lesions. The third group of publications that did not separate/specify follicular lesions from non-follicular lesions was non-contributory.
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Affiliation(s)
- Yan Peng
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9073, USA.
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Sorrenti S, Trimboli P, Catania A, Ulisse S, De Antoni E, D'Armiento M. Comparison of malignancy rate in thyroid nodules with cytology of indeterminate follicular or indeterminate Hürthle cell neoplasm. Thyroid 2009; 19:355-60. [PMID: 19355826 DOI: 10.1089/thy.2008.0338] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid nodules that are read on cytology as follicular or Hürthle cell neoplasms (FN and HN, respectively) and indeterminate for malignancy require surgery to differentiate benign from malignant nodules. We analyzed FN and HN with indeterminate cytology to determine if there were differences in the rate and types of thyroid malignancy and if the rate of thyroid malignancy was influenced by age or sex. METHODS We analyzed 463 nodules with an indeterminate cytological diagnosis of FN and 140 nodules with an indeterminate cytological diagnosis of HN. The histopathological diagnosis after thyroidectomy was the method for establishing the diagnosis and type of malignancy. RESULTS For the entire series of 603 patients there were 106 (17.6%) with thyroid cancer; 80 of these had a cytology reading of FN and 26 had HN. Extrathyroidal invasion in the grouped HN and FN patients who had papillary thyroid carcinoma (PTC) was more common in females than in males (62% vs. 25 %, p < 0.05). The rate of thyroid cancer was similar in FN (17.3%) and HN (18.6%). The rate of Hürthle cell thyroid cancer was significantly higher in HN than in FN (5.0% vs. 0.7%, p < 0.01) and the rate of the oncocytic variant of PTC was also significantly greater in HN compared to FN nodules (23.1% vs. 1.7%, p < 0.05). The rate of follicular thyroid carcinoma was almost identical in patients with HN and FN (19.2% vs. 18.8 %). CONCLUSIONS There is little difference in the rate of malignancy between thyroid nodules with a cytological reading of FN indeterminate for malignancy and HN indeterminate for malignancy but there is a difference in the types of thyroid cancers in these groups. Hürthle cell thyroid cancer and the oncocytic variant of PTC is more common in nodules with an HN indeterminate for malignancy cytology reading than in nodules with a FN indeterminate for malignancy cytology reading. Since Hürthle cell thyroid cancer and the oncocytic variant of PTC are more aggressive than other thyroid cancers, it is likely that patients with an HN indeterminate for malignancy cytology will, as a group, have more aggressive thyroid cancers than those with an FN indeterminate for malignancy cytology.
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Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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22
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de Almeida JPA, Netto SDDC, Rocha RPD, Pfuetzenreiter EG, Dedivitis RA. The role of intraoperative frozen sections for thyroid nodules. Braz J Otorhinolaryngol 2009; 75:256-60. [PMID: 19575113 PMCID: PMC9450613 DOI: 10.1016/s1808-8694(15)30787-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Accepted: 12/14/2007] [Indexed: 10/26/2022] Open
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23
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Fischer CA, Graciano AJ, Ferreira SJ, Daudt CA, Fiorini CA, Silvestri K. Fatores preditores de malignidade em neoplasias de células de Hurthle. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000400003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: neoplasias de células de Hurthle são tumores da glândula tireóide de baixa incidência que apresentam muitas controvérsias quanto à distinção entre carcinomas e adenomas. O objetivo deste estudo foi identificar fatores preditores de malignidade neste tipo específico de neoplasia. MÉTODOS: entre janeiro de 1999 e junho de 2006, 56 casos de neoplasia de células de Hurthle foram diagnosticados em nossa instituição e foram estudados retrospectivamente. RESULTADOS: trinta e sete pacientes apresentaram diagnóstico patológico de adenoma de células de Hurthle (ACH), enquanto 19 casos foram diagnosticados como carcinoma de células de Hurthle (CCH). No grupo de pacientes com adenomas a idade média foi de 47,8 anos, sendo que trinta e cinco (94%) eram do sexo feminino e apenas dois (5,5%) casos do sexo masculino. O tamanho médio dos adenomas foi de 2,1 cm variando de 0,3 a 6,0 cm. Entre os 19 casos de carcinomas a média de idade foi de 51,1 anos, sendo quatorze casos em mulheres (73%) e cinco em homens (26,4%). O tamanho médio dos nódulos neste grupo foi de 3,8 cm, variando de 2,0 cm a 7,5 cm. CONCLUSÃO: Pacientes com neoplasias de células de Hurthle apresentando nódulos maiores que três centímetros, principalmente em homens, apresentam maior risco de malignidade.
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Zhang YW, Greenblatt DY, Repplinger D, Bargren A, Adler JT, Sippel RS, Chen H. Older age and larger tumor size predict malignancy in hürthle cell neoplasms of the thyroid. Ann Surg Oncol 2008; 15:2842-6. [PMID: 18665423 DOI: 10.1245/s10434-008-0079-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hürthle cell neoplasms (HCNs) are rare tumors of the thyroid gland. The definitive treatment for Hürthle cell carcinoma (HCC) is total thyroidectomy, while thyroid lobectomy is adequate for Hürthle cell adenoma (HCA). However, differentiating HCC from HCA either before or during surgery is a challenge. The purpose of this study was to identify factors that predict malignancy in patients with HCN. METHODS Between May 1994 and January 2007, 1,199 patients underwent thyroid surgery at an academic medical center. Medical records of 55 consecutive patients who underwent thyroid resections for the preoperative diagnosis of HCN were reviewed. RESULTS Of the 55 patients with HCN, 46 (84%) had adenomas and 9 (16%) had carcinomas. Patients with HCC were significantly older than those with HCA (66 +/- 6 years versus 53 +/- 2 years, P = 0.01). Patients with carcinoma also had significantly larger thyroid nodules (4.5 +/- 0.7 cm versus 2.5 +/- 0.2 cm, P < 0.001). All HCNs less than 2 cm in diameter were benign. The malignancy rate increased with nodule size: 18% of nodules measuring 2-4 cm, and 44% of those larger than 4 cm were HCC. One patient with HCC had recurrence of the disease, but there were no disease-related deaths. CONCLUSION Advanced patient age and larger nodule size are two important factors that predict malignancy in patients with HCN. In patients with these and other known risk factors for HCC, total thyroidectomy should be considered.
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Affiliation(s)
- Yi Wei Zhang
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
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Sippel RS, Elaraj DM, Khanafshar E, Zarnegar R, Kebebew E, Duh QY, Clark OH. Tumor Size Predicts Malignant Potential in Hürthle Cell Neoplasms of the Thyroid. World J Surg 2008; 32:702-7. [DOI: 10.1007/s00268-007-9416-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mitchell JC, Grant F, Evenson AR, Parker JA, Hasselgren PO, Parangi S. Preoperative evaluation of thyroid nodules with 18FDG-PET/CT. Surgery 2005; 138:1166-74; discussion 1174-5. [PMID: 16360405 DOI: 10.1016/j.surg.2005.08.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 08/16/2005] [Accepted: 08/19/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT) has become an important tool in the postoperative management of de-differentiated thyroid cancer. The utility of this imaging modality in the preoperative assessment of thyroid nodules is unclear. This study was designed to determine whether (18)FDG-PET/CT improves the preoperative diagnosis of thyroid nodules. METHODS A total of 31 patients with 48 lesions underwent fine-needle aspiration and (18)FDG-PET/CT before surgical resection of thyroid nodules. PET/CT images were obtained 1 hour after intravenous administration of (18)FDG. Standard uptake values were calculated for regions of increased (18)FDG uptake. CT scans were evaluated to identify thyroid pathology. Final pathologic diagnoses were compared with PET/CT findings. RESULTS Fifteen of 48 lesions were malignant and 33 were benign. Nine of 15 malignant lesions were (18)FDG-avid (sensitivity 60%). Thirty of 33 benign lesions were (18)FDG-cold (specificity 91%). Positive and negative predictive values were 75% and 83%, respectively. CONCLUSIONS (18)FDG-PET/CT provides a high negative predictive value for malignancy, making this a potentially useful tool in the evaluation of thyroid nodules with indeterminate fine-needle aspiration. However further studies with larger sample sizes are needed to determine the true efficacy of this test.
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Affiliation(s)
- Jamie C Mitchell
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Alaedeen DI, Khiyami A, McHenry CR. Fine-needle aspiration biopsy specimen with a predominance of Hürthle cells: A dilemma in the management of nodular thyroid disease. Surgery 2005; 138:650-6; discussion 656-7. [PMID: 16269293 DOI: 10.1016/j.surg.2005.06.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 06/09/2005] [Accepted: 06/14/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND A fine-needle aspiration biopsy (FNAB) specimen of a thyroid nodule with a predominance of Hürthle cells usually is indicative of a Hürthle cell neoplasm, but it also may occur with nonneoplastic disease. METHODS A prospective nodular thyroid disease database was used to identify patients with a FNAB specimen consisting of a predominance of Hürthle cells. Clinical factors were investigated and FNAB specimens were examined in a blinded fashion by a single cytopathologist to determine if there were specific factors that could be used to distinguish nonneoplastic from neoplastic disease. RESULTS Of the 738 patients with nodular thyroid disease, 622 had a FNAB specimen. The FNAB specimen was interpreted as consistent with a Hürthle cell neoplasm in 45 (7%) patients, 7 (16%) with carcinoma, 21 (47%) with adenoma, 12 (27%) with adenomatous hyperplasia, and 5 (11%) with thyroiditis. Extensive cellularity and absent colloid were associated with neoplastic disease (P < .05). No cytologic feature reliably excluded neoplastic disease (P > .05). No significant differences in age (x +/- SD) (51 +/- 17 vs 54 +/- 17 y), sex (female/male ratio, 6/1 vs 15/2), nodule size (3.9 +/- 1.9 vs 3.4 +/- 2.0 cm), weight of excised thyroid tissue (42 +/- 27 vs 33 +/- 30 g), or functional status of the thyroid gland was observed between patients with neoplastic (n = 28, 62%) versus nonneoplastic (n = 17, 38%) disease. CONCLUSIONS Neoplastic disease accounts for two thirds of the pathology in patients with a predominance of Hürthle cells on FNAB specimen and neither clinical nor cytologic features reliably exclude Hürthle cell adenoma or carcinoma. As a result, thyroidectomy is recommended for all patients with a thyroid nodule and a predominance of Hürthle cells on FNAB specimen.
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Affiliation(s)
- Diya I Alaedeen
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA.
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