Lobectomy may not be suitable for patients with follicular neoplasm cytology
Lobectomy may not be suitable for patients with follicular neoplasm cytology
Background/aim: The most appropriate surgical management of follicular neoplasm/suspicious for follicular neoplasm (FN) lesions isstill contradictory. We aimed to evaluate the data of our patients with follicular neoplasm treated with thyroidectomy.Materials and methods: We retrospectively analyzed the data of 74 patients who were diagnosed with follicular neoplasm cytology(FN cytology) by fine needle aspiration biopsy (FNAB) and had undergone total thyroidectomy or lobectomy with isthmectomy (LwI).Results: We examined a total of 74 patients, of which 64 (83.7%) were female and 10 (16.3%) were male. The malignancy rate in thepathological examinations of these patients was 31/74 (41.9%). The most common cancer among the patients with malignancy waspapillary thyroid carcinomas (PTC) (20/31, 65%). Among the subtypes of PTCs, 11 were classical PTC, 5 were a follicular variant ofPTC, 2 were the oncocytic variant of PTC, 1 was the diffuse sclerosing variant, and 1 was a columnar cell variant of PTC.Conclusion: Since most FN cytology has been pathologically diagnosed with papillary cancer and some papillary cancer subtypes havebeen unfavorable pathologically, total thyroidectomy should be the most suitable treatment option in this group. Lobectomy with LwIis not suitable for patients with FNAB-proven FN cytology.
___
- 1. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH,
Coleman BG, Cronan JJ, Doubilet PM, Evans DB, Goellner
JR et al. Management of thyroid nodules detected at the US:
Society of Radiologists in ultrasound consensus conference
statement. Ultrasound Q 2006; 22: 231-238.
- 2. Mazzaferri EL. Management of a solitary thyroid nodule. N
Engl J Med 1993; 328: 553-559.
- 3. Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph
G, Vielh P, DeMay RM, Sidawy MK, Frable WJ. Diagnostic
terminology and morphologic criteria for cytologic diagnosis
of thyroid lesions: a synopsis of the National Cancer
Institute Thyroid Fine-Needle Aspiration State of the Science
Conference. Diagn Cytopathol 2008; 36: 425.
- 4. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee
SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger
M et al. Revised American Thyroid Association management
guidelines for patients with thyroid nodules and differentiated
thyroid cancer. Thyroid 2009; 19: 1167-1214.
- 5. Yoo C, Choi HJ, Im S, Jung JH, Min K, Kang CS, Suh YJ. Fine
needle aspiration cytology of thyroid follicular neoplasm:
cytohistologic correlation and accuracy. Korean J Pathol 2013 ;
47: 61-66.
- 6. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch
ZW. The Bethesda system for reporting thyroid cytopathology:
a meta-analysis. Acta Cytol 2012; 56: 333-339.
- 7. Wiseman SM, Baliski C, Irvine R, Anderson D, Wilkins
G, Filipenko D, Zhang H, Bugis S. Hemithyroidectomy: the
optimal initial surgical approach for individuals undergoing
surgery for a cytological diagnosis of follicular neoplasm. Ann
Surg Oncol 2006; 13: 425-432.
- 8. Shah JP, Loree TR, Dharker D, Strong EW. Lobectomy versus
total thyroidectomy for differentiated carcinoma of the thyroid:
a matched-pair analysis. Am J Surg 1993; 166: 331-335.
- 9. Conzo G, Calò PG, Gambardella C, Tartaglia E, Mauriello
C, Della Pietra C, Medas F, Santa Cruz R, Podda F, Santini
L et al. Controversies in the surgical management of thyroid
follicular neoplasms. Retrospective analysis of 721 patients. Int
J Surg 2014; 12: 29-34.
- 10. Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science
Conference. The Bethesda system for reporting thyroid
cytopathology. Am J Clin Pathol 2009; 132: 658-665.
- 11. Antunes CM, Taveira-Gomes A. Lobectomy in follicular
thyroid neoplasms’ treatment. Int J Surg 2013; 11: 919-922.
- 12. Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis
of ‘follicular neoplasm’: a gray zone in thyroid fine-needle
aspiration cytology. Diagn Cytopathol 2002; 26: 41-44.
- 13. Kim ES, Nam-Goong IS, Gong G, Hong SJ, Kim WB, Shong
YK. Postoperative findings and risk for malignancy in thyroid
nodules with cytological diagnosis of the so-called ‘follicular
neoplasm’. Korean J Intern Med 2003; 18: 94-97.
- 14. Spanheimer PM, Sugg SL, Lal G, Howe JR, Weigel RJ.
Surveillance and intervention after thyroid lobectomy. Ann
Surg Oncol 2011; 18: 1729-1733.
- 15. Balentine CJ, Domingo RP, Patel R, Laucirica R, Suliburk
JW. Thyroid lobectomy for indeterminate FNA: not without
consequences. J Surg Res 2013; 184: 189-192.
- 16. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch
ZW. The Bethesda system for reporting thyroid cytopathology:
a meta-analysis. Acta Cytol 2012; 56: 333-339.
- 17. Al-Hureibi KA, Al-Hureibi AA, Abdulmughni YA, Aulaqi
SM, Salman MS, Al-Zooba EM. The diagnostic value of fine
needle aspiration cytology in thyroid swellings in a university
hospital, Yemen. Saudi Med J 2003; 24: 499-450.
- 18. Wu HH, Jones JN, Osman J. Fine-needle aspiration cytology
of the thyroid: ten years’ experience in a community teaching
hospital. Diagn Cytopathol 2006; 34: 93-96.
- 19. Corso C, Gomez X, Sanabria A, Vega V, Dominguez LC, Osorio
C. Total thyroidectomy versus hemithyroidectomy for patients
with follicular neoplasm. A cost-utility analysis. Int J Surg
2014; 12: 837-842.
- 20. Zanocco K, Heller M, Elaraj D, Sturgeon C. Cost-effectiveness
of intraoperative pathology examination during diagnostic
hemithyroidectomy for unilateral follicular thyroid neoplasms.
J Am Coll Surg 2013; 217: 702-710.
- 21. Gulcelik NE, Gulcelik MA, Kuru B. The risk of malignancy
in patients with follicular neoplasm. Arch Otolaryngol Head
Neck Surg 2008; 134: 1312-1315.
- 22. Volante M, Landolfi S, Chiusa L, Palestini N, Motta
M, Codegone A, Torchio B, Papotti MG. Poorly differentiated
carcinomas of the thyroid with trabecular, insular and solid
patterns: a clinicopathologic study of 183 patients. Cancer 2004;
100: 950-957.