Follicular or Hurthle cell neoplasm of the thyroid: Can clinical factors be used to predict carcinoma and determine extent of thyroidectomy?

Background. Fine-needle aspiration biopsy (FNAB) and frozen section exam ar e of limited or no value in distinguishing benign and malignant follicular or Hurthle cell neoplasms of the thyroid gland. Methods. Patients who underwent thyroidectomy for treatment of a follicular or Hurthle cell neoplasm between 1990 and 1998 were identified and evaluat ed for ng-e, gender head and neck its irradiation, nodule size, and cytolgi c atytia to determine whether clinical factors were predictive of carcinoma . Results. Of the 352 patients evaluated for nodular thyroid disease, 75 (22% ) underwent thyroidectomy after an indeterminate FNAB finding; 66 with foll icular and 9 with a Hurthle cell neoplasm. Seventeen (23%) of the patients had carcinoma-follicular variant of papillary (10), follicular (6), and Hur thle cell (li. Carcinoma was diagnosed in IS of 64 women and 2 of I I men ( P > .05). The mean age was 43 +/- 21 years and 50 +/- 16 years, respectivel y in patients with and without carcinoma (P < .05). Three patients had prev ious neck irradiation and none had carcinoma. Mean nodule size was 4.2 +/- 2.7 cm and 4.3 +/- 3.5 cm, respectively in patients with and without carcin oma (P > .05). Cytologic alypia was present in 8 of 17 patients with carcin oma and 20 of 58 patients without carcinoma (P > .05). Conclusions. Clinical factors were not helpful in predicting carcinoma in p atients with an indeterminate FNAB finding and thus cannot be used to relia bly select patients for more extensive thyroidectomy.