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 are 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 evaluated for ng-e, gender head and neck its irradiation, nodule size, and cytolgic 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 follicular and 9 with a Hurthle cell neoplasm. Seventeen (23%) of the patients had carcinoma-follicular variant of papillary (10), follicular (6), and Hurthle 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, respectively in patients with and without carcinoma (P < .05). Three patients had previous 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 carcinoma (P > .05). Cytologic alypia was present in 8 of 17 patients with carcinoma and 20 of 58 patients without carcinoma (P > .05). Conclusions. Clinical factors were not helpful in predicting carcinoma in patients with an indeterminate FNAB finding and thus cannot be used to reliably select patients for more extensive thyroidectomy.