Fine-Needle Aspiration Cytology of Thyroid Nodules with Hürthle Cells: Cytomorphologic Predictors for Neoplasms, Improving Diagnostic Accuracy and Overcoming Pitfalls

Kasper, Katherine; Stewart, Jimmie; Das, Kasturi

doi:10.1159/000358264

Cited by 16 publications

(1 citation statement)

References 21 publications

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“…Many cytologic features have been proposed for distinguishing nonneoplastic Hürthle cell nodules from neoplastic nodules as well as benign from malignant nodules, although to the best of our knowledge no criteria have been widely accepted. These include cellularity, [2][3][4][5] the amount of colloid, [2][3][4][6][7][8] architecture (ie, macrofollicular sheets, crowded groups, singly dispersed cells), 3,5,7,8 and nuclear pleomorphism or "dysplasia," 2,3,[5][6][7][8][9] among others. Given the inconsistency of cytologic features in the evaluation of HC FNA, it also has been suggested in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) that clinicopathologic correlation can aid in evaluation.…”

Section: Introductionmentioning

confidence: 99%

Malignancy risk for solitary and multiple nodules in Hürthle cell–predominant thyroid fine‐needle aspirations: A multi‐institutional study

Wong

Lowe

et al. 2019

Cancer Cytopathology

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BACKGROUND: Hürthle cell metaplasia is common in hyperplastic nodules, particularly within the setting of lymphocytic thyroiditis (LT). The Bethesda System for Reporting Thyroid Cytopathology indicates that it is acceptable to classify Hürthle cell-predominant fine-needle aspiration (HC FNA) specimens as atypia of undetermined significance (AUS) rather than suspicious for a Hürthle cell neoplasm (HUR) within the setting of multiple nodules or known LT. The goal of the current study was to address whether this approach is justified. METHODS: HC FNA specimens were identified and correlated with ultrasound and surgical pathology reports if available. Multinodularity was determined based on findings on macroscopic examination if imaging results were unavailable. RESULTS: A total of 698 HC FNA specimens were identified, including 576 resected nodules, 455 of which (79%) were benign. The overall risk of malignancy for HUR was 27%, whereas the risk of malignancy for AUS was 10%. The mean size of the benign nodules was 2.1 cm on surgical resection specimens, with multiple nodules noted in 293 cases (64%) and histologic LT noted in 116 cases (25%). The mean size of the malignant nodules was 2.8 cm, with multiple nodules and histologic LT noted in 74 cases (61%) and 22 cases (18%), respectively. The malignancy rate did not differ between solitary or multiple nodules (P = .52) or in the presence or absence of LT (P = .12). However, size did significantly differ between malignant and benign nodules (P < 0.01). CONCLUSIONS: The malignancy rate did not differ significantly in the presence of multiple nodules or LT, although the latter demonstrated a statistical trend. A diagnosis of AUS over HUR based solely on the presence of multinodularity is not warranted.

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Section: Introductionmentioning

confidence: 99%

Malignancy risk for solitary and multiple nodules in Hürthle cell–predominant thyroid fine‐needle aspirations: A multi‐institutional study

Wong

Lowe

et al. 2019

Cancer Cytopathology

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The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid: A multi‐institutional study in 6 Asian countries

Agarwal

Bychkov

Jung

et al. 2019

Cancer Cytopathology

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BACKGROUND: Hürthle cell-rich nodules (HCNs) encompass non-neoplastic to malignant lesions. There is paucity of literature on the frequency distribution of HCNs among Bethesda categories, histologic follow-up, risk of malignancy (ROM), and risk of neoplasia (RON). The objective of this retrospective, multi-institutional study was to determine the prevalence of the cytologic diagnostic category and surgical outcomes of patients with HCN. METHODS: Nine tertiary health centers representing 6 Asian countries participated. Cases were retrieved from respective databases. The Bethesda System for Reporting Thyroid Cytopathology was used. Cytology results were correlated with surgical diagnoses. RESULTS: Of 42,190 thyroid aspirates retrieved, 760 (1.8%) had a Hürthle cell predominance. Most (61%) were categorized as atypia of undetermined significance/follicular lesion of undetermined significance, Hürthle cell type"(AUS-H); 35% were categorized as follicular neoplasm, Hürthle cell type (FN-H); and 4% were categorized as suspicious for malignancy (SFM). Histologic follow-up was available for 288 aspirates (38%). Most were benign on resection (66%), and the most common histologic diagnosis was Hürthle cell adenoma (28.5%). The ROM for AUS-H, FN-H, and SFM, as calculated on resected nodules, was 32%, 31%, and 71%, respectively; and the RON was 47%, 81%, and 77%, respectively.The 5 institutions that had an AUS-H:HCN ratio below 0.5 diagnosed HCN less frequently as AUS-H than as FN-H. CONCLUSIONS:This is the largest, contemporary, multi-institutional series of HCNs with surgical follow-up. Although there was wide interinstitutional variation in prevalence and surgical outcomes, there was no significant difference in the ROM among institutions. The categories AUS-H and FN-H had a similar ROM for resected nodules.

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Hürthle cell‐predominant thyroid fine needle aspiration cytology: A four risk‐factor model highly accurate in excluding malignancy and predicting neoplasm

Yuan

Nasr

Bena

et al. 2022

Diagnostic Cytopathology

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BackgroundInterpretation of Hürthle cell‐predominant cytologies (HCP) is very challenging as a majority is diagnosed as indeterminate. Prior studies have reported various cytologic features to help distinguish non‐neoplastic (NN) from neoplastic and malignant lesions but had contradicting results. Our aim was to identify risk factors predictive of neoplasm and/or malignancy by correlating cytologic features with clinical and ultrasound findings.MethodsSixty‐nine HCP cases with surgical follow‐up were identified, including 35 NN, 20 adenomas, and 14 carcinomas. Ultrasound data were recorded utilizing Thyroid Imaging Reporting and Data System (TI‐RADS) and American Thyroid Association (ATA) scoring systems. Sixteen cytologic criteria were evaluated and semi‐quantitatively scored. Data were assessed by univariable, multivariable and stepwise logistic regression analysis; and statistical significance achieved at P‐value <0.05.ResultsOn univariable analysis, significant predictors of neoplasm were high cellularity, isolated single cells, absent colloid, non‐uniform HC population (anisonucleosis), larger nodule size, and higher ATA score. Large‐cell dysplasia and transgressing blood vessels were not found to be significant factors. Multivariable analysis identified a combination of four risk factors (high cellularity, anisonucleosis, absent colloid, and size ≥2.9 cm) that was associated with neoplasm in 10/11 patients. None of 15 patients with zero or 1 out of 4 risk factors had malignancy or neoplasm on follow‐up. This model also significantly outperformed ATA and TI‐RADS scoring systems.ConclusionIn the absence of four or three risk factors, the model excluded malignancy and neoplasm in all patients. The presence of all four factors predicted neoplasm and malignancy in 91% and 46% of cases, respectively.

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Fine-Needle Aspiration Cytology of Thyroid Nodules with Hürthle Cells: Cytomorphologic Predictors for Neoplasms, Improving Diagnostic Accuracy and Overcoming Pitfalls

Cited by 16 publications

References 21 publications

Malignancy risk for solitary and multiple nodules in Hürthle cell–predominant thyroid fine‐needle aspirations: A multi‐institutional study

Malignancy risk for solitary and multiple nodules in Hürthle cell–predominant thyroid fine‐needle aspirations: A multi‐institutional study

The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid: A multi‐institutional study in 6 Asian countries

Hürthle cell‐predominant thyroid fine needle aspiration cytology: A four risk‐factor model highly accurate in excluding malignancy and predicting neoplasm

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