Hürthle cell neoplasms of the thyroid: Pathologic outcomes and ultrasonographic analysis

Abstract

Background: Fine-needle aspiration (FNA) of thyroid nodules suspicious for Hürthle cell neoplasms (HCN) have uncertain rate of malignancy. We aim to characterize rate and predictors of malignancy at our institution and compare these findings with established literature to help guide management. Methods: Single tertiary-referral center, retrospective study of 166 adults who underwent hemithyroidectomy or total thyroidectomy following FNA suspicious for HCN from 1998-2018. Demographic information and surgical histopathologic results were collected. Preoperative ultrasonography was independently scored on the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) by a board-certified head and neck radiologist. Results: There were 39 males and 127 females. Overall, 25 (15.1%) patients had carcinoma, with 15 (9%) being Hürthle cell carcinoma (HCC). Men had higher incidence of carcinoma (25.6% v. 11.8%, P = .035), and especially older males. Contralateral carcinoma was seen in 3 of 13 (23.1%) patients that underwent completion thyroidectomy. Patients with carcinoma had larger nodules (average diameter 3.3 cm versus 2.5 cm, respectively, P = .01), but no association with TI-RADS. Conclusion: Adults with nodules suspicious for HCN have significant risk of malignancy consistent with prior studies. Older males and larger nodule diameter are associated with malignancy in this cohort, but TI-RADS grade is not. These findings provide a framework for management and counseling for lesions suspicious for HCN.

Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma

“…The 2015 American Thyroid Association guidelines address OTC as a variant of FTC and apply the same risk stratification parameters, with diagnostic lobectomy an accepted intervention for a nodule less than 4 cm, unless clinical features prompt consideration of more extensive resection . Ultimately, less than 10% of nodules that undergo surgery for an FNAB interpreted as suggestive for Hürthle cell (oncocytic) neoplasm (Bethesda System, category IV), prove to be OTC . More extensive surgical intervention may result from preoperative recognition of lymph node metastasis or evidence of distant disease.…”