General Question

Aster's avatar

Should a histology thyroid FNA report say "carcinoma" if it's cancer?

Asked by Aster (15339 points ) January 25th, 2014

If a patient’s thyroid fine needle aspiration histology report does not mention the words “metastases” OR “carcinoma” but just “suspicious Hurthle cells” do you think the patient should have the thyroid removed because the endo says to?

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6 Answers

Quakwatch's avatar

According to this paper, roughly 31% of individual who had an FNA diagnosis of a Hurthle cell lesion were found to have a true carcinoma when the thyroid was removed. I imagine there are other similar papers, but the underlying question is, does the patient want to risk leaving a potentially curable cancer in place because they think there is a 69% chance it will be benign? I know if I were put in that position I would favor thyroidectomy.

This answer is not a substitute for professional medical advice. This answer is for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor or (in the United States) 911 immediately. Always seek the advice of your doctor before starting or changing treatment.

kounoupi's avatar

The FNA report will be describing exactly what the professional pathologist who issued it saw. The appropriate course of action for the patient after an FNA is something that will have to be discussed with the physician who is monitoring the patient.

Response moderated (Off-Topic)
JLeslie's avatar

I’m not a doctor. I know nothing about thyroid cancer and diagnosing it.

I would think you could have the tissue evaluated by another lab if you want a second opinion, and then also talk to another doctor. I once had this done for a biopsy, it was not my thyroid, and the concern was not something as scary as cancer, so this is not apples to apples. The two labs said two different things. Maybe the doctors on the Q can comment on having it analyzed by another lab.

The information @Quakwatch gave is pretty compelling to me. The risk sounds pretty high, 31%.

gorillapaws's avatar

I think this sounds like the kind of decision each patient would need to make for herself. It would be interesting to know the stats on the complications for thyroid removal. My father is a general surgeon who has performed this procedure many times in his long career. I can recall him describing how it is a difficult and risky procedure compared to many of the other surgical procedures he did. There is a significant risk of damaging the vocal chords for example I believe.

If it were me, I would find a surgeon I trusted and roll the dice. 1 in 3 seems like too big of a risk to ignore. Also I am pretty young (still in my 30s). If I were in my 70s I might look at the situation very differently.

hearkat's avatar

There is always the option to get a second opinion. The E.N.T. Physicians I work with also perform FNAs and thyroidectomies, so one might even consider consulting a different specialist.

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