Management considerations in Hürthle cell carcinoma.

BACKGROUND: Hürthle cell tumors still pose issues concerning diagnosis and management. METHODS: From 1984 to 1993 forty-seven patients underwent thyroidectomy, and they were diagnosed after operation to have presumptive Hürthle cell tumors. The surgical pathologic findings were reviewed. In the neoplastic group the chart was reviewed for clinical features and outcome. RESULTS: Thirty-one patients had nonneoplastic Hürthle cell nodules. Eleven (69%) of the 16 tumors were malignant affecting 11 women and five men ranging in age from 22 to 86 years. Two patients died of cancer for a 18% rate; one patient is alive with disease. Operations were uncomplicated. Factors for adverse outcome include tumor size greater than 4 cm, woman older than 60 years of age, and complete capsular invasion on surgical pathologic findings. CONCLUSIONS: Fine-needle aspiration biopsy demonstration of Hürthle cell lesion is an indication for operation, providing Hashimoto's thyroiditis is excluded. Our surgical practice (I.B.R.) is to perform total thyroidectomy for all Hürthle cell neoplasms, as well as jugular node sampling and adjuvant radioiodine for cancer. Stringent histologic interpretation is possible and necessary for true appreciation of Hürthle cell tumor incidence and behavior. Cancer mortality of 18% is greater than the rate (2%) of our well-differentiated thyroid cancer group.

Adverse aspects of small thyroid cancer and need for treatment.

BACKGROUND: Small, well-differentiated thyroid cancer (tumor < 1.5 cm) is frequently dismissed as biologically inconsequential, although varied reports have offered differing experiences. METHODS: A total of 382 thyroid cancer patients were reviewed. Of these, 99 patients had tumors that were < or = 1.5 cm. Thirty-five patients in this group with positive nodes, extrathyroidal invasion, or metastatic disease were studied. RESULTS: Thirty-five patients (one-third of the < 1.5 cm group) showed other sites of involvement: nodes, 28; lung, 1; muscle, 7; nerve, 5; and bone, 2. Six patients had residual cancer following surgery. Surgery included thyroidectomy and neck dissection as well as orthopedic procedures for metastatic bone disease. Radioiodine ablation was used in 33 patients, external radiation in 5. Thirty-one patients are well without disease, 3 are alive with disease, 1 died of disease. CONCLUSIONS: Small, well-differentiated thyroid cancer is infrequently aggressive, but it may be a source for metastatic morbidity and recurrence and can be viewed as potentially lethal. Need for treatment should not be ignored based solely on the size of the tumor.

Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease.

During a 23-month period, 59 patients were referred for ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) of the thyroid gland because of inadequate orthodox (office) FNAB, a clinically small lesion, or an occult lesion. Seventy percent of the group (41 patients) was referred for surgery, which revealed cancer in 37% of patients, adenoma in 19%, and benign disease in 44%. US-guided FNAB yielded false-positive reports in 0% of patients, false-negative reports in 5% to 12%, and inadequate aspirates in 32%. The US-guided FNAB technique had a sensitivity of 60% to 90%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 80%, and an accuracy of 85%. US-guided FNAB provides cytologic information in 60% of patients in whom a diagnosis cannot be established by orthodox (office) means, thus enhancing the diagnostic ability of clinicians who can recommend a treatment program with confidence.