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Cancer Cytopathol. 2019 Mar;127(3):181-191. doi: 10.1002/cncy.22101. Epub 2019 Jan 22.

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

Author information

1
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
2
Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
3
Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
4
Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan.
5
Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan.
6
Department of Pathology, Yonsei University, College of Medicine, Seoul, South Korea.
7
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
8
Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Shandong, China.
9
Department of Pathology, Qilu Hospital of Shandong University, Shandong, China.
10
Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan.

Abstract

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.

KEYWORDS:

Hürthle cell lesion; Hürthle cell neoplasm; Hürthle cell type; atypia of undetermined significance/follicular lesion of undetermined significance; fine-needle aspiration (FNA); follicular neoplasm; risk of malignancy (ROM); risk of neoplasia (RON); the Bethesda System for Reporting Thyroid Cytopathology

PMID:
30668897
DOI:
10.1002/cncy.22101

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