Abstract
Introduction:The management of follicular (FN) and Hurthle cell neoplasms (HCN) is often difficult because of the uncertainty of malignancy risk. We aimed to assess characteristics of benign and malignant follicular and Hurthle neoplasms based on their shape and size. Materials and methods:Patients with Follicular adenoma (FA) or carcinoma (FC) and Hurthle Cell adenoma (HCA) or carcinoma (HCC) who had preoperative ultrasonography were included. Demographic data were retrieved. Size and shape of the nodules were measured. Logistic regression analyses and odds ratios were performed.Results:A total of 115 nodules with 57 carcinomas and 58 adenomas were included. Logistic regression analysis shows that the nodule height and the patient age are predictors of malignancy (p-values = 0.001 and 0.042). A cutoff value of nodule height ≥ 4 cm. produces an odds ratio of 4.5 (p-value = 0.006). An age ≥ 55 year-old demonstrates an odds ratio of 2.4-3.6 (p-value = 0.03). Taller-than-wide shape was not statistically significant (p-value = 0.613). Conclusion:FC and HCC are larger than FA and HCA in size, with a cutoff at 4 cm. Increasing age increases the odds of malignancy with a cutoff at 55 year-old. Taller-than-wide shape is not a predictor of malignancy.
Highlights
The management of follicular (FN) and Hurthle cell neoplasms (HCN) is often difficult because of the uncertainty of malignancy risk
One hundred twenty of the patients did not have both transverse and longitudinal images. This left a total of 115 patients that could be analyzed, including 58 benign (39 Follicular adenoma (FA) and 19 Hurthle Cell adenoma (HCA)) and 57 malignant (35 follicular carcinoma (FC) and 22 Hurthle cell carcinoma (HCC))
The gender, age, width, depth, height and taller-than-wide appearance is found to be statistically significant (P-values = 0.031, 0.014, 0.001, 0.001,
Summary
The management of follicular (FN) and Hurthle cell neoplasms (HCN) is often difficult because of the uncertainty of malignancy risk. There is not yet a true consensus criteria for triaging these patients, since the main focus of thyroid cancer is mainly on the papillary thyroid carcinoma (PTC) For both FN and HCN, cytological features that are obtained with fine-needle aspiration biopsy (FNAB) cannot accurately differentiate benign lesions from malignant ones. Proper selection of the appropriate procedure would benefit patients in terms of postoperative complications, avoidance of reoperation, and overall quality of life (Megwalu and Green, 2016; Kuba et al, 2017) Several ultrasound features, such as lack of a sonographic halo, hypoechoic appearance, predominantly solid contents, a heterogeneous echotexture, and the presence of calcifications, were reported to be predictors of follicular carcinomas (Sillery et al, 2010; Zhang and Hu, 2014). There are not many articles had compared the size of FC and HCC directly to the size of follicular adenoma (FA) and Hurthle cell adenoma (HCA) and the results are discrepancy (Seo et al, 2009; Sillery et al, 2010; Zhang and Hu, 2014)
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