Endocrine Abstracts

Background: Differential diagnosis of a thyroid nodule is difficult if it is a follicular lesion. Follicular lesions include follicular adenoma (FA) or a malign neoplasm (follicular cancer (FC) or follicular variant of papillary thyroid carcinoma (FVPTC)). Cytology can’t separate benign from malignant condition in follicular lesions. Differential diagnosis is important because patients often undergo less than ideal interventions, such as a total thyroidectomy for a benign lesion or require completion thyroidectomy after a lobectomy for a malignant nodule. Herein we aimed to search whether there is a clinical or ultrasonographic marker discriminating malign lesions from benign ones.

Method: Eighty consecutive patients with an operated follicular thyroid neoplasm at a tertiary hospital from 2007 to 2014 were reviewed. Age, gender, symptoms, history, physical findings, nodule size, sonographic, cytologic, and final pathologic results were recorded. Malignant and benign groups were compared according to preoperative clinical and imaging features.

Results: 34 of 102 nodules were malignant where as 68 were benign. Gender distribution, baseline thyroid function tests and thyroid autoantibody positivity were similar between the benign and malignant groups. Family history of differentiated thyroid cancer (DTC) was significantly higher in the malignant group (P=0.002). Regarding to ultrasonographic parameters, nodule volume and vascularity were significantly greater in the malignant nodules (P=0.04 and 0.008, respectively) Presence of microcalcification/irregular macrocalcification was also higher in the malignant group compared to benign group (P=0.017). When we subdivided malignant nodules as FVPTC (18 lesions) and FC (16 lesions), microcalfication was significantly more common in FVPTC (P=0.022).

Conclusion: Family history and certain ultrasonographic parameters might be helpful in preoperative differentiation of benign and malignant follicular neoplasms. A combination ofthose with both FNA and molecular results may help us to decide management of patients with follicular thyroid lesion.