Follicular neoplasm of the thyroid: can clinical, ultrasonographical and cytological factors be used to predict carcinoma and determine extent of surgery


  • Shivraj Meena Department of General Surgery, Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan, India
  • Sunita Meena Department of General Surgery, Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan, India
  • Seemant Saini Department of General Surgery, Pacific Institute of Medical Sciences, Umarda, Udaipur, Rajasthan, India



Follicular neoplasm, Indeterminate lesions, Sonography, Fine needle aspiration cytology


Background: The optimal management of cytologically indeterminate thyroid nodules in follicular neoplasm is controversial. We examined the prevalence of malignancy within cytologically indeterminate follicular thyroid lesions in an attempt to predict malignancy based on clinical, sonographic and cytologic features.

Methods: Retrospective study was done in between April 2017 to July 2019 of 46 patients having a diagnosis of follicular neoplasm on fine needle aspiration cytology.

Results: A total of 46 patients (8 men, 38 women; mean age 47 year) with indeterminate cytology underwent thyroidectomy and had histopathological diagnoses. The prevalence of malignancy in patients was 34.7%. The size of nodules and ultrasonographic feature were significant predictor of malignancy with p value <0.05.

Conclusions: Author can predict malignancy in follicular neoplasm of thyroid with indeterminate nodule by using clinical and sonographic feature for the best compromise between the risk of missing carcinomas and the need for reducing unnecessary surgical procedures and cost benefit of the patients. 


Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas: prevalence by palpation and ultrasonography. Archives Inter Med. 1994;154(16):1838-40.

Brander A, Viikinkoski P, Nickels J, Kivisaari L. Thyroid gland: US screening in a random adult population. Radiol. 1991;181(3):683-7.

Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med. 2003;22(10):1027-31.

Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: A study of 535 eases observed in a 5o-year period. Surg. 1992;112(6):1139-47.

Tourniaire J, Bernard MH, Bizollon-Roblin MH, Bertholon-Gregoire M, Berger-Dutrieux N. Papillary microcarcinoma of the thyroid. 179 cases reported since 1973. Presse medicale (Paris, France: 1983). 1998;27(29):1467-9.

Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clini Endocrinol Metabolism. 2002;87(5):1941-6.

Lupoli G, Vitale G, Caraglia M, Fittipaldi MR, Abbruzzese A, Tagliaferri P, et al. Familial papillary thyroid microcarcinoma: a new clinical entity. Lancet. 1999;353(9153):637-9.

Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, et al. Thyroid gland tumor diagnosis at US elastography. Radiol. 2005;237(1):202-11.

Goldstein RE, Netterville JL, Burkey B, Johnson JE. Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules. Annals Surg. 2002;235(5):656-64.

Tyler DS, Winchester DJ, Caraway NP, Hickey RC, Evans DB. Indeterminate fine needle aspiration biopsy of the thyroid: identification of subgroups at high risk for invasive carcinoma. Surg. 1994;116:1054-60.

Sclabas GM, Staerkel GA, Shapiro SE, Fornage BD, Sherman SI, Vassillopoulou-Sellin R, et al. Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients. Am J Surg. 2003;186(6):702-10.

Haugen BR, Woodmansee WW, McDermott MT. Towards improving the utility of fine‐needle aspiration biopsy for the diagnosis of thyroid tumours. Clini Endocrinol. 2002;56(3):281-90.

Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Annals Internal Med. 1993;118(4):282-9.

McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A. Follicular or Hu ̈rthle cell neoplasm of the thyroid: Can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surg. 1999;126(4):798-804.

Kelman AS, Rathan A, Leibowitz J, Burstein DE, Haber RS. Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens. Thyroid. 2001;11(3):271-7.

Mehrotra A, Goel MM, Singh K. Ki-67 and AgNOR proliferative markers as diagnostic adjuncts to fine needle aspiration cytology of thyroid follicular lesions. Analytical Quantitative Cytolo Histolo. 2002;24(4):205-11.

Ohta K, Endo T, Onaya T. The mRNA levels of thyrotropin receptor, thyroglobulin and thyroid peroxidase in neoplastic human thyroid tissues. Biochem Biophysical Resea Commu. 1991;174(3):1148-53.

De Micco C, Chrestian MA, Gros N, Ruf J, Carayon P, Henry JF. Immunohistochemical study of thyroid peroxidase in normal, hyperplastic, and neoplastic human thyroid tissues. Cancer. 1991;67(12):3036-41.

Giuffrida D, Gharib H. Controversies in the management of cold, hot, and occult thyroid nodules. Am J Med. 1995;99(6):642-50.

Leenhardt L, Hejblum G, Franc B, Du Pasquier Fediaevsky L, Delbot T, Le Guillouzic D, et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clini Endocrinol Metabolism. 1999;84(1):24-8.

Lin JD, Chao TC, Huang BY, Chen ST, Chang HY, Hsueh C. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology. Thyro. 2005;15(7):708-17.

Tan GH, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Annals Internal Med. 1997;126(3):226-31.

Hegedüs L. The thyroid nodule. N Engl J Med. 2004;351(17):1764-71.

Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Annals Inter Med. 2005;142(11):926-31.

Davis NL, Gordon M, Germann E, Robins E, McGregor GI. Clinical parameters predictive of malignancy of thyroid follicular neoplasms. Am J Surg. 1991;161:567-9.

McCleod MK, Thompson NW. Hürthle cell neoplasms. Otolaryngol Clin North Am. 1990;23:441-52.

Layfield LJ, Reichman A, Bottles K, Giuliano A. Clinical determinants for management of thyroid nodules by fine needle aspiration cytology. Arch Otolaryngol Head Neck Surg. 1992;118(7):717-21.






Original Research Articles