FNA results.......not sure if this is good or bad ???

[rmpc98]

Hi Dr. Lupo,
I'm trying to decipher my FNA thyroid biopsy results and am a little confused ......here is what the report said

" The smear contains blood, little colloid material, rare macrophages and several groups of follicular cells showing no evidence of malignancy (specifically, no features of papillary carcinoma are observed).  Most of the groups show relatively well preserved honeycomb architecture.  Rare groups show features consistent with reparative changes.  Overall, these are features of cellular follicular lesion, and the differential diagnosis includes benign lesions (nodular hyperplasia or follicular adenoma) and malignant (follicular carcinoma).  Considering the size of the lesion (4.2 x2.2 x 3.0 cm), local excision should be considered for definitive purposes".

I've read some information about follicular lesions and how diagnostically it is difficult to differentiate btw the benign and malignant kind.  I'm not sure if the report is good or bad and now feel no further in the diagnosis.  I have been referred to a head and neck specialist and am currently awaiting that appointment.  Dr. Lupo, if you could help explain these results, it would be greatly appreciated.  Thanks in advance for your assistance.  

[Mark Lupo, M.D.]

Would send the slides to an expert -- this report pretty much says it could be benign or malginant...ie non-commital and not helpful.  There is a classification system that should be used that commits the pathologist - I don't see any diagnostic category.

I would think this a benign nodule with some cystic degenerative features (macrophages and reparative features) - however there are some who argue anything above 4cm should be removed b/c FNA is less accurate. In our experience and in the experience of the Mayo clinic, this is not the case --- but there is disagreement in the field.

So in summary, this sounds benign but would consider sending the slides to an expert (Dr. Massoll at Arkansas or Dr Baloch at U Penn for example or mayo clinic etc).
If you are having any symptoms (choking, etc) due to the mass (nodule) that would be another reason to consider removing it.

[rmpc98]

Hi Dr. Lupo,
I was totally unaware of the existence of thyroid nodule prior to my annual physical exam.  However, now that I am aware of it, I do feel a choking sensation at times.  I've also had some pain in the left clavicle region which alarms me as I'm not sure if it is related to the nodule or not.

I've included a copy of my ultrasound report and would appreciate your review of the results:  
  
" There is a large complex lesion occupying essentially the entire right lobe of the thyroid gland.  Lesion measures 4.2 x 2.2 x 3.0 cm and is predominantly solid and heterogenous with minor cystic component.  Vascular flow is present within it.  No suspicious calcifications are identified.  No additional thyroid abnormalities are identified on either side and overall size of the gland is not enlarged, with isthmus measuring 3 mm, the right lobe 4.6 x 2.8 x 3.0 and the left lobe 4.5 x 1.3 x 1.5 cm.  No lymphadenopathy."

Thanks again for your help!