Help deciphering ultrasound and FNA biopsy results, please

[nervous986]

I am a 31-year-old female with a solitary thyroid nodule about 4cm large.  I recently had an ultrasound and FNA biopsy performed and would appreciate a second opinion/explanation of my cytology results.  My endocrinologist has recommended a hemithyroidectomy and placed the odds that it is cancer at about 50%.  The report was as follows:

Thyroid function test was normal.  Thyroid ultrasound showed 3.97 cm x  1.84 cm APx 2.67 cm complex solid  isoechoic thyroid nodules with irregular margins, halo and Grade II vascularity on Color Flow Doppler.   Nodule appears to be a solid structure with 6-7 cystic small nodules within.
No pathologic lymph nodes were seen.   FNA was performed.
          
Cytology showed Follicular lesion of undetermined significance. There are numerous groups of bland follicular cells with nuclear crowding and nuclear overlap. Scant/absent colloid material is worrisome; however no diagnostic neoplastic features are present. Close follow-up with repeat FNA is recommended. There are greater than 20 groups of follicular cells identified.  

Although it was not mentioned in the report, my doctor also told me during the biopsy that there were calcifications present.

I'm also wondering whether, if her estimation of about 50% probability of malignancy is accurate, would there be any reason to go straight for a total thyroidectomy in order to avoid two surgeries?  My ultrasound report seemed to have an awful lot of red flags which, combined with the FNA results, have me extremely concerned.

[898_1]

Your nodule has 20 % chance of malignancy based on the information provided.
The result is “indeterminate”
(Isoechoic nodule, normal lymph nodes, halo around the nodule are suggesting benign process)
Nuclear overlapping is commonly found among the people exposed to nuclear radiation damage, but is NOT indication of cancer.
Bland follicular cells with nuclear crowding can be present in follicular thyroid tumors (both benign and malignant)
If calcifications are present they should be identified and listed on ultrasound report.
If you have time please take a look on this article:
http://www.jultrasoundmed.org/content/23/11/1455.full
“Internal vascularity by color Doppler flow examination was ranked for each nodule on a scale of 0 through 4, in the order of increasing flow. A score of 0 was defined as no internal flow. Internal flow rates constituting approximately 25% or less, 26% to 50%, 51% to 75%, and greater than 75% on color Doppler cross-sectional imaging were assigned grades of 1 through 4, respectively. The grade of internal blood flow as determined by color Doppler analysis was not a statistically significant criterion to suggest benign or malignant disease in this study”
Recommendation: have ultrasound images and biopsy slides to be reviewed by second specialist for second opinion. If results still the same, either repeat the test of review Afirma testing option

[Red_Star]

Hyperechoic solid nodule - 5% chance of being malignant
Isoechoic solid nodule - 25% (follicular and medullary)
Hypoechoic solid nodule - 65% (anaplastic and lymphoma)