Please translate this FNA report

[gertfrobe]

I have a small solitary solid nodule on my thyroid and have a history of thyroid cancer in family (brother had papillary and is now fine).  FNA is inconclusive and I'm about to see a surgeon but would like to have some understanding of my report before I go if possible.  It says:

Moderately cellular specimen consisting of numerous sheets and three dimensional clusters of follicular epithelial cells, some with a microfollicular arrangement with scanty colloid and abundand background partially obscuring blood.

Impression: Follicular Lesion, Favor Neoplasm.

Does this sound likely to be cancerous?  And in situations like this, is surgery to determine whether this is malignant typically the best option or should I perhaps have a second FNA?

[gertfrobe]

Thanks again.  That helps a lot.

[898_1]

It is always a very good idea to seek the second opinion!

[898_1]

No, I am not M.D:)
Neoplastic nodule is the other name for  follicular neoplasm.
Based on the biopsy findings: 1) very little (scant) colloid AND 2)microfollicular arangements [in sheets] the nodule was considered neoplastic - follicular neoplasm.
Most doctors agreed that the nodule with such findings should be surgically removed with lobe, to determine if it is cancerous or it is follicular adenoma (not cancer). So far only post-surgical testing can determine that. According to statistics, about 83% of removed neoplasms are adenomas, and 17% is cancer.

[gertfrobe]

Thanks for reply but I'm still really confused.  Are you saying it sounds like I have a non-neoplastic nodule or that it does not sound like one?   As for the "abundant background", I also found that a bit incomplete sounding but that's exactly what it says on my report.  

A few other questions -

- for a a follicular neoplasm is removal of the lobe always the next step or is a second FNA biopsy a worthwhile (if I were trying be conservative) approach?

- you mention that 83% of neoplastic nodules are benign.  Any idea what % of follicular neoplasms are benign?

- for my curiosity, are you an MD?  

Thanks again.  I appreciate it.

[898_1]

The diagnose: follicular neoplasm had been made based on the results
1)Microfollicular arrangement vs loose cells or MACRO follicular arrangement  in non-neoplastic nodule
2)Scant colloid vs abundant colloid in colloid nodule.
Sometimes the specimen is contaminated by blood; the blood tends to displace colloid in the sample, leading in some cases to the wrong diagnostics. In some rare cases non neoplastic nodules show microfollicular pattern WITH abundant colloid.
the phrase: "abundand background (of what??) partially obscuring blood" sounds incomplete to me.
About 83 % of neoplastic nodules are non-cancerous, but if nodule invades thyroid capsule, it considered cancerous. This can be determined only after the lobe, containg nodule is removed and examined. Best of luck.

[froggy0936]

When I had my FNA it was because I also had a small nodule and biopsy came back as "follicular neoplasm." So, due to the fact that my sister just went through follicular cancer and dr found that I also had Hashi"s he advised me to have TT just to be safe. As I also had kidney cancer before, as well. The surgeon disagreed with the endo as far as removing the whole thyroid but I didn't want to go through 2 surgeries as my sister did. They removed half of hers and the path report came back cancer, so she had to have the other half removed a week later. So, I had my TT on 12/17/09 and my report was that it was such a tiny spot of cancer...the surgeon said 1 in 4 people were probably walking around with it and didn't even know. To late though now as thyroid is gone. I suppose it was the best choice in case it would have grown or spread because then I would have had to have RAI as my sister did. I lucked out in that way. I will tell you that being without a thyroid takes alot of time and patience getting adjusted to med that you will be on the rest of your life. I suppose once they have your dose tweeked to where it needs to be that you will feel fine. As I said though, I'm still not where I need to be and it's very frustrating. You don't know how much that little gland controls! But considering that I didn't want to take even a chance of anymore cancer, I know I made the right choice. Get a 2nd opinion if you must or are unsure because once it's gone...it's gone and it is a very difficult thing to get used to. Best wishes. Make sure you have a good endo! Let me know how things are going for you!  Lynda xoxo.