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Q. Please explain my thyroid FNA report.

Answered by
Dr. Prakash H. Muddegowda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 11, 2017 and last reviewed on: Apr 21, 2021

Hi doctor,

Please find the attachments of my thyroid FNA report. The result showed suspicious of malignancy. I hope you explain to me further. Thanks in advance.

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#

Hi,

Welcome to icliniq.com.

Based on your query and attached reports (attachment removed to protect patient identity), my opinion is as follows:

  • Yes, the report does say suspicious for malignancy. When sometimes, we are not 100% sure or if there is overlap with benign or normal findings, we do report it as suspicious for malignancy.
  • In these circumstances, we advise biopsy or surgery for confirmation as we do not want any cancer to be missed.
  • Looking at the findings, it most likely appears to be papillary carcinoma of the thyroid. If it is the case, it has the best prognosis amongst all thyroid cancer and is usually curable.
  • The cytology study is not always 100%, and we always try to be careful as not to miss anything important. Diagnosis appears to be well done. I would also suggest surgery or biopsy for confirmation. Do meet your treating surgeon for a further opinion.

For further information consult a pathologist online --> https://www.icliniq.com/ask-a-doctor-online/pathologist

Thank you doctor,

I would like to understand more, please. You are telling that there is a high chance to be cancer. In which stage it is? Why the report not shown as cancer? Is there any possibility that it could be benign?

#

Hi,

Welcome to icliniq.com.

  • Yes, there is a very low possibility that it could be benign. However, a biopsy is necessary for confirmation.
  • If we diagnose it as cancer and as there is no lymph nodes involvement as seen now (otherwise they would have tested it also if present), it should be early stage and excision or removal of thyroid alone might be adequate.
  • Staging cannot be done without confirmation of diagnosis.
  • First, get the biopsy or surgery done. Once pathologist report confirms it, then the next decision can be made. If nothing is there, then not to worry. If it is papillary carcinoma of thyroid, then still nothing to worry as it is easily curable.
  • Going by the report, it is probably cancer. Do meet your doctor at the earliest.

For further information consult a pathologist online --> https://www.icliniq.com/ask-a-doctor-online/pathologist

Hi doctor,

I had three ultrasounds in the last 18 months but different hospitals. All show thyroid goiter, except the last ultrasound, which I sent to you. If I do have thyroid goiter, will that reflect on the biopsy findings?

#

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

  • Goiter by definition is enlargement of the thyroid. Over time, the degenerative changes or progression to cancer may occur. This is one of the reason, the reporting pathologist is not confident enough to confirm it as malignancy (positive for malignancy) and has called it as suspicious.
  • The degenerative change can mimic cancer at times. Hard to comment and hence, the biopsy is necessary. Yes, it might be just colloid goiter with degenerative changes. However, if it were to be cancer, then early identification is helpful.
  • Yes, if surgery is done, it might be a colloid goiter. Depends on the amount of degeneration, which could be mimicking cancer. Do get the biopsy done. Hopefully, it is goiter.

For further information consult a pathologist online --> https://www.icliniq.com/ask-a-doctor-online/pathologist

Thanks doctor, but question is even with overlapping cluster and enlargement of nucleus etc, could it be goiter?? Is goiter have same specfcation?? And who they decide after surgery and disnguitsh?? Sorry for so many question? But I really rely on you best regards
# Hi,
Thanks for asking again.
Sorry for the delay. Based on your query, my opinion is as follows:

Overlapping cells in cluster and nuclear enlargement is not the usual features of goiter. We call it as honey comb pattern, just sheets and without nuclear size or cell size variation and with some amount of colloid.
Absence of colloid is usually viewed seriously and especially with nuclear features classical of possible carcinoma, we do advise biopsy.
You can always ask questions, as you need to be 100% sure about the next step. Not easy to think of a possible cancer, when mostly it appear benign goiter in the past 1.5 years.

Do get a biopsy done.

Hope it helps.
Any further queries, here to help again.
Dear Doctor , pls find the attachments, pls explain to me fruther and let me is the cauterized really can not treat with idoine?? Best regards Ahmed
# Hi,
Thanks for asking.

The image is very much partial and not been scanned completely. Difficult to opine. Please do upload a complete image.

Thank you.
--file attached--
# Hi,
Thanks for sending the reports.
Based on reports and query, my opinion is as follows:

1. It is multifocal papillary thyroid carcinoma. Four focus have been found and the largest of 0.5cm has been ablated.
2. Radioiodine therapy is rarely necessary in these situations as it is decided on case to case basis. As there is no lymphatic spread, it is not risky. Multifocal papillary thyroid carcinoma of size of 0.5cm sometimes require radioiodine therapy. However, as I told you it is a case to case basis based on treating doctor.
3. If your doctor insists, there might be a reason for it as the conditions at present are at best borderline. Below 0.5 cm and single focus, no radioiodine therapy necessary. Above 0.5cm or multifocal (>5 foci), radioiodine therapy necessary.

As I told you earlier, this carcinoma has best prognosis and as there is no spread beyond thyroid, there is nothing much to worry. Follow-up needed for a year or two to rule out recurrence.

Hope it helps.
Any further queries, here to help again.

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