Thyroid FNA suspicious for malignancy. Should I be worried?

Hi,

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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 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 cancers and is usually curable. The cytology study is not always 100%, and we always try to be careful so as not to miss anything important. Diagnosis appears to be well done.

I would also suggest surgery or a biopsy for confirmation. Do meet your treating surgeon for a further opinion.

I hope this information helps you.

Thank you.

Hi,

Welcome back 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 node involvement as seen now (otherwise they would have tested it also if present), it should be an early stage and excision or removal of the thyroid alone might be adequate. Staging cannot be done without confirmation of diagnosis.

First, get the biopsy or surgery done. Once the pathologist's report confirms it, then the next decision can be made. If nothing is there, then not to worry. If it is papillary carcinoma of the thyroid, then still nothing to worry about, as it is easily curable. Going by the report, it is probably cancer. Do meet your doctor at the earliest.

Thank you.

Hi,

Welcome back to icliniq.com.

Based on your query, my opinion is as follows. Goiter, by definition, is the enlargement of the thyroid. Over time, the degenerative changes or progression to cancer may occur. This is one of the reasons the reporting pathologist is not confident enough to confirm it as a malignancy (positive for malignancy) and has called it suspicious.

The degenerative change can mimic cancer at times. Hard to comment and hence, the biopsy is necessary. Yes, it might be just a colloid goiter with degenerative changes. However, if it were 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.

Thank you.

Hi,

Welcome back to icliniq.com.

Overlapping cells in a cluster and nuclear enlargement are not the usual features of goiter. It is called a honeycomb pattern, just sheets without nuclear size or cell size variation, and with some colloid. The absence of colloid is usually viewed seriously, and especially with nuclear features characteristic of possible carcinoma, a biopsy is advised. It is not easy to think of possible cancer when it has mostly appeared as a benign goiter in the past one and a half years. I suggest you get a biopsy done.

Feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

I had gone through the reports (attachments removed to protect the patients' identity). The image is partial and not scanned completely. Please do upload a complete image.

Thank you.

Hi,

Welcome back to icliniq.com.

I had gone through the reports (attachments were removed to protect the patient's identity). According to reports, it is a multifocal papillary thyroid carcinoma. Four focuses have been found, and the largest of 0.2 inches has been ablated. Radioiodine therapy is rarely necessary for these situations, as it is decided on a case-by-case basis.

As there is no lymphatic spread, it is not risky. Multifocal papillary thyroid carcinoma of the size of 0.2 inches sometimes requires radioiodine therapy. However, it will vary in each case depending on the treating doctor. If your doctor insists, there might be a reason for it as the conditions are present at borderline - below 0.2 inches and single focus, no radioiodine therapy necessary. Above 0.2 inches or multifocal (>5 foci), radioiodine therapy is necessary.

As I told you earlier, this carcinoma has the best prognosis, as there is no spread beyond the thyroid. Follow-up is needed for a year or two to rule out recurrence.

I hope this information helps you.

Feel free to reach out in case of further queries.

Thank you.