The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid: A multi-institutional study in 6 Asian countries

Shipra Agarwal, Andrey Bychkov, Chan Kwon Jung, Mitsuyoshi Hirokawa, Chiung Ru Lai, Soon Won Hong, Hyeong Ju Kwon, Samreung Rangdaeng, Zhiyan Liu, Peng Su, Kennichi Kakudo, Deepali Jain

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Abstract

Background: Hürthle cell-rich nodules (HCNs) encompass non-neoplastic to malignant lesions. There is paucity of literature on the frequency distribution of HCNs among Bethesda categories, histologic follow-up, risk of malignancy (ROM), and risk of neoplasia (RON). The objective of this retrospective, multi-institutional study was to determine the prevalence of the cytologic diagnostic category and surgical outcomes of patients with HCN. Methods: Nine tertiary health centers representing 6 Asian countries participated. Cases were retrieved from respective databases. The Bethesda System for Reporting Thyroid Cytopathology was used. Cytology results were correlated with surgical diagnoses. Results: Of 42,190 thyroid aspirates retrieved, 760 (1.8%) had a Hürthle cell predominance. Most (61%) were categorized as atypia of undetermined significance/follicular lesion of undetermined significance, Hürthle cell type” (AUS-H); 35% were categorized as follicular neoplasm, Hürthle cell type (FN-H); and 4% were categorized as suspicious for malignancy (SFM). Histologic follow-up was available for 288 aspirates (38%). Most were benign on resection (66%), and the most common histologic diagnosis was Hürthle cell adenoma (28.5%). The ROM for AUS-H, FN-H, and SFM, as calculated on resected nodules, was 32%, 31%, and 71%, respectively; and the RON was 47%, 81%, and 77%, respectively. The 5 institutions that had an AUS-H:HCN ratio below 0.5 diagnosed HCN less frequently as AUS-H than as FN-H. Conclusions: This is the largest, contemporary, multi-institutional series of HCNs with surgical follow-up. Although there was wide interinstitutional variation in prevalence and surgical outcomes, there was no significant difference in the ROM among institutions. The categories AUS-H and FN-H had a similar ROM for resected nodules.

Original languageEnglish
Pages (from-to)181-191
Number of pages11
JournalCancer Cytopathology
Volume127
Issue number3
DOIs
Publication statusPublished - 2019 Mar

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Thyroid Gland
Neoplasms
Adenoma
Cell Biology
Databases
Health

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Agarwal, Shipra ; Bychkov, Andrey ; Jung, Chan Kwon ; Hirokawa, Mitsuyoshi ; Lai, Chiung Ru ; Hong, Soon Won ; Kwon, Hyeong Ju ; Rangdaeng, Samreung ; Liu, Zhiyan ; Su, Peng ; Kakudo, Kennichi ; Jain, Deepali. / The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid : A multi-institutional study in 6 Asian countries. In: Cancer Cytopathology. 2019 ; Vol. 127, No. 3. pp. 181-191.
@article{22189f0875994bf59c04cf1046f37ea2,
title = "The prevalence and surgical outcomes of H{\"u}rthle cell lesions in FNAs of the thyroid: A multi-institutional study in 6 Asian countries",
abstract = "Background: H{\"u}rthle cell-rich nodules (HCNs) encompass non-neoplastic to malignant lesions. There is paucity of literature on the frequency distribution of HCNs among Bethesda categories, histologic follow-up, risk of malignancy (ROM), and risk of neoplasia (RON). The objective of this retrospective, multi-institutional study was to determine the prevalence of the cytologic diagnostic category and surgical outcomes of patients with HCN. Methods: Nine tertiary health centers representing 6 Asian countries participated. Cases were retrieved from respective databases. The Bethesda System for Reporting Thyroid Cytopathology was used. Cytology results were correlated with surgical diagnoses. Results: Of 42,190 thyroid aspirates retrieved, 760 (1.8{\%}) had a H{\"u}rthle cell predominance. Most (61{\%}) were categorized as atypia of undetermined significance/follicular lesion of undetermined significance, H{\"u}rthle cell type” (AUS-H); 35{\%} were categorized as follicular neoplasm, H{\"u}rthle cell type (FN-H); and 4{\%} were categorized as suspicious for malignancy (SFM). Histologic follow-up was available for 288 aspirates (38{\%}). Most were benign on resection (66{\%}), and the most common histologic diagnosis was H{\"u}rthle cell adenoma (28.5{\%}). The ROM for AUS-H, FN-H, and SFM, as calculated on resected nodules, was 32{\%}, 31{\%}, and 71{\%}, respectively; and the RON was 47{\%}, 81{\%}, and 77{\%}, respectively. The 5 institutions that had an AUS-H:HCN ratio below 0.5 diagnosed HCN less frequently as AUS-H than as FN-H. Conclusions: This is the largest, contemporary, multi-institutional series of HCNs with surgical follow-up. Although there was wide interinstitutional variation in prevalence and surgical outcomes, there was no significant difference in the ROM among institutions. The categories AUS-H and FN-H had a similar ROM for resected nodules.",
author = "Shipra Agarwal and Andrey Bychkov and Jung, {Chan Kwon} and Mitsuyoshi Hirokawa and Lai, {Chiung Ru} and Hong, {Soon Won} and Kwon, {Hyeong Ju} and Samreung Rangdaeng and Zhiyan Liu and Peng Su and Kennichi Kakudo and Deepali Jain",
year = "2019",
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doi = "10.1002/cncy.22101",
language = "English",
volume = "127",
pages = "181--191",
journal = "Cancer cytopathology",
issn = "1934-662X",
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Agarwal, S, Bychkov, A, Jung, CK, Hirokawa, M, Lai, CR, Hong, SW, Kwon, HJ, Rangdaeng, S, Liu, Z, Su, P, Kakudo, K & Jain, D 2019, 'The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid: A multi-institutional study in 6 Asian countries', Cancer Cytopathology, vol. 127, no. 3, pp. 181-191. https://doi.org/10.1002/cncy.22101

The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid : A multi-institutional study in 6 Asian countries. / Agarwal, Shipra; Bychkov, Andrey; Jung, Chan Kwon; Hirokawa, Mitsuyoshi; Lai, Chiung Ru; Hong, Soon Won; Kwon, Hyeong Ju; Rangdaeng, Samreung; Liu, Zhiyan; Su, Peng; Kakudo, Kennichi; Jain, Deepali.

In: Cancer Cytopathology, Vol. 127, No. 3, 03.2019, p. 181-191.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid

T2 - A multi-institutional study in 6 Asian countries

AU - Agarwal, Shipra

AU - Bychkov, Andrey

AU - Jung, Chan Kwon

AU - Hirokawa, Mitsuyoshi

AU - Lai, Chiung Ru

AU - Hong, Soon Won

AU - Kwon, Hyeong Ju

AU - Rangdaeng, Samreung

AU - Liu, Zhiyan

AU - Su, Peng

AU - Kakudo, Kennichi

AU - Jain, Deepali

PY - 2019/3

Y1 - 2019/3

N2 - Background: Hürthle cell-rich nodules (HCNs) encompass non-neoplastic to malignant lesions. There is paucity of literature on the frequency distribution of HCNs among Bethesda categories, histologic follow-up, risk of malignancy (ROM), and risk of neoplasia (RON). The objective of this retrospective, multi-institutional study was to determine the prevalence of the cytologic diagnostic category and surgical outcomes of patients with HCN. Methods: Nine tertiary health centers representing 6 Asian countries participated. Cases were retrieved from respective databases. The Bethesda System for Reporting Thyroid Cytopathology was used. Cytology results were correlated with surgical diagnoses. Results: Of 42,190 thyroid aspirates retrieved, 760 (1.8%) had a Hürthle cell predominance. Most (61%) were categorized as atypia of undetermined significance/follicular lesion of undetermined significance, Hürthle cell type” (AUS-H); 35% were categorized as follicular neoplasm, Hürthle cell type (FN-H); and 4% were categorized as suspicious for malignancy (SFM). Histologic follow-up was available for 288 aspirates (38%). Most were benign on resection (66%), and the most common histologic diagnosis was Hürthle cell adenoma (28.5%). The ROM for AUS-H, FN-H, and SFM, as calculated on resected nodules, was 32%, 31%, and 71%, respectively; and the RON was 47%, 81%, and 77%, respectively. The 5 institutions that had an AUS-H:HCN ratio below 0.5 diagnosed HCN less frequently as AUS-H than as FN-H. Conclusions: This is the largest, contemporary, multi-institutional series of HCNs with surgical follow-up. Although there was wide interinstitutional variation in prevalence and surgical outcomes, there was no significant difference in the ROM among institutions. The categories AUS-H and FN-H had a similar ROM for resected nodules.

AB - Background: Hürthle cell-rich nodules (HCNs) encompass non-neoplastic to malignant lesions. There is paucity of literature on the frequency distribution of HCNs among Bethesda categories, histologic follow-up, risk of malignancy (ROM), and risk of neoplasia (RON). The objective of this retrospective, multi-institutional study was to determine the prevalence of the cytologic diagnostic category and surgical outcomes of patients with HCN. Methods: Nine tertiary health centers representing 6 Asian countries participated. Cases were retrieved from respective databases. The Bethesda System for Reporting Thyroid Cytopathology was used. Cytology results were correlated with surgical diagnoses. Results: Of 42,190 thyroid aspirates retrieved, 760 (1.8%) had a Hürthle cell predominance. Most (61%) were categorized as atypia of undetermined significance/follicular lesion of undetermined significance, Hürthle cell type” (AUS-H); 35% were categorized as follicular neoplasm, Hürthle cell type (FN-H); and 4% were categorized as suspicious for malignancy (SFM). Histologic follow-up was available for 288 aspirates (38%). Most were benign on resection (66%), and the most common histologic diagnosis was Hürthle cell adenoma (28.5%). The ROM for AUS-H, FN-H, and SFM, as calculated on resected nodules, was 32%, 31%, and 71%, respectively; and the RON was 47%, 81%, and 77%, respectively. The 5 institutions that had an AUS-H:HCN ratio below 0.5 diagnosed HCN less frequently as AUS-H than as FN-H. Conclusions: This is the largest, contemporary, multi-institutional series of HCNs with surgical follow-up. Although there was wide interinstitutional variation in prevalence and surgical outcomes, there was no significant difference in the ROM among institutions. The categories AUS-H and FN-H had a similar ROM for resected nodules.

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U2 - 10.1002/cncy.22101

DO - 10.1002/cncy.22101

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JF - Cancer cytopathology

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