Follicular Cells Cancer??

[ceegee]

Hi.  I posted a couple of weeks ago about having a FNA biopsy on two lesions on my thyroid.  I had it on August 14 and there were people from pathology there to be sure the doctor had obtained enough cells to evaluate.

However the diagnosis was not benign or malignant.  My endo said there were follicular cells and they could be benign or malignant, that they look the same.  He said the only way to rule out malignancy is to take half the thyroid out and look at the blood vessels while I am still knocked-out.  If it is malignant they would take the whole thing out, if benign they would leave the rest in.

Does this sound right?  I go back on August 31 to discuss this with him and hopefully the surgeon.  Are there any questions I should ask?  Would a second opinion be warranted?  I don't want to go through surgery if there is another way.

Thanks for your answer.

[Mark Lupo, M.D.]

Hmmm..  It sounds partially correct.  You have what we call a follicular lesion based on your description.  Some studies suggest that about 20% of these are malignant.  The only way to know if it's cancer is surgery.  HOWEVER, the frozen section (intra-operative look at the mass) cannot distinguish malignant and benign lesions -- unless there are features of papillary cancer.  That means if only half the thyroid comes out and it turns out malignant, the other half will come out on subsequent surgery.

The problem is that there is no other test to distinguish benign vs malignant.  There has been a few reports using ultrasound blood flow measurements (high vascularity more likely malignant).  

Surgery is the best option.  The question is taking the whole thyroid at once vs just half.....

[roa]

My diagnosis sounds pretty much like yours.  I had a total thyroidectomy on Sept. 7., as I had nodules on both sides of the thyroid and the center, as well.

[ceegee]

What were your results?  Benign I hope. : )

[lara1228]

I recently had an FNA on a thyroid nodule and my results were similar to yours as well.  My doctor recommended surgery as this is the only sure way to tell if it has malignancy.  So basically the ball is in my court.  As an aside, this is the third doctor who recommended surgery on this nodule.  Two of them recommended surgery before even having the biopsy.  I would rather not have surgery, but I think that it will be the only way to give me piece of mind knowing that the thing is out.   I hope that things work out for you.

[ceegee]

I hope so for you too.  My surgeon told me there wasn't any real rush to have the surgery, but since I already have had one diagnosis of cancer three years ago, I didn't want to wait.  But it does seem like a lot to go through just to determine malignancy or not.

Good luck with your decision, and I wish benign results for you.