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'Atypical' Needle Biopsy .. Are there Statistics for % that a...
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'Atypical' Needle Biopsy .. Are there Statistics for % that are actually Cancer

when examined either during surgery or after final report is received?

The pathologist told me 17% of Atypical Thyroid Nodules go on to become Cancerous if not cancer now and I've read online stats showing 33% of all those atypical FNA biopsies actually are deemed cancer upon partial or total thyroidectomy.

I've been told 95% are benign and another ENT told me 90-95% are benign and the Endocronologist didn't talk stats but prepared me of the total protocol for treatment if it is cancerous.

My nodule was found upon routine exam and is 1.7cm solid growth.

The pathology report states: Atypical Follicular Cells Present in a Background of Goiter.  The pathologist did a physical exam after viewing my slides and was positive I had atypical cells without a doubt and strongly recommended having 1/2 the thyroid removed .. this is the right lobe and it contains another nodule that is .5cm which he didn't biopsy as he said I must have the surgery so no need to biopsy it.

I am a healthy 47 yr old woman with a strong history for other atypical cells in the way of moles that are not melanoma but atypical and re-excised to the margin, atypical colon polyp, and atypical urtethrial cells that are inflammatory in nature and not bladder/renal cancer (they are from many many kidney stones along with a condition known as MSK which is medullary sponge kidney and they are stuck in the medullary of the kidney .. I am followed by a world-reknowned kidney stone specialis in NY City with excellent care, etc.)

My surgery is scheduled for Nov 9th.

Cheryl
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Not sure this is what you want or answers your question.

More than 90 percent of all thyroid nodules are not cancerous
Benign. This means your nodule is not cancerous. Approximately 70% of nodules will come back benign.
Malignant. This means your nodule is cancerous. Approximately 5 % of suspicious nodules will be malignant.
Suspicious. This means diagnosis wasn't conclusive, but there was possible cancer.
Inconclusive. If the sampling wasn't sufficient, a diagnosis might be difficult. In this case, an additional biopsy might be recommended.

Federal resource Cancer of the Thyroid
http://www.4women.gov/statistics/

Fast Stats: Thyroid Cancer http://seer.cancer.gov/faststats/sites.php?site=Thyroid+Cancer&stat=Definitions

THYROID CANCER (Invasive). Percent Diagnosed With Cancer In 10, ... For additional detailed cancer statistics by state, please visit the State Cancer ...http://72.14.253.104/search?=cache:Q3GEnnPJds8J:seer.cancer.gov/csr/1975_2002/results_merged/sect_26_thyroid.pdf+Statistics+in+percentage+for+thyroid+Cancer&hl=en&gl=us&ct=clnk&cd=11

Cancer statistics, 2004
http://cancerres.aacrjournals.org/cgi/content/full/65/11/4716


utahmomma might be more helpful
and/or;
You can address your question, if its thyroid related issue, to:
Mark Lupo, M.D. at "The Thyroid Disorder Forum" Medhelp
click on the title at top of page,  or
http://www.medhelp.org/forums/thyroid/wwwboard.html
It might take a few days for the doctor to answer, so be patient and keep checking in.

Good Luck!


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158939_tn?1274918797
Two words stand out which are concerning  
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168348_tn?1379360675
Thank you both so much for the detailed posts + links to do further reading.  OOOPS .. I had a typo.  The surgery is January 9th.  The surgeon did a scope thru my nose to be certain there was no internal involvement and all 3 Dr's I've seen + my Primary Dr. feel confident Jan. is okay.  The surgeon is booked with 3 thryoid cancer patients and then going away in Dec and I appreciated his honesty in never wanting to overbook but I am the type that would have it out tomorrow to be rid of any risk!

The gameplan is 1/2 the thyroid on the table and if the path results come back + for cancer the whole thyroid will be removed at the same time.

I have a very small node (2mm) on the left side but all professionals at this point say they don't want to zap it as the risks outweigh the benefits of surgical removal if no cancer is shown on the other side while I'm in surgery.

Atypical = suspicious I believe.  The pathologist assured me he captured an excellent catch and was clearly positive of his atypical findings.  So that ruled out indeterminate borderline atypical just to come up with a diagnosis .. he said it was clearly atypical.

I, too read that follicular is more aggressive than papillary.

The first surgeon I met with was so non-chalant it made me VERY upset when I left the office.  He wanted to wait and see and said, "there are only a few atypical cells found!" .. then went on to say, "some others have waited 6 mos via serial ultrasound and, yes, they had cancer & it came with regret but no further spread of the cancer!!".  Geez, what is his problem?  I could be that person!

Yes, the Endocronologist mentioned the radioactive pills and body scan to see if any thyroid cells spread elsewhere and spoke of lifelong meds.  She said the 1/2 thyroid should be ok w/o supplements but we'll continue to monitor afer the surgery.

My Urologist wants kidney stone bloodwork panel done, too, as he said the parathyroids can be injured during surgery and/or go wacko after the surgery and affect my kidney stones.  

I have no family history at all .. I am so sorry you and your sisters and daughter have had to endure this .. my dad passed away 17 yrs ago from pancreatic cancer.

So bottom line it looks like the stats are all over the place as far as % of atypicals being cancer at final biopsy .. the am't of all nodes being cancerous seems consistent across the board but great variations among the websites for actual funky cells to prove cancerous.

I have the e-mail of my pathologist and I was thinking of e-mailing him with my ? .. he seemed to know the 17% mark of atypicals remaining to turn cancerous right off the bat.

That morning of my FNA they told me the first lady of the day was cancerous, the second was benign, and mine atypical.  It was done at a large Breast Cancer center in the cytodiagnostic area with immediate results.

To top things off .. I had a gallbladder attack last night .. first time in 2 ys.  It goes to prove that Stress does play a very imp. part in our health .... It was a 5 on a scale of 1-10.  I think I forgot to tell you ladies I have gallstones, too ... slipped my mind as they've been "asymptomatic" until this thyroid stuff all started .... it's been on/off small symptoms of gas and pain b/t the shoulders that would come and go and then last night a true attack but thankfully it went away after 45mins and I am fine now.  I threw a stone during a C-Section in 1998 .. they said it was gas and to relax .. then I doubled over the next day .. gas my foot --> the ultrasound showed gallstones!  But it settled down for many yrs.

I laugh and say we'd be rich if we could sell our stones (kidney/gallbladder and thyroid nodules) on e-bay << wink wink >>.

Cheryl

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158939_tn?1274918797
Wow - gallbladder problems too.  Congratulations, you just became an honorary member of my family!  :-)  Oh, and from what I can find, my family is RARE - only one of two that I know of that has a lot of papillary carcinoma in it.  The other family is in Europe somewhere - probably relatives though :-).  We are even in a research study because this type of cancer is not supposed to be hereditary.

Did you eat anything excessively greasy last night or anything with chocolate that may have set the gallbladder off?  My mother, two of my sisters, and I have all had the gallbladder thing.  My mother and my baby sister had bad gallbladder problems during pregnancies.  It cost my mother her only son when the gallbladder became infected from a stone that wouldn't pass (this was nearly 40 years ago) and threw her into early labor.  My sister had her baby in the morning and emergency gallbladder surgery in the afternoon.

Ahhh, the human body - what fun.

It sounds like you have a good gameplan for your thyroid - 1/2 in surgery then if pathology is positive take the entire little monster out and toss it across the OR!  That works.  Thyroid exorcism.  :-)

It wouldn't hurt to email your doctor.  You have the right to have all your questions addressed because this is kind of important!  Are you going with the nonchalant surgeon or have you found another one you like better?  Mine was awesome - that's why my entire family went to her.  She has the looks and personality of a college cheerleader but she is amazing with a scalpel.  The nice thing is she will come into your room and sit on the bed and talk to you all you want before and after surgery.  We made her an honorary sister.  :-)  I did talk to A LOT of doctors who had known her since her internship and they all agreed she was an amazing surgeon - having a personality was just a bonus.

Everyone I've personally known who has gone through thyroid surgery DID have problems directly after with calcium (parathyroid issues).  Apparently those pesky parathyroids are very touchy about being disturbed.  Good idea to check your panels if you have kidney stones (ouch!).

I'm liking your eBay suggestion.  Wonder if I could get some of my organs back to sell . . . hmmmmm.  :-)

Hang in there.  It sounds like you are on top of it.
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168348_tn?1379360675
"We are even in a research study because this type of cancer is not supposed to be hereditary."

Yes, the key words are "not supposed to" .. I love it!
~~~~~~~~~~~~~~~~~~~~

"Did you eat anything excessively greasy last night or anything with chocolate that may have set the gallbladder off? "

YES YES YES ... it happened 1 hr after eating a fried chicken sandwich thing from Wendy's .. the SNACK SIZE no less.  And, I don't usually eat the fried stuff .. not a health nut but good cholesterol and not always eating fried things so this did me in good!!!

~~~~~~~~~~~~~~~~~~

"Are you going with the nonchalant surgeon or have you found another one you like better? "

No Way .. I live too close to NY City to settle no matter what .. the surgeon I chose has all the qualities you mentioned about yours, too.  He apologized for running late, didn't end my appt early or abruptly and his staff was top notch!  Both this Dr. and the Pathologist are in Top Doctor Magazine which was reassuring, too.  The pathologist recommended him to me.  Only thing is that he isn't in the "boyz club" in that my primary dr. doesn't have attending rights at this hospital but that is the least of my worries.  Hope he isn't offended but HE sent me to the hospital for the biopsy in the first place bcz of better pathologists!!!

~~~~~~~~~~~~

"Everyone I've personally known who has gone through thyroid surgery DID have problems directly after with calcium (parathyroid issues). Apparently those pesky parathyroids are very touchy about being disturbed. Good idea to check your panels if you have kidney stones (ouch!)."

This is good to know & I bet my Uro knew it .. he is affiliated with the hospital that you ladies suggested I do reading with .. Columbia .. The Thyroid Center, etc.  UGH.  My MSK diagnosis is a defect in the tiny tubes and the urine tends to pool and, thus, more at risk to form stones.  They are stuck in the kidney deep inside and not moving anywhere ... the largest is only 4mm but it is enough to always have blood in urine when tested, etc. and give those atypical cells.  I had an IVP X-ray (with dye) that found the MSK when they were looking for a tumor in the ureters or kidney to be certain no cancer with those atypical cells.  HAve had cystoscopes, too and all normal!!!! YEAH bcz Renal Cancer is NOT one you want to have.

~~~~~~~~~~~~~~~~~~~~~~
Hang in there. It sounds like you are on top of it.

I Am so so so so glad I found this board .. WOW!!!!!!!! I feel soooooo good already and not so alone!!!!!!

Thanks :)  Cheryl
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158939_tn?1274918797
My sisters and I all joke that we are so hollow you get us together on a windy day we could sound like a pipe organ.  Welcome to our recital!

It's nice that you have such a good selection of doctors.  The selection here (Salt Lake) is pretty good in most specialties but there are others on this forum who live in rural areas are have NO selection.  I guess you and I are some of the lucky ones!

I passed a large gall stone about a month after delivering my second child.  Thought I was going to die!  The ultrasound showed a clear gallbladder but a VERY dilated bile duct with scaring and blood.  That one was out of the blue.  When I finally had my gallbladder removed years later it was after about two years of non-stop problems and pain.  I had developed "sludge" and nothing was moving through there.  Apparently my family has what's called "hereditary spherocytic hemolytic anemia" - fancy term for small, sphere-shaped red blood cells that get caught in the liver and clog up your gallbladder.

Hmmm . . . hereditary "non hereditary" thyroid cancer, weird blood cells, gallbladder problems . . . I swear - my ancestors needed to venture a little further from the village when looking for mates!!!  :-)

Sounds like you are in good hands and have an entire team of top-notch professionals around you to make sure you get the best possible care!  Keep us all posted - what a great way to ring in the New Year by saying goodbye to the thyroid and its "atypical" cells!
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168348_tn?1379360675
I just read this blurb from Aetna on a site about the recurrence of gallstone attacks .. fits me to a "T" as I mentioned in my post I've been asymptomatic for 2yrs now until last night ...

~*~*~*~*~*~*~*~*~*

Expected Duration

Smaller gallstones sometimes float out of the gallbladder on their own and are eliminated from the body through the intestines. Gallstone attacks also can calm down on their own if the bothersome stones shift position within the gallbladder.

However, the majority of people whose gallstones cause symptoms will require surgery to cure the problem and will continue to have symptoms until the gallbladder is removed.

Even when gallstone attacks subside on their own, the symptoms will return within two years 70% of the time.

~*~*~*~*~*~*~*~*~*~*~*

So that makes me feel better LOL .. I fit into the 70% of the time with repeat symptoms .... :0 .......

Cheryl

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You don't pass gall stones thats the problem. They usually build up in the gall bladder and can cause infection. Result...Gall Bladder attack. Yes you can see Kidney stones(if you can feel it you can see it. My physician had me urinate into something that resembles a coffee filter to catch the stones for evaluation. They can be cause by calcium, cholesterol or sometimes from unknown reasons.
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We have similar stories. I too had biopsy with atypical cells seen in the background of a goiter(Favored hyperplastic nodule), I also had my gall bladder removed due to an attack, and have had kidney stones twice in the past three years. My husband kids around and calls me a sicko.  He says how can one person have so much wrong with them. He never has any health issues the lucky duck. I had a repeat biopsy approx. two weeks ago and it came back as benign. I was a little uncomfortable because it wasn't the usual Endo I see. He was away on vacation so I had to see the other physician in his office. I will be seeing him the first week of Dec. I have found I have come up with a lot of questions for him. I have a nodule that I can feel in my throat. It gives me the sensation of a pill swallowed the wrong way. They can't treat it with meds because my thyroid levels are normal. From what I read there isn't much success in shrinking nodules anyway. I still see my thyroid coming out sometime in the near future. You definitly need to keep us updated on how you make out. Best of Luck Marla 13
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168348_tn?1379360675
How do you know if you pass a gallstone?  I had very loose stools and heartburn 24hrs before I had this "attack" and it started with a knife searing sharp pain in my intestinal area like I was being cut up by a kidney stone but in my belly area moreso than my bladder or ureters .. so I think I'm safe to say a good sized one came down and out .. I have stoneS in my bladder per the CT scans ... didn't venture on size as the CT scans were for the kidney stones ..

I woke up this AM very tender and sore to the morning up and around as well as to the touch in the gallbladder area but now I'm ok ... so I know for certain it was gallstone.

Do you actually see a stone (sorry so graphic) in the toilet?  

I can tell you all about kidney stone findings in the water but gallstones are a new breed for me.

Thanks for allowing me the time to talk gallstones on the thyroid board .......the gallstones get caught in the middle on both this board and my kidney stone board ROTFLOL .... they are an "aside" :)

Yes, your ancestors caused all your current issues .. hee hee hee .. blame it all on them .. that is a good, safe idea!!!!

My bloodwork all came back normal .. the Endo called yesterday so this is good baseline info to draw upon after the surgery if comparisons are ever needed.

C~
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168348_tn?1379360675
I e-mailed the pathologist.  Here is his response regarding the % of atypical thyroid nodule FNA's that go on to be cancer upon removal.

~~~~~~~~~~~~~~~~~~~~~~~~

"Hi. I trayed to answer 3 time and my computer crashes on spellcheck.

30% chances of a tumor .3% of a malignant tumor.

Good luck"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Those sound like very very good odds to go into surgery with.  

I mentioned in my e-mail to him that the %'s are all over the place online and was really curious more than anything.  

(For anybody reading this, pls keep in mind this response was directly related to my nodule and the fine needle biopsy I had done by the same pathologist who gave this response so I am not sure if it applies to all atypical findings, etc.)

C~
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We have similar stories. I too had biopsy with atypical cells seen in the background of a goiter(Favored hyperplastic nodule), I also had my gall bladder removed due to an attack, and have had kidney stones twice in the past three years. My husband kids around and calls me a sicko.  He says how can one person have so much wrong with them. He never has any health issues the lucky duck. I had a repeat biopsy approx. two weeks ago and it came back as benign. I was a little uncomfortable because it wasn't the usual Endo I see. He was away on vacation so I had to see the other physician in his office. I will be seeing him the first week of Dec. I have found I have come up with a lot of questions for him. I have a nodule that I can feel in my throat. It gives me the sensation of a pill swallowed the wrong way. They can't treat it with meds because my thyroid levels are normal. From what I read there isn't much success in shrinking nodules anyway. I still see my thyroid coming out sometime in the near future. You definitly need to keep us updated on how you make out. Best of Luck Marla 13
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158939_tn?1274918797
I didn't know I passed a gallstone.  I didn't know WHAT was wrong with me.  I was rushed to the hospital and they ran all kinds of labs on me.  They saw the dilated bile duct, scarring, and blood on an ultrasound and a nuclear medicine scan.  I seriously thought I was going to die.  

I didn't know I had a stone.  Just out of the blue I had a sharp, searing pain that dropped me to my knees (so bad I couldn't breathe) followed by uncontrolled vomiting (mostly blood and bile).

Back to the thyroid - I'm glad you were able to get some answers from your pathologist.  All the more reason to get it out.  Please keep us posted!!
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168348_tn?1379360675
Yes, just the word "tumor" says goodbye to 1/2 of the thyroid.  I just with the surgery wasn't until January but I have the holidays in between to keep me busy.  I'm the kind of person who just needs to have things done with and move forward .. this lingering in mid-space is the worst but I'm doing ok since I have my "ducks in a row" now and also bcz I've found this board!!!!!

Have a wonderful Thanksgiving to all if those reading live in the US.

Cheryl
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171867_tn?1271047748
Hi there,

I am new at this just found this site I am scheduled to have my right thyroid removed march 5th and am very scared I have a large nodule on the right lobe with a cyst and a slightly smaller nodule on the left , my right nodule is suspicious for follicular neoplasm  and the left is benign by FNA I had these test done at the Mayo Clinic here in AZ twice in two months two different docs and FNA biopsys. Has anyone had this surgery how did it turn out I am scared of the possibilty of cancer, has anyone been through this or is going thru the same thing it would be great to hear some advice. THX :)
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