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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 46942
Experience:  Board Certified Oncologist
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male 52 yrs old 1.8cm well differentiated single nodule

Resolved Question:

male
52 yrs old
1.8cm well differentiated single nodule of thyroid
FNA TEST RESULT= Follicular Neoplasm
Surgeon advises removal of right gland but I m not so sure there is sufficient evedence to consider surgery? Is there another path to follow? i would have expected another FNA test an perhaps monitoring the nodule with ultra sound over the next 6 to 12 months to see any changes?
your advice please?
Submitted: 3 years ago.
Category: Oncology
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

the biopsy shows a follicular thyroid cancer.

Dr. David :

the best treatment is thyroid surgery.

Dr. David :

you can also take super high doses of radioactive I-131 iodine to destroy the whole thyroid gland with radioactive iodine.

Dr. David :

but this method guarnatees that you will need to take oral thyroid hormones for the rest of your life.

Dr. David :

if you have just 1/2 of your thyroid gland removed, you could still have a normal 1/2 thyroid which will produce thyroid hormone for you.

Dr. David :

why don't you want to have thyroid surgery?

Customer:

it was follicular neoplasm result on fna ...not follicular carcinoma?

Customer:

(FNA) diagnosis of "follicular neoplasm" does not differentiate between a benign and malignant tumor.

Dr. David :

neoplasm is another way of saying cancer.

Dr. David :

or carcinoma.

Dr. David :

neoplasm is a malignant cancer.

Customer:

yes but .....(FNA) diagnosis of "follicular neoplasm" does not differentiate between a benign and malignant tumor.

Customer:

The diagnosis "follicular neoplasm" is indeterminate, and the majority of cases (70% in the current study) are benign. However, clinical features, including gender, nodule size, and age, can be a part of the decision analysis in selecting patients for surgery.

Customer:

i guess its a decision only i can make

Customer:

i thought you couldhave cleared this up ...never mind!

Dr. David :

I am trying to help you clear it up

Dr. David :

you can talk to the pathologist who read your biopsy report.

Dr. David :

I am a cancer doctor

Dr. David :

I read these biopsy reports all the time.

Dr. David :

there is no benign follicular neoplasm in the thyroid gland.

Dr. David :

the pathologist is using it as a term for malignant cancer.

Dr. David :

if you have doubts, call up the pathologist who read your biopsy report.

Dr. David :

I'm sure the pathologist will clarify it for you.

Dr. David :

I will be that they mean it is a malignant thyroid cancer.

Dr. David :

these follicular thyroid cancers are slow growing and have very high cure rates with surgery like a hemithyroidectomy.

Customer:

no its not as i spoke with the surgeon today...perhaps in the uk it is different terminology?

Customer:

this is important

Customer:

The diagnosis "follicular neoplasm" is indeterminate, and the majority of cases (70% in the current study) are benign. However, clinical features, including gender, nodule size, and age, can be a part of the decision analysis in selecting patients for surgery.

Customer:

pls read it

Customer:

he clearly tol me the only way to determine if it is cancer or benign is to remove it and send to path/

Dr. David :

well, then I would follow his recommendations

Customer:

however the percentage is 75% bengn 25% cancer

Dr. David :

and have the surgery to know for sure

Dr. David :

or else you will continue to worry.

Dr. David :

why did they do the biopsy if the biopsy can't tell anything for sure?

Dr. David :

FNA biopsies have a good accuracy rate of knowing what the nodule is if read by a experienced cytopathologist.

Customer:

from a FNA test there are 3 possible readings

Customer:

cancer

Customer:

not cancer

Customer:

follicular neoplasm/indeterminate

Customer:

and also 50% of population will have a thyroid nodule

Customer:

95% will be benign

Customer:

these are resons to not consider surgery

Dr. David :

I worked in a thyroid nodule clinic

Dr. David :

we saw 6-10 patients each 2 weeks with thyroid nodules.

Dr. David :

every nodule larger than 1cm was biopsied.

Dr. David :

nodules larger than 1cm in size have a 20% chance of being malignant thyroid cancer.

Customer:

yes

Dr. David :

the most common thyroid cancers are well behaved like a papillary or follicular cancer which have high cure rates with surgery.

Customer:

thats what he said

Dr. David :

90-99% cure rates.

Dr. David :

good.

Dr. David :

in the USA, the word neoplasm means malignant cancer.

Customer:

yesi thought it was a terminology

Customer:

my dilema is do i opt for surgery or not given i feel amazing and have absolute no health issues at all

Dr. David :

thyroid cancer will not cause health issues or symptoms.

Dr. David :

the idea is to catch these cancers early and cut them out.

Dr. David :

I have also treated patients with metastatic papillary or follicular thyroid cancers

Customer:

are you also a surgeon?

Dr. David :

when they have spread.

Dr. David :

that is not any fun.

Dr. David :

I am a radiation oncology doctor.

Dr. David :

I am a cancer specialist.

Dr. David :

I am not a surgeon.

Dr. David :

but I work with surgeons and radiologist and pathologist to diagnose these cancers.

Customer:

do you not feel it necesarry to have another fna test? i have had one test onlt and that it!

Customer:

so i guess there is no other option then?

Dr. David :

I bet the second FNA test wills how the same thing as this one.

Dr. David :

I would call up the pathologist.

Dr. David :

an FNA when read correctly has a 80-90% chance of knowing if it is malignant or benign.

Dr. David :

if malignant, you need the surgery

Dr. David :

to be cured of this thyroid cancer.

Dr. David :

you don't want to live worrying about this nodule.

Dr. David :

and the possibility of it spreading.

Customer:

yes when i had the fan trst done the operator complained that it was in a very awkward place and that the result may prove inconclusive?

Dr. David :

well the results Follicular Neoplasm does not sound inconclusive to me.

Customer:

pls read this

Customer:

The thyroid fine-needle aspiration (FNA) diagnosis of "follicular neoplasm" does not differentiate between a benign and malignant tumor. Often cases diagnosed as "follicular or Hürthle-cell neoplasm" undergo surgical excision for further characterization. The aim of this study was to identify clinical features that may help in predicting malignancy in patients with an FNA diagnosis of follicular neoplasm. One hundred eighty-four cases in 167 patients were diagnosed as "follicular neoplasm" among 1,024 thyroid FNA evaluated with on-site interpretation from 1998-2000. The cases were evaluated for the following variables: histologic diagnosis, age, sex, and size of the nodule. One hundred thirty-nine patients were female, and 28 were male (age range, 23-80 yr). Among 122 patients (67%) undergoing surgical excision (lobectomy, 96; total thyroidectomy, 26), malignancy was identified in 37 cases (31%). Nonpapillary (follicular/Hürthle) carcinoma was diagnosed in 11 (9%), follicular variant of papillary carcinoma in 25, and medullary carcinoma in 1 case. The risk of malignancy was greater in males (47% vs. 29%, P < 0.0004) than females, in nodules measuring 3 cm or more (55% vs. 23%, P < 0.0001), than in nodules measuring less than 3 cm, and in patients 40 or more yr old (20% vs. 10%, P = 0.0001) than in patients younger than 40 years. The diagnosis "follicular neoplasm" is indeterminate, and the majority of cases (70% in the current study) are benign. However, clinical features, including gender, nodule size, and age, can be a part of the decision analysis in selecting patients for surgery.

Copyright 2002 Wiley-Liss, Inc.

Dr. David :

http://www.ncbi.nlm.nih.gov/pubmed/17968160

Dr. David :

FNA can miss 1/3 of all thyroid cancers.

Customer:

i guess having follicular neoplasm is like living with a time bomb

Dr. David :

Analysis of the data reveals that the sensitivity of FNA ranges from 65% to 98% (mean, 83%), and specificity ranges from 72% to 100% (mean, 92%) (11,20,26). The predictive value of a positive or suspicious cytologic result is approximately 50%. The overall accuracy for cytologic diagnosis approaches 95% (Table 1).

Table 1. Summary Data From Literature Survey on Thyroid FNA*














































Feature Mean Range Definition
Sensitivity, % 83 65-98 Likelihood that patient who has disease has positive test results
Specificity, % 92 72-100 Likelihood that patient without disease has negative test results
Positive predictive value, %75 50-96Fraction of patients who have positive test who have disease
False-negative rate, % 5 1-11 FNA negative; histology positive for cancer
False-positive rate, % 5 0-7 FNA positive; histology negative for cancer
FNA, fine-needle aspiration.*From AACE/AME Task Force on Thyroid Nodules (2). Used with permission.
Dr. David :

FNA have a high chance of predicting what is there.

Dr. David :

I would have the surgery because I would not want to live with an known neoplasm in my thyroid gland.

Customer:

yes i understand you

Customer:

the irony is dr my wife is in right now, this is her second operation

Customer:

crazy isnt it

Customer:

so my turn next!!

Customer:

she has exact same except heres was multinodular aand 5cm

Customer:

its not cancer thank god

Customer:

the surgeon wants me in next week but ill have to postpone as i need to take care of my wife first

Dr. David :

I see.

Dr. David :

best of luck to you and your wife.

Dr. David :

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Dr. David :

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Dr. David :

is my webpage if you need to reach me again with other questions.

Dr. David :

thanks for using justAnswer.com

Customer:

thankyou and i hope you didnt mind me being a bit direct :)

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