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A 30-year-old member asked:

My thyroid nodule fna came back as "benign follicularadenoma." i thought follicular growths had to be examinedthrough surgery. are these results accurate?

4 doctor answers9 doctors weighed in
Dr. Bac Nguyen
Family Medicine 23 years experience
Adenoma = ok: Most thyroid adenomas are actually follicular in nature and adenomas are benign, but carcinoma is not. So the fna confirms that it is adenoma and not carcinoma! most adenomas can be managed by watchful waiting (without surgical excision) with regular monitoring--periodic ultrasound and possible repeat of fna etc..Consult doc if u are still concerned. Good luck.
Dr. Michael Zadeh
General Surgery 17 years experience
You are right: A thyroid fna can only tell you whether follicular cells are present. It cannot tell you whether the specimen is an adenoma or carcinoma. You need to have the involved lobe removed so the pathologist can examine the entire thing. Based on the results, a total thyroidectomy may be needed.
Dr. Bac Nguyen
Dr. Bac Nguyen commented
Family Medicine 23 years experience
Dear Dr. Zadeh: I respectfully disgree that FNA sample cannot tell whether the cells are adenoma vs carcinoma. That is the point of FNA biopsy: to determine cancerous vs benign lesion. Yours, Bac X. Nguyen, MD
May 13, 2012
Dr. Michael Zadeh
General Surgery 17 years experience
Provided original answer
Dear Dr. Nguyen: FNA can differentiate papillary, medullary, and anaplastic carcinomas from adenomas. However follicular carcinoma requires identification of invasion of the basement membrane in order to differentiate it from a follicular adenoma. This is usually done through a core biopsy or surgical lobectomy after the findings on FNA
Dec 11, 2012
Dr. Eric Whitman
Surgical Oncology 36 years experience
Gray area: Thyroid fna can be difficult for a pathologist, on the limited sample, to be confident that the nodule is benign. For that reason, the pathology report may leave open the possibility that it is either benign or malignant. There is no absolute right or wrong, and it can depend on the experience and decisiveness of the examining pathologist.
Dr. Barry Kahn
Pathology 31 years experience
Difficult to say....: "benign follicular adenoma" is not a typical diagnosis from a fna. You are absolutely correct that follicular neoplasms need to be pathologically examined through complete surgical excision to differentiate adenoma from carcinoma. It often involves examining the entire periphery of the nodule under the microscope, a feature that cannot be evaluated by fna.

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Last updated Nov 6, 2016

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