Follicular Neoplasm/Suspicious for a Follicular Neoplasm

  • Michael R. Henry
  • Richard M. DeMay
  • Katherine Berezowski


There has been great variability in the way thyroid aspirates that are suspicious for a follicular neoplasm have been reported, as demonstrated by a review of the literature compiled for the NCI-sponsored State of the Science Conference in 2007. The terminology used has ranged from broad terms like “follicular lesion,” “follicular proliferation,” and “indeterminate” to the more specific terms like “rule out/suggestive of/suspicious for follicular neoplasm” to the definitive “follicular neoplasm.” Much of this variability results from the fact that the so-called “follicular lesions,” comprised of nodular goiter (nodular hyperplasia), follicular adenoma, and follicular carcinoma, have overlapping cytomorphologic features and cannot be accurately distinguished by fine needle aspiration (FNA) alone. Nevertheless, certain cytologic features are very useful in raising the possibility of a neoplasm, most importantly the possibility of a follicular carcinoma. In this regard, FNA can be considered a screening test, selecting for surgery those nodules with a greater probability of malignancy. The final diagnosis depends upon lobectomy because capsular and/or vascular invasion are the sine qua non of follicular carcinoma.


Papillary Thyroid Carcinoma Fine Needle Aspiration Papillary Carcinoma Parathyroid Adenoma Follicular Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Baloch ZW, LiVolsi VA, Asa SL, et al. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008;36(6):425-37.CrossRefPubMedGoogle Scholar
  2. 2.
    Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Int Med. 1993;118:282-9.PubMedGoogle Scholar
  3. 3.
    Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306-15.CrossRefPubMedGoogle Scholar
  4. 4.
    Deveci MS, Deveci G, LiVolsi VA, Baloch ZW. Fine-needle aspiration of follicular lesions of the thyroid Diagnosis and follow-Up. Cytojournal. 2006;3:9.CrossRefPubMedGoogle Scholar
  5. 5.
    Baloch ZW, Fleisher S, LiVolsi VA, Gupta PK. Diagnosis of “follicular neoplasm”: a gray zone in thyroid fine-needle aspiration cytology. Diagn Cytopathol. 2002;26(1):41-4.CrossRefPubMedGoogle Scholar
  6. 6.
    Yang GC, Liebeskind D, Messina AV. Should cytopathologists stop reporting follicular neoplasms on fine-needle aspiration of the thyroid? Cancer. 2003;99(2):69-74.CrossRefPubMedGoogle Scholar
  7. 7.
    Greaves TS, Olvera M, Florentine BD, et al. Follicular lesions of thyroid: a 5-year fine-needle aspiration experience. Cancer. 2000;90(6):335-41.CrossRefPubMedGoogle Scholar
  8. 8.
    Guidelines of the Papanicolaou Society of Cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Diagn Cytopathol 1996;15(1):84-9.Google Scholar
  9. 9.
    Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-16.CrossRefPubMedGoogle Scholar
  10. 10.
    Wang HH. Reporting thyroid fine-needle aspiration: literature review and a proposal. Diagn Cytopathol. 2006;34(1):67-76.CrossRefPubMedGoogle Scholar
  11. 11.
    Schlinkert RT, van Heerden JA, Goellner JR, et al. Factors that predict malignant thyroid lesions when fine-needle aspiration is “suspicious for follicular neoplasm”. Mayo Clin Proc. 1997;72(10):913-6.CrossRefPubMedGoogle Scholar
  12. 12.
    Kelman AS, Rathan A, Leibowitz J, Burstein DE, Haber RS. Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens. Thyroid. 2001;11(3):271-7.CrossRefPubMedGoogle Scholar
  13. 13.
    Elsheikh TM, Asa SL, Chan JK, et al. Interobserver and intraobserver variation among experts in the diagnosis of thyroid follicular lesions with borderline nuclear features of papillary carcinoma. Am J Clin Pathol. 2008;130(5):736-44.CrossRefPubMedGoogle Scholar
  14. 14.
    Renshaw AA, Wang E, Wilbur D, Hughes JH, Haja J, Henry MR. Interobserver agreement on microfollicles in thyroid fine-needle aspirates. Arch Pathol Lab Med. 2006;130(2):148-52.PubMedGoogle Scholar
  15. 15.
    Suen KC. How does one separate cellular follicular lesions of the thyroid by fine-needle aspiration biopsy? Diagn Cytopathol. 1988;4:78-81.CrossRefPubMedGoogle Scholar
  16. 16.
    Stelow EB, Bardales RH, Crary GS, et al. Interobserver variability in thyroid fine-needle aspiration interpretation of lesions showing predominantly colloid and follicular groups. Am J Clin Pathol. 2005;124(2):239-44.CrossRefPubMedGoogle Scholar
  17. 17.
    Clary KM, Condel JL, Liu Y, Johnson DR, Grzybicki DM, Raab SS. Interobserver variability in the fine needle aspiration biopsy diagnosis of follicular lesions of the thyroid gland. Acta Cytol. 2005;49(4):378-82.PubMedGoogle Scholar
  18. 18.
    Goldstein RE, Netterville JL, Burkey B, Johnson JE. Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules. Ann Surg 2002;235(5):656–662; discussion 62-4.Google Scholar
  19. 19.
    Layfield LJ, Abrams J, Cochand-Priollet B, et al. Post-thyroid FNA testing and treatment options: a synopsis of the National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Diagn Cytopathol. 2008;36(6):442-8.CrossRefPubMedGoogle Scholar
  20. 20.
    Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16(2):109-42.CrossRefPubMedGoogle Scholar
  21. 21.
    Gharib H, Papini E, Valcavi R. et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006;12(1):63-102.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Michael R. Henry
    • 1
  • Richard M. DeMay
    • 2
  • Katherine Berezowski
    • 3
  1. 1.Department of Laboratory Medicine and PathologyMayo Clinic and FoundationRochesterUSA
  2. 2.Department of PathologyUniversity of ChicagoChicagoUSA
  3. 3.Department of PathologyVirginia Hospital CenterArlingtonUSA

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