Article
Do Benign Thyroid Nodules Have Malignant Potential? An Evidence-Based Review
Nimmi Arora,
Theresa Scognamiglio,
Baixin Zhu,
Thomas J. Fahey III,
Nimmi Arora
Department of Surgery, New York Presbyterian Hospital-Cornell University, 1300 York Avenue, 10065 New York, NY, USA
Search for more papers by this authorTheresa Scognamiglio
Department of Pathology, New York Presbyterian Hospital-Cornell University, 10065 New York, NY, USA
Search for more papers by this authorBaixin Zhu
Department of Surgery, New York Presbyterian Hospital-Cornell University, 1300 York Avenue, 10065 New York, NY, USA
Search for more papers by this authorCorresponding Author
Thomas J. Fahey III
Department of Surgery, New York Presbyterian Hospital-Cornell University, 1300 York Avenue, 10065 New York, NY, USA
New York Presbyterian Hospital-Cornell University, 525 East 68th Street, Room F-2024, 10065 New York, NY, USA
[email protected]Search for more papers by this authorNimmi Arora,
Theresa Scognamiglio,
Baixin Zhu,
Thomas J. Fahey III,
Nimmi Arora
Department of Surgery, New York Presbyterian Hospital-Cornell University, 1300 York Avenue, 10065 New York, NY, USA
Search for more papers by this authorTheresa Scognamiglio
Department of Pathology, New York Presbyterian Hospital-Cornell University, 10065 New York, NY, USA
Search for more papers by this authorBaixin Zhu
Department of Surgery, New York Presbyterian Hospital-Cornell University, 1300 York Avenue, 10065 New York, NY, USA
Search for more papers by this authorCorresponding Author
Thomas J. Fahey III
Department of Surgery, New York Presbyterian Hospital-Cornell University, 1300 York Avenue, 10065 New York, NY, USA
New York Presbyterian Hospital-Cornell University, 525 East 68th Street, Room F-2024, 10065 New York, NY, USA
[email protected]Search for more papers by this authorAbstract
Background
Benign thyroid tumors account for most nodular thyroid disease. Determination of whether a thyroid nodule is benign or malignant is a major clinical dilemma and underlies the decision to proceed to surgery in many patients. Although the accuracy of thyroid nodule fine-needle aspiration (FNA) has reduced the need for surgery over the years, questions regarding how to follow FNA-designated benign nodules remain unresolved. This is true at least in part because of uncertainty over whether some benign nodules harbor malignant potential.
Methods
An evidence-based review of recent clinical, pathologic, and molecular data is presented. A summary of data and observations from our own experience is also provided.
Results
Review of our recent 10-year experience indicates that 2% of thyroid malignancies arise within a preexisting benign thyroid nodule. In addition, both cytologic and molecular tumor markers, including Gal-3, CITED1, HBME-1, Ras, RET/PTC, and PAX8/PPARγ, have been identified in some histopathologically classified benign nodules. Gene expression profiling suggests that follicular adenomas and Hürthle cell adenomas have similarities to both benign and malignant tumors, suggesting that some of these tumors are premalignant. In addition, 10% of surgically excised follicular tumors are encapsulated follicular lesions with nuclear atypia, which have been termed “well-differentiated tumors of uncertain malignant potential.” The data available suggest that these tumors could be precursors to carcinoma.
Conclusion
Some benign thyroid nodules have malignant potential. Further molecular testing of these tumors can shed light on the pathogenesis of early malignant transformation.
References
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