# FNA "gray" area (papillary cancer is not excluded)



## kagealy (Aug 2, 2011)

I'm wondering if anyone has any information on how they determine if you are in-between benign and malignant (suspicious for cancer)?

I read on one site, that if you have 3 or less of the cellular traits for cancer you are determined to be benign. 5 or more is determined malignant. And 4 is the unknown?
I found this on a pathology website and I'm not sure if I understood it correctly.

Here is my FNA:
Atypia of undetermined significance. Moderately cellular specimen containing numerous sheets of somewhat atypical follicular cells sometimes in a microacinar and sometimes in a papillary configuration. Some powdery chromatin and rare nuclear inclusions. Some colloid is also seen. A papillary carcinoma is not excluded.

U/S: 1cm hypoechoic vascular nodule with calcification.

Blood work is normal.

Surgery on 9/28 to find out if it's cancer or not.

Anyone have experience with being in the "suspicious for cancer" catagory?
Thank you for sharing!


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## lainey (Aug 26, 2010)

It's usually called "indeterminate"--the pathologist feels it could go either way.

Do I read correctly that the nodule sampled was 1cm? If so part of the problem would be the small nodule size. It is difficult to get a good sampling of cells from a nodule that is of smaller size.

Because of the small sample size of a FNA, it is sometimes difficult to tell what a larger sample would show--that can only be done on removal of the gland with a full pathology from samples from different areas.

Did you have other nodules? Are they just removing the lobe with the nodule or the whole thyroid?


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## Andros (Aug 26, 2009)

kagealy said:


> I'm wondering if anyone has any information on how they determine if you are in-between benign and malignant (suspicious for cancer)?
> 
> I read on one site, that if you have 3 or less of the cellular traits for cancer you are determined to be benign. 5 or more is determined malignant. And 4 is the unknown?
> I found this on a pathology website and I'm not sure if I understood it correctly.
> ...


It is suspicious because it cannot be excluded. I am glad you are having the surgery.


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## kagealy (Aug 2, 2011)

Thank you for your responses.

Yes, 1 cm is very small to get a good sample from. Maybe that's the issue? It's so nerve racking to be in this gray area!

I only have 1 nodule on the left side and a cyst on the right side.

When I have surgery, they will remove the left side and do a frozen section while I'm under. If it comes back as cancer they will remove the right side right then.

If I wake up and they still don't know and have to send the whole thing to the lab, I will go crazy! But, I guess I will final know!


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## Octavia (Aug 1, 2011)

kagealy, your FNA results are similar to mine, and your surgery plan is similar to whan mine was. My FNA was suspicious but inconclusive. Had to have surgery. The frozen section was not definite for cancer, so they closed me up after a hemithyroidectomy. In my case, it did turn out to be cancerous after all (the full sample is much better and more accurate than the frozen section...they probably explained all of that to you), so I had to have the completion thyroidectomy. Good times.


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## kagealy (Aug 2, 2011)

Thank you all for your posts. 
Well, surgery is tomorrow so we will see if they can figure out if it's cancer or not.
Octava, so you had to have 2 thyroid surgeries? That's what I'm afraid of! Not just the 2 surgeries, but waking up and still not knowing the answer!
I will post my results when I can!

Keri


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## CLRRN (Jun 22, 2011)

Hey Keri,
I know today is your surgery day. Hope you're doing well. My FNA was vague for follicular so when I woke up, I still didn't know because unlike papillary, they can't read a frozen section of the nodule because they needed the entire nodule.
Either way...you will get through it....if you need 2 surgeries your support group will be here cheering you on!!!

Let us know how you are doing.

Chris


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