What are suspicious or indeterminate results?

When the results of a thyroid fine needle biopsy are called suspicious or indeterminate, it means that no definite answer can be drawn about whether the nodule is cancer or not. Even though a sufficient number of cells exists for examination in such biopsies, the nature of the cells simply does not permit a definite answer. One out of five biopsies (20%) fall into this category. Only one out of five nodules with indeterminate findings (20%) ultimately prove to be cancer; four out of five (80%) are benign. There are several categories of indeterminate biopsy findings: follicular neoplasms, Hurthle cell neoplasms, and atypical hypercellular samples. In the most common category, the follicular neoplasm, the only way to know if the nodule is cancer or not is to see whether the thyroid cells have pushed through (invaded or penetrated) the fibrous capsule around the nodule or have spread to enter blood vessels. Unfortunately, these are characteristics that cannot be seen on fine needle biopsy specimens and can only be revealed when the entire nodule is removed. Further biopsies are seldom helpful in patients who have had one indeterminate biopsy. Even a benign subsequent biopsy does not take away the fact that some of the cells are suspicious. Since patients with indeterminate biopsy findings do have a chance their nodule is cancer, the majority are advised to undergo surgery to remove one or both lobes of the thyroid. In a few patients who have other reassuring aspects to their case, or in patients with other serious medical illness that make them poor candidates for surgery, observation is a less desirable but necessary alternative.

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