Figure 2-4. Fine-needle aspiration biopsy of a follicular neoplasm demonstrating numerous microfollicular structures and an absence of colloid (May-Grunwald/Giemsa stain; x20 original magnification).

from benign FA (Figure 2-4). This is because the cytology obtained from FNAB of an FTC may be identical to that obtained from an FA, and the diagnosis of malignancy is based on the presence of capsular or vascular invasion on histologic examination of the surgical specimen (Figure 2-5). FNAB may yield one of four results (Figure 2-6): benign, malignant, suspicious, or insufficient yield. The management strategy may be summarized as follows: if the lesion is benign, the patient may be put on thyroxine (T4) therapy to suppress TSH to a level just below normal, or the patient may simply be followed for evidence of growth or obstructive symptoms. If the lesion is malignant (PTC), the patient is referred for surgery. If the finding is suspicious for follicular or Hürthle cell

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