Current dilemmas in the diagnosis and management of follicular thyroid tumors

ABSTRACT

Follicular carcinoma (FTC) is a relatively uncommon type of differentiated thyroid carcinoma. Guidelines have often dealt with FTC and papillary thyroid cancer as a single disease. Over the last decade, however, a better understanding of these two types of thyroid cancer indicates that they cannot be analysed together.

Neither ultrasonography nor fine-needle aspiration cytology can provide a clear distinction between FTC and follicular adenoma. New molecular diagnostic techniques may be used to identify a subpopulation of follicular neoplasms with a low probability of being malignant.

Diagnostic surgery—usually hemithyroidectomy- is recommended for most thyroid follicular lesions without a certain preoperative diagnosis. If FTC is diagnosed most—perhaps not all- patients will require a completion thyroidectomy.

While widely invasive FTC usually does not pose diagnostic or therapeutic doubts, consensus on the diagnosis of non-invasive follicular lesions is still lacking.

Prognosis of FTC is mostly dependent on local invasion and distant metastasis that, in turn, correlate with tumor size.

KEYWORDS:

• Thyroid cancer
• follicular
• management
• Bethesda IV
• pathology

Declaration of interest

M. Renard received a research grant and took part in the CITHY study sponsored by Diaxonhit (France). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.