Follicular thyroid cancer diagnostic study of choice: Difference between revisions

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==Overview==
==Overview==
According to the American Joint Committee on Cancer (AJCC)<ref> Stage Information for Thyroid Cancer  Cancer.gov
Biopsy is the gold standard for diagnosing thyroid cancer. According to the American Joint Committee on Cancer (AJCC), there are 4 stages of follicular thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of lymph node regions involved, and metastasis.
(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015</ref> there are 4 stages of follicular thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of lymph node regions involved, and metastasis.


==Diagnostic Study of Choice==
==Diagnostic Study of Choice==
Line 20: Line 19:




===Staging===
===Staging<ref> Stage Information for Thyroid Cancer  Cancer.gov
(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015</ref>===
<br>
<br>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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|-
|-
! style="background: #DCDCDC;" |TX
! style="background: #DCDCDC;" |TX
! style="background: #F5F5F5;" |Primary [[tumor]] cannot be assessed
| style="background: #F5F5F5;" |
* Primary [[tumor]] cannot be assessed
|-
|-
! style="background: #DCDCDC;" |T0
! style="background: #DCDCDC;" |T0
! style="background: #F5F5F5;" |No evidence of primary [[tumor]]
| style="background: #F5F5F5;" |
* No evidence of primary [[tumor]]
|-
|-
! style="background: #DCDCDC;" |T1
! style="background: #DCDCDC;" |T1
! style="background: #F5F5F5;" |[[Tumor]] ≤2 cm in greatest dimension limited to the [[thyroid]]
| style="background: #F5F5F5;" |
* [[Tumor]] ≤ 2 cm in greatest dimension limited to the [[thyroid]]
|-
|-
! style="background: #DCDCDC;" |T1a
! style="background: #DCDCDC;" |T1a
! style="background: #F5F5F5;" |[[Tumor]] ≤1 cm, limited to the [[thyroid]]
| style="background: #F5F5F5;" |
* [[Tumor]] ≤ 1 cm, limited to the [[thyroid]]
|-
|-
! style="background: #DCDCDC;" |T1b
! style="background: #DCDCDC;" |T1b
! style="background: #F5F5F5;" |[[Tumor]] >1 cm but ≤2 cm in greatest dimension, limited to the [[thyroid]]
| style="background: #F5F5F5;" |
* [[Tumor]] > 1 cm but ≤ 2 cm in greatest dimension, limited to the [[thyroid]]
|-
|-
! style="background: #DCDCDC;" |T2
! style="background: #DCDCDC;" |T2
! style="background: #F5F5F5;" |[[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
| style="background: #F5F5F5;" |
* [[Tumor]] > 2 cm but ≤ 4 cm in greatest dimension, limited to the [[thyroid]]
|-
|-
! style="background: #DCDCDC;" |T3
! style="background: #DCDCDC;" |T3
! style="background: #F5F5F5;" |[[Tumor]] >4 cm in greatest dimension limited to the [[thyroid]] or any [[tumor]] with minimal extrathyroid extension (e.g., extension to [[sternothyroid muscle]] or perithyroid soft tissues)
| style="background: #F5F5F5;" |
* [[Tumor]] > 4 cm in greatest dimension limited to the [[thyroid]] or any [[tumor]] with minimal extrathyroid extension (e.g., extension to [[sternothyroid muscle]] or perithyroid soft tissues)
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4a
! style="background: #DCDCDC;" rowspan=2|T4a
! style="background: #F5F5F5;" |Moderately advanced [[disease]]
| style="background: #F5F5F5;" |
* Moderately advanced [[disease]]
|-
|-
! style="background: #F5F5F5;" |[[Tumor]] of any size extending beyond the thyroid capsule to invade subcutaneous [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
| style="background: #F5F5F5;" |
* [[Tumor]] of any size extending beyond the thyroid capsule to invade subcutaneous [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4b
! style="background: #DCDCDC;" rowspan=2|T4b
! style="background: #F5F5F5;" |Very advanced [[disease]]
| style="background: #F5F5F5;" |
* Very advanced [[disease]]
|-
|-
! style="background: #F5F5F5;" |[[Tumor]] invades prevertebral fascia or encases [[carotid artery]] or mediastinal vessel
| style="background: #F5F5F5;" |
* [[Tumor]] invades prevertebral fascia or encases [[carotid artery]] or mediastinal vessel
|}
|}
<br>
<br>
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|-
|-
! style="background: #DCDCDC;" |NX
! style="background: #DCDCDC;" |NX
! style="background: #F5F5F5;" |Regional [[lymph node]] cannot be assessed
| style="background: #F5F5F5;" |
* Regional [[lymph node]] cannot be assessed
|-
|-
! style="background: #DCDCDC;" |N0
! style="background: #DCDCDC;" |N0
! style="background: #F5F5F5;" |No regional lymph node metastasis
| style="background: #F5F5F5;" |
* No regional lymph node metastasis
|-
|-
! style="background: #DCDCDC;" |N1
! style="background: #DCDCDC;" |N1
! style="background: #F5F5F5;" |Regional [[lymph node]] metastasis
| style="background: #F5F5F5;" |
* Regional [[lymph node]] metastasis
|-
|-
! style="background: #DCDCDC;" |N1a
! style="background: #DCDCDC;" |N1a
! style="background: #F5F5F5;" |[[Metastases]] to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
| style="background: #F5F5F5;" |
* [[Metastases]] to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
|-
|-
! style="background: #DCDCDC;" |N1b
! style="background: #DCDCDC;" |N1b
! style="background: #F5F5F5;" |[[Metastases]] to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)
| style="background: #F5F5F5;" |
* [[Metastases]] to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)
|}
|}


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|-
|-
! style="background: #DCDCDC;" |M0
! style="background: #DCDCDC;" |M0
! style="background: #F5F5F5;" |No distant [[metastasis]]
| style="background: #F5F5F5;" |
* No distant [[metastasis]]
|-
|-
! style="background: #DCDCDC;" |M1
! style="background: #DCDCDC;" |M1
! style="background: #F5F5F5;" |Distant [[metastasis]]
| style="background: #F5F5F5;" |
* Distant [[metastasis]]
|}
|}


Line 105: Line 123:
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
! style="background: #F5F5F5;" |Any T
| style="background: #F5F5F5;" |
* Any T


! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
* Any N


! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* M0
|-
|-
! style="background: #DCDCDC;" |II
! style="background: #DCDCDC;" |II
! style="background: #F5F5F5;" |Any T
| style="background: #F5F5F5;" |
* Any T


! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
* Any N


! style="background: #F5F5F5;" |M1
| style="background: #F5F5F5;" |
* M1


|-
|-
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|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
! style="background: #F5F5F5;" |T1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |Any N
* T1
! style="background: #F5F5F5;" |M1
| style="background: #F5F5F5;" |
* Any N
| style="background: #F5F5F5;" |
* M1
|-
|-
! style="background: #DCDCDC;" |II
! style="background: #DCDCDC;" |II
! style="background: #F5F5F5;" |T2
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N0
* T2
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N0
| style="background: #F5F5F5;" |
* M0
|-
|-


! style="background: #DCDCDC;" |III
! style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |T3
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N0
* T3
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N0
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1a
* T1
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T2
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1a
* T2
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T3
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1a
* T3
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |IVA
! style="background: #DCDCDC;" |IVA
! style="background: #F5F5F5;" |T4a
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N0
* T4a
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N0
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T4a
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1a
* T4a
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1b
* T1
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T2
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1b
* T2
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T3
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1b
* T3
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |T4a
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |N1b
* T4a
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |IVB
! style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |T4b
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |Any N  
* T4b
! style="background: #F5F5F5;" |M0
| style="background: #F5F5F5;" |
* Any N
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |Stage IVC
! style="background: #DCDCDC;" |Stage IVC
! style="background: #F5F5F5;" |Any T
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |Any N  
* Any T
! style="background: #F5F5F5;" |M1
| style="background: #F5F5F5;" |
* Any N
| style="background: #F5F5F5;" |
* M1
|}
|}


Revision as of 18:51, 23 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Biopsy is the gold standard for diagnosing thyroid cancer. According to the American Joint Committee on Cancer (AJCC), there are 4 stages of follicular thyroid cancer based on the clinical features and findings on imaging. Each stage is assigned a letter and a number that designate the tumor size, number of lymph node regions involved, and metastasis.

Diagnostic Study of Choice

Study of Choice

  • Biopsy is the gold standard for diagnosing thyroid cancer.
  • Biopsy can be taken by the following methods:

1. Fine Needle Aspiration Biopsy (FNAC)

  • The removal of thyroid tissue using a thin needle. The needle is inserted through the skin into the thyroid. Several tissue samples are removed from different parts of the thyroid.

2. Surgical Biopsy

  • Surgical biopsy is the removal of the thyroid nodule or one lobe of the thyroid during surgery.
  • On microscopic examination, trabecular follicular tumor cells that invade tumor capsule or surrounding vascular structures are found.

Images of Biopsy Specimen

Staging[1]


Thyroid TNM staging
Stage Description
TX
  • Primary tumor cannot be assessed
T0
  • No evidence of primary tumor
T1
T1a
T1b
  • Tumor > 1 cm but ≤ 2 cm in greatest dimension, limited to the thyroid
T2
  • Tumor > 2 cm but ≤ 4 cm in greatest dimension, limited to the thyroid
T3
T4a
T4b


Regional Lymph Nodes (N)
Stage Description
NX
N0
  • No regional lymph node metastasis
N1
N1a
  • Metastases to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
N1b
  • Metastases to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII)
Distant Metastasis (M)
Stage Description
M0
M1


Anatomic Stage/Prognostic Groups
Stage T N M
Follicular thyroid carcinoma
YOUNGER THAN 45 YEARS
I
  • Any T
  • Any N
  • M0
II
  • Any T
  • Any N
  • M1
45 YEARS AND OLDER
I
  • T1
  • Any N
  • M1
II
  • T2
  • N0
  • M0
III
  • T3
  • N0
  • M0
  • T1
  • N1a
  • M0
  • T2
  • N1a
  • M0
  • T3
  • N1a
  • M0
IVA
  • T4a
  • N0
  • M0
  • T4a
  • N1a
  • M0
  • T1
  • N1b
  • M0
  • T2
  • N1b
  • M0
  • T3
  • N1b
  • M0
  • T4a
  • N1b
  • M0
IVB
  • T4b
  • Any N
  • M0
Stage IVC
  • Any T
  • Any N
  • M1

Follicular Thyroid Cancer

Stage I Follicular Thyroid Cancer

  • Stage I follicular carcinoma is localized to the thyroid gland. Follicular thyroid carcinoma must be distinguished from follicular adenomas, which are characterized by their lack of invasion through the capsule into the surrounding thyroid tissue.

Stage II Follicular Thyroid Cancer

  • Stage II follicular carcinoma is defined as either tumor that has spread distantly in patients younger than 45 years, or tumor that is larger than 2 cm but smaller than 4 cm and is limited to the thyroid gland in patients older than 45 years. The presence of lymph node metastases does not worsen the prognosis among patients younger than 45 years. Follicular thyroid carcinoma must be distinguished from follicular adenomas, which are characterized by their lack of invasion through the capsule into the surrounding thyroid tissue. While follicular cancer has a good prognosis, it is less favorable than that of papillary carcinoma. The 10-year survival is better for patients with follicular carcinoma without vascular invasion than for patients with vascular invasion.

Stage III Follicular Thyroid Cancer

  • Stage III follicular carcinoma in patients older than 45 years is defined as tumor larger than 4 cm and limited to the thyroid or with minimal extrathyroid extension, or lymph node involvement limited to the pretracheal, paratracheal, or prelaryngeal/Delphian nodes.

Stage IV Follicular Thyroid Cancer

  • Stage IV follicular carcinoma in patients older than 45 years is defined as tumors with extension beyond the thyroid capsule to the soft tissues of the neck, cervical lymph node metastases, or distant metastases. The lungs and bone are the most frequent sites of spread. Follicular carcinomas more commonly have blood vessel invasion and tend to metastasize hematogenously to the lungs and to the bone rather than through the lymphatic system.

Reference

  1. ↑ Stage Information for Thyroid Cancer Cancer.gov (2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015
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