Follicular thyroid cancer diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 17: Line 17:


====Images of Biopsy Specimen====
====Images of Biopsy Specimen====
 
<gallery>
Image:Metastatic follicular thyroid carcinoma - Case 264 (8558730243).jpg|400px|left|Metastatic follicular thyroid carcinoma<ref>http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg Accessed on October, 29 2015</ref>
Image:Metastatic follicular thyroid carcinoma - Case 264.jpg|400px|center|Metastatic follicular thyroid carcinoma<ref>http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8559837390).jpg  Accessed on October, 29 2015</ref>
</gallery>


===Staging<ref> Stage Information for Thyroid Cancer  Cancer.gov
===Staging<ref> Stage Information for Thyroid Cancer  Cancer.gov
Line 24: Line 27:
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Thyroid TNM staging'''''
|+'''''Thyroid TNM staging'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 80px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
|-
|-
! style="background: #DCDCDC;" |TX
! style="background: #DCDCDC;" |TX
Line 72: Line 75:
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Regional Lymph Nodes (N)'''''
|+'''''Regional Lymph Nodes (N)'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 80px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
|-
|-
! style="background: #DCDCDC;" |NX
! style="background: #DCDCDC;" |NX
Line 98: Line 101:
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Distant Metastasis (M)'''''
|+'''''Distant Metastasis (M)'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 135px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|Description}}
|-
|-
! style="background: #DCDCDC;" |M0
! style="background: #DCDCDC;" |M0
Line 113: Line 116:
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Anatomic Stage/Prognostic Groups'''''
|+'''''Anatomic Stage/Prognostic Groups'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 135px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|M}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Follicular thyroid carcinoma'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 align=center| '''Follicular thyroid carcinoma'''

Revision as of 19:11, 23 July 2019

Follicular thyroid cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Follicular thyroid cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X-ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Follicular thyroid cancer diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Follicular thyroid cancer diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Follicular thyroid cancer diagnostic study of choice

CDC on Follicular thyroid cancer diagnostic study of choice

Follicular thyroid cancer diagnostic study of choice in the news

Blogs on Follicular thyroid cancer diagnostic study of choice

Directions to Hospitals Treating Follicular thyroid cancer

Risk calculators and risk factors for Follicular thyroid cancer diagnostic study of choice

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[3]


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