Follicular thyroid cancer diagnostic study of choice

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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

1. Fine Needle Aspiration Biopsy (FNAC)

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[4]


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
N1
N1a
N1b
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

Reference

  1. https://www.cancer.org/cancer/thyroid-cancer/detection-diagnosis-staging/how-diagnosed.html. Missing or empty |title= (help)
  2. http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg Accessed on October, 29 2015
  3. http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8559837390).jpg Accessed on October, 29 2015
  4. 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