Follicular thyroid cancer diagnostic study of choice: Difference between revisions

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==Overview==
==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.
[[Biopsy]] is the [[Gold standard (test)|gold standard]] for [[Diagnosis|diagnosing]] thyroid cancer. According to the [[American Joint Committee on Cancer|American Joint Committee on Cancer (AJCC)]], there are 4 [[Cancer staging|stages]] of follicular thyroid cancer based on the [[clinical]] features and findings on [[imaging]]. Each [[Cancer staging|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==
===Study of Choice===
===Study of Choice===


* Biopsy is the gold standard for diagnosing thyroid cancer.
*[[Biopsy]] is the [[Gold standard (test)|gold standard]] for [[Diagnosis|diagnosing]] thyroid cancer.<ref>{{Cite web|url=https://www.cancer.org/cancer/thyroid-cancer/detection-diagnosis-staging/how-diagnosed.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
* Biopsy can be taken by the following methods:
*[[Biopsy]] can be taken by the following methods:
====1. Fine Needle Aspiration Biopsy (FNAC)====
**'''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.
*** It involves [[extraction]] of [[thyroid]] [[Tissue (biology)|tissue]] using a thin needle.
====2. Surgical Biopsy====
***The needle is inserted through the [[skin]] into the [[thyroid]]. Several [[Tissue (biology)|tissue]] samples are taken from different parts of the [[thyroid]].
* Surgical biopsy is the removal of the thyroid nodule or one lobe of the thyroid during surgery.
**'''Surgical Biopsy'''
* On microscopic examination, trabecular follicular tumor cells that invade tumor capsule or surrounding vascular structures are found.
***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====
====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 name="urlThyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#_441_toc |title=Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref>===
<br>
{| class="wikitable"
|+


===Staging<ref> Stage Information for Thyroid Cancer  Cancer.gov
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Primary tumor
(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015</ref>===
<br>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Thyroid TNM staging'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|-
|-
! style="background: #DCDCDC;" |TX
| align="center" style="background:#f0f0f0;" |'''Tumor size'''
| style="background: #F5F5F5;" |
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
* Primary [[tumor]] cannot be assessed
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #DCDCDC;" |T0
| T0
| style="background: #F5F5F5;" |
| ||
* No evidence of primary [[tumor]]
* No evidence of primary [[tumor]]
|
|-
| T1
|  ||
* [[Tumor]] ≤2 cm in greatest dimension limited to the [[thyroid]]
|
|-
| T1
| a||
* [[Tumor]] ≤1 cm, limited to the [[thyroid]]
| [[Image:Diagram showing stage T1a thyroid cancer CRUK 250.png|200px|thumb|none]]
|-
| T1
| b||
* [[Tumor]] >1 cm but ≤2 cm in greatest dimension, limited to the [[thyroid]]
| [[Image:Diagram showing stage T1b thyroid cancer CRUK 251.svg.png|200px|thumb|none]]
|-
| T2
|  ||
* [[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
|
|-
| T3
|  ||
* [[Tumor]] >4 cm limited to the [[thyroid]], or gross extrathyroidal extension invading only strap [[muscles]]
| [[Image:Diagram showing stage T3 thyroid cancer CRUK 265.png|200px|thumb|none]]
|-
|T3
|a
|
* [[Tumor]] >4 cm limited to the [[thyroid]]
|
|-
|T3
|b
|
* Gross extrathyroidal extension invading only strap [[muscles]] ([[sternohyoid]], [[sternothyroid]], [[thyrohyoid]], or [[Omohyoid muscle|omohyoid muscles]]) from a [[tumor]] of any size
|
|-
| T4
|  ||
* [[Tumor]] includes gross extrathyroidal extension beyond the strap [[muscles]]
|
|-
| T4
| a||
* [[Tumor]] with gross extrathyroidal extension invading subcutaneous [[Soft tissue|soft tissues]], [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]] from a [[tumor]] of any size
|[[Image:Diagram showing stage T4a thyroid cancer CRUK 272.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T1
| T4
| style="background: #F5F5F5;" |
| b||
* [[Tumor]] ≤ 2 cm in greatest dimension limited to the [[thyroid]]
* [[Tumor]] with gross extrathyroidal extension invading [[prevertebral fascia]] or encasing the [[carotid artery]] or [[mediastinal]] vessels from a [[tumor]] of any size.
|[[Image:Diagram showing stage T4b thyroid cancer CRUK 273.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |T1a
| TX
| style="background: #F5F5F5;" |
| ||
* [[Tumor]] ≤ 1 cm, limited to the [[thyroid]]
* Primary [[tumor]] cannot be assessed
|
|-
|-
! style="background: #DCDCDC;" |T1b
|+
| style="background: #F5F5F5;" |
 
* [[Tumor]] > 1 cm but ≤ 2 cm in greatest dimension, limited to the [[thyroid]]
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Regional lymph node involvement
|-
|-
! style="background: #DCDCDC;" |T2
| align="center" style="background:#f0f0f0;" |'''Node involvement'''
| style="background: #F5F5F5;" |
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
* [[Tumor]] > 2 cm but ≤ 4 cm in greatest dimension, limited to the [[thyroid]]
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #DCDCDC;" |T3
| N0
| 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)
* No [[lymph node]] involvement
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4a
|N0
| style="background: #F5F5F5;" |
|a
* Moderately advanced [[disease]]
|
* One or more cytologically or [[histologically]] confirmed benign [[lymph nodes]]
|
|-
|-
| style="background: #F5F5F5;" |
|N0
* [[Tumor]] of any size extending beyond the thyroid capsule to invade subcutaneous [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
|b
|
* No [[Radiological|radiologic]] or clinical evidence of locoregional [[lymph node]] [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4b
| N1
| style="background: #F5F5F5;" |
| ||
* Very advanced [[disease]]
* [[Metastasis]] to regional nodes
|
|-
|-
| style="background: #F5F5F5;" |
| N1
* [[Tumor]] invades prevertebral fascia or encases [[carotid artery]] or mediastinal vessel
| a||
|}
* [[Metastasis]] to level VI or VII ([[Pretracheal lymph nodes|pretracheal]], [[Paratracheal lymph nodes|paratracheal]], or [[Prelaryngeal lymph nodes|prelaryngeal]]/Delphian, or upper mediastinal) [[lymph nodes]]. This can be unilateral or bilateral [[disease]]
<br>
|[[Image:Diagram showing stage N1a thyroid cancer CRUK 242.png|200px|thumb|none]]
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|-
|+'''''Regional Lymph Nodes (N)'''''
| N1
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
| b||
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
* [[Metastasis]] to unilateral, bilateral, or contralateral [[Cervical lymph nodes|cervical]] neck [[lymph nodes]] (levels I, II, III, IV, or V) or [[retropharyngeal lymph nodes]]
|[[Image:Diagram showing stage N1b thyroid cancer CRUK 243.png|200px|thumb|none]]
|-
|-
! style="background: #DCDCDC;" |NX
| NX
| style="background: #F5F5F5;" |
| ||
* Regional [[lymph node]] cannot be assessed
* Regional [[lymph node]] cannot be assessed
|
|-
|-
! style="background: #DCDCDC;" |N0
|+
| style="background: #F5F5F5;" |
 
* No regional lymph node metastasis
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Distant metastasis
|-
|-
! style="background: #DCDCDC;" |N1
| align="center" style="background:#f0f0f0;" |'''Presence of metastasis'''
| style="background: #F5F5F5;" |
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
* Regional [[lymph node]] metastasis
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #DCDCDC;" |N1a
| M0
| style="background: #F5F5F5;" |
| ||
* [[Metastases]] to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
* No distant [[metastasis]]
|
|-
| M1
| IV||
* Distant [[metastasis]]
|[[Image:Stage M1 Thyroid cancer.png|200px|thumb|none]]
|-
|-
! 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="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Distant Metastasis (M)'''''
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
 
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Description}}
|-
 
|-
 
|-
 
|-
 
|-
 
|-
 
|-
 
|-
 
|-
|-
! style="background: #DCDCDC;" |M0
 
| style="background: #F5F5F5;" |
* No distant [[metastasis]]
|-
|-
! style="background: #DCDCDC;" |M1
| style="background: #F5F5F5;" |
* Distant [[metastasis]]
|}


|-


|}
<br />
{| 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'''''
Line 120: Line 200:
| 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'''
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''YOUNGER THAN 45 YEARS'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''YOUNGER THAN 55 YEARS'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |Any T
* Any T


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


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


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


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


|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''45 YEARS AND OLDER'''
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" colspan=4 | '''55 YEARS AND OLDER'''
|-
|-
! style="background: #DCDCDC;" |I
! style="background: #DCDCDC;" |I
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |T1
* T1
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* Any N
| style="background: #F5F5F5;" |
* M1
|-
|-
! style="background: #DCDCDC;" |II
! rowspan="4" style="background: #DCDCDC;" |II
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |T1
* T2
! style="background: #F5F5F5;" |N1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* N0
| style="background: #F5F5F5;" |
* M0
|-
|-
 
! style="background: #F5F5F5;" |T2
! style="background: #DCDCDC;" |III
! style="background: #F5F5F5;" |N1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T3
| style="background: #F5F5F5;" |
* N0
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T3a
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T1
| style="background: #F5F5F5;" |
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T3b
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T2
| style="background: #F5F5F5;" |
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! style="background: #DCDCDC;" |III
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |T4a
* T3
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |IVA
! style="background: #DCDCDC;" |IVA
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |T4b
* T4a
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* N0
| style="background: #F5F5F5;" |
* M0


|-
|-


! style="background: #DCDCDC;" |
! rowspan="6" style="background: #DCDCDC;" |IVB
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |Any T
* T4a
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M1
* N1a
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T1
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |N1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T1
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T2
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |N1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T2
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T3a
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |N1
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T3
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T3b
! style="background: #DCDCDC;" |
! style="background: #F5F5F5;" |Any N
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T4a
| style="background: #F5F5F5;" |
* N1b
| style="background: #F5F5F5;" |
* M0


|-
|-
 
! style="background: #F5F5F5;" |T4
! style="background: #DCDCDC;" |IVB
! style="background: #F5F5F5;" |Any N  
| style="background: #F5F5F5;" |
! style="background: #F5F5F5;" |M0
* T4b
| style="background: #F5F5F5;" |
* Any N
| style="background: #F5F5F5;" |
* M0


|-
|-


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

Latest revision as of 15:42, 29 October 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

Images of Biopsy Specimen

  • Metastatic follicular thyroid carcinoma[2]

    Metastatic follicular thyroid carcinoma[2]

  • Metastatic follicular thyroid carcinoma[3]

    Metastatic follicular thyroid carcinoma[3]

Staging[4]


Primary tumor
Tumor size Sub-stage Finding Image
T0
  • No evidence of primary tumor
T1
T1 a
T1 b
  • 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
  • Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles
T3 a
T3 b
T4
  • Tumor includes gross extrathyroidal extension beyond the strap muscles
T4 a
T4 b
TX
  • Primary tumor cannot be assessed
Regional lymph node involvement
Node involvement Sub-stage Finding Image
N0
N0 a
N0 b
N1
N1 a
N1 b
NX
Distant metastasis
Presence of metastasis Sub-stage Finding Image
M0
M1 IV


Anatomic Stage/Prognostic Groups
Stage T N M
Follicular thyroid carcinoma
YOUNGER THAN 55 YEARS
I Any T Any N M0
II Any T Any N M1
55 YEARS AND OLDER
I T1 Any N M0
II T1 N1 M0
T2 N1 M0
T3a Any N M0
T3b Any N M0
III T4a Any N M0
IVA T4b Any N M0
IVB Any T Any N M1
T1 N1 M0
T2 N1 M0
T3a N1 M0
T3b Any N M0
T4 Any N M0
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. ↑ "Thyroid Cancer Treatment (Adult) (PDQ®)–Health Professional Version - National Cancer Institute".
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