Follicular thyroid cancer diagnostic study of choice: Difference between revisions

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*[[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]] 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)'''
* It involves [[extraction]] of [[thyroid]] [[Tissue (biology)|tissue]] using a thin needle.  
*** It involves [[extraction]] of [[thyroid]] [[Tissue (biology)|tissue]] using a thin needle.
*The needle is inserted through the [[skin]] into the [[thyroid]]. Several [[Tissue (biology)|tissue]] samples are taken from different parts of the [[thyroid]].
***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'''
====2. Surgical Biopsy====
***Surgical [[biopsy]] is the removal of the [[thyroid]] nodule or one [[lobe]] of the [[thyroid]] during [[surgery]].
* 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.
* 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====
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</gallery>
</gallery>


===Staging<ref> Stage Information for Thyroid Cancer Cancer.gov
===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>===
(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
{| class="wikitable"
|+'''''Thyroid TNM staging'''''
|+
! style="background: #4479BA; width: 80px;" | {{fontcolor|#FFF|Stage}}
 
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Primary tumor
|-
|-
! 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]]
|-
|-
! style="background: #DCDCDC;" |T1
| T2
| style="background: #F5F5F5;" |
| ||
* [[Tumor]] ≤ 2 cm in greatest dimension limited to the [[thyroid]]
* [[Tumor]] >2 cm but ≤4 cm in greatest dimension, limited to the [[thyroid]]
|
|-
|-
! style="background: #DCDCDC;" |T1a
| T3
| style="background: #F5F5F5;" |
| ||
* [[Tumor]] ≤ 1 cm, limited to the [[thyroid]]
* [[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]]
|-
|-
! style="background: #DCDCDC;" |T1b
|T3
| style="background: #F5F5F5;" |
|a
* [[Tumor]] > 1 cm but ≤ 2 cm in greatest dimension, limited to the [[thyroid]]
|
* [[Tumor]] >4 cm limited to the [[thyroid]]
|
|-
|-
! style="background: #DCDCDC;" |T2
|T3
| style="background: #F5F5F5;" |
|b
* [[Tumor]] > 2 cm but ≤ 4 cm in greatest dimension, limited to the [[thyroid]]
|
* Gross extrathyroidal extension invading only strap [[muscles]] ([[sternohyoid]], [[sternothyroid]], [[thyrohyoid]], or [[Omohyoid muscle|omohyoid muscles]]) from a [[tumor]] of any size
|
|-
|-
! style="background: #DCDCDC;" |T3
| T4
| 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)
* [[Tumor]] includes gross extrathyroidal extension beyond the strap [[muscles]]
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4a
| T4
| style="background: #F5F5F5;" |
| a||
* Moderately advanced [[disease]]
* [[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: #F5F5F5;" |
| T4
* [[Tumor]] of any size extending beyond the [[thyroid]] capsule to invade [[subcutaneous]] [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
| b||
* [[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;" rowspan=2|T4b
| TX
| style="background: #F5F5F5;" |
| ||
* Very advanced [[disease]]
* Primary [[tumor]] cannot be assessed
|
|-
|-
| style="background: #F5F5F5;" |
|+
* [[Tumor]] invades [[prevertebral fascia]] or encases [[carotid artery]] or [[Mediastinum|mediastinal]] [[Blood vessel|vessels]]
 
|}
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Regional lymph node involvement
<br>
|-
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| align="center" style="background:#f0f0f0;" |'''Node involvement'''
|+'''''Regional Lymph Nodes (N)'''''
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
! style="background: #4479BA; width: 80px;" | {{fontcolor|#FFF|Stage}}
| align="center" style="background:#f0f0f0;" |'''Finding'''
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
|'''Image'''
|-
| N0
| ||
* No [[lymph node]] involvement
|
|-
|N0
|a
|
* One or more cytologically or [[histologically]] confirmed benign [[lymph nodes]]
|
|-
|N0
|b
|
* No [[Radiological|radiologic]] or clinical evidence of locoregional [[lymph node]] [[metastasis]]
|
|-
| N1
|  ||
* [[Metastasis]] to regional nodes
|
|-
| N1
| 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]]
|[[Image:Diagram showing stage N1a thyroid cancer CRUK 242.png|200px|thumb|none]]
|-
| N1
| b||
* [[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'''
|-
| M0
| ||
* No distant [[metastasis]]
|
|-
|-
! style="background: #DCDCDC;" |N1a
| M1
| style="background: #F5F5F5;" |
| IV||
* [[Metastases]] to Level VI ([[Pretracheal lymph nodes|pretracheal]], [[Paratracheal lymph nodes|paratracheal]], and [[Prelaryngeal lymph nodes|prelaryngeal]]/Delphian [[Lymph node|lymph nodes]])
* 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 lymph nodes|cervical]] (Levels I, II, III, IV, or V) or [[Retropharyngeal lymph nodes|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: 135px;" | {{fontcolor|#FFF|Stage}}
 
! style="background: #4479BA; width: 250px;" | {{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'''''
! style="background: #4479BA; width: 135px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|T}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|N}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|M}}
! style="background: #4479BA; width: 550px;" | {{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'''
|-
|-
| 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
|}
|}


Latest revision as of 15:42, 29 October 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

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Follicular thyroid cancer diagnostic study of choice On the Web

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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

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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