Follicular thyroid cancer diagnostic study of choice: Difference between revisions

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(2015). http://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq#link/stoc_h2_2- Accessed on October, 29 2015</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]]
|-
| 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
|
|-
|-
! style="background: #DCDCDC;" |T1
| T4
| style="background: #F5F5F5;" |
|  ||
* [[Tumor]] ≤ 2 cm in greatest dimension limited to the [[thyroid]]
* [[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]]
|-
| T4
| 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]]
|-
| TX
|  ||
* Primary [[tumor]] cannot be assessed
|
|-
|-
! style="background: #DCDCDC;" |T1a
|+
| style="background: #F5F5F5;" |
 
* [[Tumor]] ≤ 1 cm, limited to the [[thyroid]]
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Regional lymph node involvement
|-
|-
! style="background: #DCDCDC;" |T1b
| align="center" style="background:#f0f0f0;" |'''Node involvement'''
| style="background: #F5F5F5;" |
| align="center" style="background:#f0f0f0;" |'''Sub-stage'''
* [[Tumor]] > 1 cm but ≤ 2 cm in greatest dimension, limited to the [[thyroid]]
| align="center" style="background:#f0f0f0;" |'''Finding'''
|'''Image'''
|-
|-
! style="background: #DCDCDC;" |T2
| N0
| style="background: #F5F5F5;" |
| ||
* [[Tumor]] > 2 cm but ≤ 4 cm in greatest dimension, limited to the [[thyroid]]
* No [[lymph node]] involvement
|
|-
|-
! style="background: #DCDCDC;" |T3
|N0
| style="background: #F5F5F5;" |
|a
* [[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)
|
* One or more cytologically or [[histologically]] confirmed benign [[lymph nodes]]
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4a
|N0
| style="background: #F5F5F5;" |
|b
* Moderately advanced [[disease]]
|
* No [[Radiological|radiologic]] or clinical evidence of locoregional [[lymph node]] [[metastasis]]
|
|-
|-
| style="background: #F5F5F5;" |
| N1
* [[Tumor]] of any size extending beyond the [[thyroid]] capsule to invade [[subcutaneous]] [[soft tissue]]s, [[larynx]], [[trachea]], [[esophagus]], or [[recurrent laryngeal nerve]]
|  ||
* [[Metastasis]] to regional nodes
|
|-
|-
! style="background: #DCDCDC;" rowspan=2|T4b
| N1
| style="background: #F5F5F5;" |
| a||
* Very advanced [[disease]]
* [[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]]
|-
|-
| style="background: #F5F5F5;" |
| N1
* [[Tumor]] invades [[prevertebral fascia]] or encases [[carotid artery]] or [[Mediastinum|mediastinal]] [[Blood vessel|vessels]]
| 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]]
<br>
|[[Image:Diagram showing stage N1b thyroid cancer CRUK 243.png|200px|thumb|none]]
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Regional Lymph Nodes (N)'''''
! style="background: #4479BA; width: 80px;" | {{fontcolor|#FFF|Stage}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
|-
|-
! 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 lymph nodes|pretracheal]], [[Paratracheal lymph nodes|paratracheal]], and [[Prelaryngeal lymph nodes|prelaryngeal]]/Delphian [[Lymph node|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 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| '''Papillary 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
|}
|}
==Reference==
==Reference==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 21:26, 14 August 2019

Follicular thyroid cancer Microchapters

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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

  • 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
Papillary 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. ↑ 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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