Diagnostic Algorithm & Some Quick Facts of Follicular Carcinoma of Thyroid.
๐ง๐ต๐ฒ ๐๐ถ๐ฎ๐ด๐ป๐ผ๐๐ถ๐ ๐ผ๐ณ ๐๐ผ๐น๐น๐ถ๐ฐ๐๐น๐ฎ๐ฟ ๐ง๐ต๐๐ฟ๐ผ๐ถ๐ฑ ๐๐ฎ๐ป๐ฐ๐ฒ๐ฟ: ๐ค๐๐ถ๐ฐ๐ธ ๐๐ฎ๐ฐ๐๐:
โถ๏ธ-The diagnosis of follicular thyroid cancer cannot be made by fine needle aspiration of a thyroid nodule.
โท๏ธ-The diagnosis of follicular thyroid cancer in a thyroid nodule can only be obtained by complete removal of the thyroid mass & less likely by preoperatively estimation of thyroglobulin level or intraoperative by frozen sections.
โธ๏ธ-The diagnosis of follicular thyroid cancer accounts for less than10% of all thyroid cancers.
โน๏ธ-The diagnosis of follicular thyroid cancer is 3 times more common in women than in men.
โบ๏ธ-The diagnosis of follicular thyroid cancer occurs most commonly above 40 years of age and rarely occurs in children.
โป๏ธ-Follicular thyroid cancer rarely spreads to lymph nodes (far less than 10%).
โผ๏ธ-The diagnosis of follicular thyroid cancer is rarely associated with a history of radiation exposure.
โฝ๏ธ- A good history, examination and USG play a vital rules for pre-op diagnosis of follicular carcinoma.
LAST BUT NOT LEAST!
โ๐๐ผ๐ฟ ๐๐ถ๐ฎ๐ด๐ป๐ผ๐๐ถ๐ ๐ผ๐ณ ๐ณ๐ผ๐น๐น๐ถ๐ฐ๐๐น๐ฎ๐ฟ ๐๐ต๐๐ฟ๐ผ๐ถ๐ฑ ๐ฐ๐ฎ๐ป๐ฐ๐ฒ๐ฟ: ๐ง๐ต๐ฒ ๐๐ฒ๐๐ ๐ง๐ฟ๐ฒ๐ฎ๐๐บ๐ฒ๐ป๐ ๐ถ๐ ๐ฎ ๐๐ผ๐ผ๐ฑ ๐ฆ๐๐ฟ๐ด๐ฒ๐ฟ๐โ
๐๐ฎ๐๐ฒ๐๐ ๐ฎ๐ฑ๐๐ฎ๐ป๐ฐ๐ฒ๐ ๐ถ๐ป ๐ฑ๐ถ๐ฎ๐ด๐ป๐ผ๐๐ถ๐ ๐ผ๐ณ ๐ณ๐ผ๐น๐น๐ถ๐ฐ๐๐น๐ฎ๐ฟ ๐๐:
๐ ๏ธ-Reverse transcriptase polymerase reaction for TSH receptor and thyroglobulin messenger RNA may help differentiate follicular adenoma from follicular carcinoma.
๐ ๏ธ-The current commercially available genetic testing for thyroid nodules are Veracyte (Afirma), Asuragen, and Thyroseq. These tests have little to no benefit in the diagnosis of follicular thyroid cancer. The genetic abnormalities of non-cancers of follicular origin (follicular adenoma and follicular neoplasm of uncertain malignant potential) are also found in follicular thyroid cancers!
a-The Veracyte test has the best ability to tell whether the FNA cytology is benign. This is called a โrule outโ test.
b-Both Asuragen and Thyroseq are โrule inโ tests. What this means is that they look for genetic abnormalities known to be associated with a diagnosis of follicular thyroid cancer. . In particular, the follicular variant of papillary thyroid cancer (see diagnosis of follicular variant of papillary thyroid cancer). Finding these particular genetic changes makes a diagnosis of follicular thyroid cancer much more likely, and in some circumstances may also play a role in determining the best surgery for the cancer.