Diagnostic Algorithm & Some Quick Facts of Follicular Carcinoma of Thyroid.
𝗧𝗵𝗲 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀 𝗼𝗳 𝗙𝗼𝗹𝗹𝗶𝗰𝘂𝗹𝗮𝗿 𝗧𝗵𝘆𝗿𝗼𝗶𝗱 𝗖𝗮𝗻𝗰𝗲𝗿: 𝗤𝘂𝗶𝗰𝗸 𝗙𝗮𝗰𝘁𝘀:
Ⓐ︎-The diagnosis of follicular thyroid cancer cannot be made by fine needle aspiration of a thyroid nodule.
Ⓑ︎-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.
Ⓒ︎-The diagnosis of follicular thyroid cancer accounts for less than10% of all thyroid cancers.
Ⓓ︎-The diagnosis of follicular thyroid cancer is 3 times more common in women than in men.
Ⓔ︎-The diagnosis of follicular thyroid cancer occurs most commonly above 40 years of age and rarely occurs in children.
Ⓕ︎-Follicular thyroid cancer rarely spreads to lymph nodes (far less than 10%).
Ⓖ︎-The diagnosis of follicular thyroid cancer is rarely associated with a history of radiation exposure.
Ⓗ︎- A good history, examination and USG play a vital rules for pre-op diagnosis of follicular carcinoma.
LAST BUT NOT LEAST!
“𝗙𝗼𝗿 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀 𝗼𝗳 𝗳𝗼𝗹𝗹𝗶𝗰𝘂𝗹𝗮𝗿 𝘁𝗵𝘆𝗿𝗼𝗶𝗱 𝗰𝗮𝗻𝗰𝗲𝗿: 𝗧𝗵𝗲 𝗕𝗲𝘀𝘁 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗶𝘀 𝗮 𝗚𝗼𝗼𝗱 𝗦𝘂𝗿𝗴𝗲𝗿𝘆”
𝗟𝗮𝘁𝗲𝘀𝘁 𝗮𝗱𝘃𝗮𝗻𝗰𝗲𝘀 𝗶𝗻 𝗱𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀 𝗼𝗳 𝗳𝗼𝗹𝗹𝗶𝗰𝘂𝗹𝗮𝗿 𝗖𝗔:
🅐︎-Reverse transcriptase polymerase reaction for TSH receptor and thyroglobulin messenger RNA may help differentiate follicular adenoma from follicular carcinoma.
🅑︎-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 “rule out” test.
b-Both Asuragen and Thyroseq are “rule in” 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.