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The surgical dilemma of primary surgery for follicular thyroid neoplasms.

Abstract

Follicular thyroid carcinoma is the second most prevalent form of differentiated thyroid carcinoma, following papillary thyroid carcinoma. Preoperative diagnosis is hampered by the fact that fine-needle aspiration cytology as well as supplemental molecular analysis cannot unambiguously distinguish between follicular thyroid carcinoma and benign follicular thyroid adenoma. The 2017 WHO classification defines three histological subtypes of follicular thyroid carcinoma: minimally invasive (excellent prognosis), encapsulated angioinvasive, and widely invasive type (higher risk of recurrence and metastatic spread). The fact that definite characterization of follicular neoplasms is predominantly a postoperative histological diagnosis (core criteria: capsular, vascular and adjacent tissue invasion) translates into the challenge for the thyroid surgeon to plan preoperatively for presence of malignancy and, if required, to adapt the surgical strategy according to intraoperative (frozen section) or postoperative histological findings. Until improved tools for pre-/intraoperative diagnosis are available, the malignant potential of a follicular thyroid lesion can be assessed by stratifying the patient according to clinical risk factors (presence of metastases, advanced patient age, tumor size). A stepwise, escalating surgical approach with restricted primary resection (hemithyroidectomy) and completion surgery based on the definite histopathology is another option to solve this dilemma. The currently recommended surgical treatment strategies for FTCs as published by ATA, BTA, CAEK and ESES are discussed. There is consensus that prophylactic lymphadenectomy is not required for FTCs and that hemithyroidectomy is sufficient in low-risk FTCs (capsular invasion only) whereas thyroidectomy with postoperative radioiodine therapy is indicated in high-risk FTCs (angioinvasion; widely invasive FTC).

Authors+Show Affiliations

Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraβe 1, 55131, Mainz, Germany. Electronic address: julia.staubitz@unimedizin-mainz.de.Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraβe 1, 55131, Mainz, Germany. Electronic address: musholt@uni-mainz.de.Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraβe 1, 55131, Mainz, Germany. Electronic address: musholt@uni-mainz.de.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31434622

Citation

Staubitz, Julia I., et al. "The Surgical Dilemma of Primary Surgery for Follicular Thyroid Neoplasms." Best Practice & Research. Clinical Endocrinology & Metabolism, vol. 33, no. 4, 2019, p. 101292.
Staubitz JI, Musholt PB, Musholt TJ. The surgical dilemma of primary surgery for follicular thyroid neoplasms. Best Pract Res Clin Endocrinol Metab. 2019;33(4):101292.
Staubitz, J. I., Musholt, P. B., & Musholt, T. J. (2019). The surgical dilemma of primary surgery for follicular thyroid neoplasms. Best Practice & Research. Clinical Endocrinology & Metabolism, 33(4), p. 101292. doi:10.1016/j.beem.2019.101292.
Staubitz JI, Musholt PB, Musholt TJ. The Surgical Dilemma of Primary Surgery for Follicular Thyroid Neoplasms. Best Pract Res Clin Endocrinol Metab. 2019;33(4):101292. PubMed PMID: 31434622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The surgical dilemma of primary surgery for follicular thyroid neoplasms. AU - Staubitz,Julia I, AU - Musholt,Petra B, AU - Musholt,Thomas J, Y1 - 2019/07/09/ PY - 2019/8/23/pubmed PY - 2019/8/23/medline PY - 2019/8/23/entrez KW - completion thyroidectomy KW - follicular thyroid carcinoma KW - follicular thyroid neoplasm KW - guidelines KW - thyroidectomy KW - treatment recommendations SP - 101292 EP - 101292 JF - Best practice & research. Clinical endocrinology & metabolism JO - Best Pract. Res. Clin. Endocrinol. Metab. VL - 33 IS - 4 N2 - Follicular thyroid carcinoma is the second most prevalent form of differentiated thyroid carcinoma, following papillary thyroid carcinoma. Preoperative diagnosis is hampered by the fact that fine-needle aspiration cytology as well as supplemental molecular analysis cannot unambiguously distinguish between follicular thyroid carcinoma and benign follicular thyroid adenoma. The 2017 WHO classification defines three histological subtypes of follicular thyroid carcinoma: minimally invasive (excellent prognosis), encapsulated angioinvasive, and widely invasive type (higher risk of recurrence and metastatic spread). The fact that definite characterization of follicular neoplasms is predominantly a postoperative histological diagnosis (core criteria: capsular, vascular and adjacent tissue invasion) translates into the challenge for the thyroid surgeon to plan preoperatively for presence of malignancy and, if required, to adapt the surgical strategy according to intraoperative (frozen section) or postoperative histological findings. Until improved tools for pre-/intraoperative diagnosis are available, the malignant potential of a follicular thyroid lesion can be assessed by stratifying the patient according to clinical risk factors (presence of metastases, advanced patient age, tumor size). A stepwise, escalating surgical approach with restricted primary resection (hemithyroidectomy) and completion surgery based on the definite histopathology is another option to solve this dilemma. The currently recommended surgical treatment strategies for FTCs as published by ATA, BTA, CAEK and ESES are discussed. There is consensus that prophylactic lymphadenectomy is not required for FTCs and that hemithyroidectomy is sufficient in low-risk FTCs (capsular invasion only) whereas thyroidectomy with postoperative radioiodine therapy is indicated in high-risk FTCs (angioinvasion; widely invasive FTC). SN - 1878-1594 UR - https://www.unboundmedicine.com/medline/citation/31434622/The_surgical_dilemma_of_primary_surgery_for_follicular_thyroid_neoplasms L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-690X(19)30043-0 DB - PRIME DP - Unbound Medicine ER -