Management of follicular tumors of the thyroid

The incidence of well-differentiated thyroid cancers is rising. Follicular cancer represents 10-20% of these lesions. While the vast majority of thyroid nodules of follicular origin are benign, fine needle aspiration cannot provide cytologic evidence of capsular and/or vascular invasion; therefore, patients should undergo surgical excision. Frozen section is not recommended for intraoperative evaluation of follicular neoplasia. Patients deemed to have follicular cancer require near-total or total thyroidectomy and postoperative (131)I ablation. The optimal management of minimally invasive follicular cancer remains an area of controversy, but long-term prognosis for these patients is excellent. Areas of research should focus on identification of molecular markers of malignancy and aggressiveness of follicular neoplasia.