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Diagnosis and treatment of small follicular thyroid carcinomas
1Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
Background:
Follicular thyroid microcarcinomas (mFTCs) of 10 mm or less in size rarely manifest clinically and their clinical significance is controversial. This study assessed their characteristics and incidence, and analysed treatment modalities used for mFTC.
Methods:
Members of the German Association of Endocrine Surgeons were asked to review patients with mFTC operated on between 1990 and 2005.
Results:
Data for 90 patients from 26 institutions were reported. Histopathological slides were available for re-evaluation in 35 patients. Most initial diagnoses had to be revised because of incorrect size assessment or incorrect diagnosis (benign adenoma, papillary thyroid carcinoma (PTC), follicular variant of PTC). The diagnosis of mFTC was confirmed in only four patients. As a result of the incorrect histopathological diagnosis, unnecessary completion thyroidectomy and radioiodine ablation were performed in 17 and 20 patients respectively. The incidence of mFTC was calculated to be 0.12 per million population per year.
Conclusion:
mFTC is exceptionally rare. Such tumours are overdiagnosed, resulting in unnecessary treatment associated with avoidable morbidity. Histopathological re-evaluation by an experienced pathologist is recommended before embarking on further treatments when a diagnosis of mFTC is made.
Insights
Follicular thyroid microcarcinomas (mFTCs) are rare and often overdiagnosed. Re-evaluating histopathology is crucial to prevent unnecessary treatments and associated complications for patients.
Area of Science:
- Endocrinology
- Surgical Oncology
- Pathology
Background:
- Follicular thyroid microcarcinomas (mFTCs) are defined as tumors ≤10 mm.
- The clinical significance and incidence of mFTCs remain controversial.
- This study aimed to assess mFTC characteristics, incidence, and treatment patterns.
Purpose of the Study:
- To evaluate the characteristics and incidence of follicular thyroid microcarcinomas (mFTCs).
- To analyze treatment modalities employed for mFTCs.
- To determine the impact of diagnostic accuracy on patient treatment.
Main Methods:
- A retrospective review of patients operated on for mFTC between 1990 and 2005 was conducted.
- Data were collected from 26 institutions involving 90 patients.
- Histopathological slides from 35 patients were re-evaluated.
Main Results:
- Histopathological re-evaluation revealed that the initial mFTC diagnosis was confirmed in only 4 out of 35 patients.
- Incorrect diagnoses led to unnecessary completion thyroidectomy in 17 patients and radioiodine ablation in 20 patients.
- The calculated incidence of mFTC was 0.12 per million population per year.
Conclusions:
- Follicular thyroid microcarcinomas (mFTCs) are exceptionally rare and frequently overdiagnosed.
- Overdiagnosis leads to unnecessary and potentially harmful treatments.
- Histopathological re-evaluation by experienced pathologists is recommended prior to initiating treatment for suspected mFTCs.
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