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. 2022 May;50(5):223-229.
doi: 10.1002/dc.24937. Epub 2022 Feb 8.

Criteria for follow-up of thyroid nodules diagnosed as follicular neoplasm without molecular testing - The experience of a high-volume thyroid centre in Japan

Mitsuyoshi Hirokawa  1 , Ayana Suzuki  1 , Makoto Kawakami  2 , Takumi Kudo  3 , Akira Miyauchi  4
Affiliations

Criteria for follow-up of thyroid nodules diagnosed as follicular neoplasm without molecular testing - The experience of a high-volume thyroid centre in Japan

Mitsuyoshi Hirokawa et al. Diagn Cytopathol. 2022 May.

Abstract

Background: Clinical management of follicular neoplasms (FNs) using molecular testing of thyroid-aspirated materials is not routinely performed in Japan. This article aims to identify low-risk FN nodules that can be followed up without molecular testing.

Methods: The relationship between preoperative findings, factors influencing surgical decision, and the risk of malignancy (ROM) was examined in 356 thyroid nodules with cytological diagnosis of FN at Kuma Hospital from January to December 2020.

Results: ROMs of FN with cytology results favouring malignancy (41.2%) were significantly higher than those favouring benign (7.7%) or borderline (8.2%) (p < .001). Moreover, ROMs of FN with ultrasonography results of high suspicion (54.5%) were significantly higher than those with low (4.5%) or intermediate suspicion (0%) (p < .0001). There was a large difference in overall ROM in tumours bordering 30 mm in size (<30 mm; 3.6%, ≥30 mm; 20.0%). ROMs of FNs with a tumour volume doubling rate (TVDR) of 1.0/year or more (28.6%) were higher than those of FNs with a lower TVDR (9.9%) (p < .05). The ROMs of FNs with or without one or more of the following four findings suggestive of malignancy: cytological findings favouring malignancy, ultrasonography findings of high suspicion, tumour size ≥30 mm, and TV-DR ≥1.0/year, were 14.6% and 1.0%, respectively.

Conclusion: FNs with no cytological findings favouring malignancy, no ultrasonography findings of high suspicion, tumour size <30 mm and TV-DR <1.0/year, are considered low risk and can be followed up without the need for molecular testing.

Keywords: follicular neoplasm; molecular testing; risk of malignancy; thyroid; tumour volume-doubling rate.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Five cytological findings suggestive of follicular carcinoma. (A) dense follicles; (B) three‐dimensional microfollicles; (C) trabecular arrangements; (D) hyperchromasia and enlarged nuclei. (Papanicolaou staining, (A) ×4; (B, C) ×20; (D) ×40) [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19(11):1159‐1165. - PubMed
    1. Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341‐1346. - PubMed
    1. Hirokawa M, Suzuki A, Higuchi M, et al. The Japanese reporting system for thyroid aspiration cytology 2019 (JRSTAC2019). Gland Surg. 2020;9(5):1653‐1662. - PMC - PubMed
    1. Sakamoto A, Hirokawa M, Ito M, et al. Introduction of histological classification and cytology reporting format of the Japanese General Rules for the Description of thyroid Cancer with a special focus on the differences of the WHO Histological Classification and the Bethesda System of thyroid Cytology. Endocr J. 2021;68(6):621‐630. - PubMed
    1. Hirokawa M, Higuchi M, Suzuki A, Hayashi T, Kuma S, Miyauchi A. Prevalence and diagnostic significance of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features among tumors previously diagnosed as follicular adenoma: a single‐institutional study in Japan. Endocr J. 2020;67(10):1071‐1075. - PubMed

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