Background
Histopathologic criterion for follicular variant of papillary thyroid cancer (FVPTC)
has only recently been utilized universally. The purpose was to determine whether,
on review, these criteria would result in a change in diagnosis of follicular neoplasm
(FN).
Methods
A ten-year clinical cohort included patients with a diagnosis of a follicular adenoma,
follicular carcinoma (FC), or FVPTC. The archived sections were re-examined by two
pathologists blinded to the original diagnoses. Clinical follow-up, including ultrasonography,
was carried out on all patients with a change in diagnosis.
Results
One hundred eighty-five patients met the inclusion criteria. Initially, 118 were benign,
56 were FVPTC, and 11 were FC. Overall, 46 (25%) patients had a change in diagnosis
on re-review; 35 were reclassified from a benign diagnosis to a re-reviewed malignant
diagnosis, with 5 reclassified as minimally invasive FC, 4 as occult PTC, and 26 (74%)
as FVPTC. Of the 26 FVPTC, only 10 (38%) had undergone a total thyroidectomy (TT).
The mean follow-up was 105 months (range, 24-156). None of these patients had evidence
of recurrent or persistent disease. Eleven patients were reclassified to a benign
diagnosis. Eight have undergone a TT, with 3 of these patients receiving I131 ablation therapy. A third independent thyroid pathologist also reviewed the histopathologic
slides of these 46 patients and concurred with the change in diagnosis in 41 of the
46 patients.
Conclusions
Reclassification of FN increased malignant lesions from 36% to 48%. Although there
have been no clinical ramifications in the patients with a changed diagnosis, the
ethical issues surrounding these 46 patients are important and present a substantive
quandary to the clinicians responsible for their care.
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Article info
Publication history
Published online: January 31, 2008
Accepted:
November 24,
2007
Footnotes
See related commentary on pages 99-100 of this issue.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
