J.Jpn. Surg. Soc.. 124(1): 25-31, 2023

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Feature topic

MANAGEMENT OF FOLLICULAR THYROID NEOPLASIA AND BORDERLINE LESIONS

Most thyroid malignancies are diagnosed preoperatively by ultrasonography and other imaging methods and aspiration biopsy cytology, and the treatment plan is determined according to the presumed histology. However, since follicular carcinoma is diagnosed by structural atypia, it is difficult to make a diagnosis before surgery using the above methods. In clinical practice, making full use of ultrasonography and cytological diagnostic findings will help avoid missing patients with follicular carcinoma. Outside Japan, it has been reported that when aspiration cytology results are indeterminate, cytological specimens can be used to identify genetic mutations, thereby reducing the need for diagnostic thyroidectomy. However, it is difficult to diagnose follicular carcinoma specifically. The prognosis of follicular carcinoma is generally good, but distant metastasis may have a poor prognosis. Among factors related to recurrence, age, tumor size, and histological findings are reported to be important. On the other hand, the fourth edition of the histological classification proposed by WHO in 2017 raised a new disease concept of encapsulated follicular tumors, which corresponds to an intermediate stage between benign and malignant or borderline lesions. The prognosis and management of these diseases are still not satisfactory, and regular follow-up continues to be required after surgery.

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