Unidad de Endocrinología, Departamento de Medicina Interna, Centro Oncológico Fundación Arturo López Pérez, Santiago, Chile.
Departamento de Endocrinología, CETREN-UC, Facultad de Medicina de la Pontificia Universidad Católica de Chile, Santiago, Chile.
Arch Endocrinol Metab. 2023 Mar 30;67(3):348-354. doi: 10.20945/2359-3997000000580. Epub 2023 Jan 17.
Follicular thyroid carcinoma (FTC) is less frequent but has a worse prognosis than papillary carcinoma. The available evidence on pre-operative characteristics of FTC is controversial. Our objective was to characterize the clinical, ultrasound and histopathological presentation of FTC patients treated Chile.
Retrospective analysis of 97 patients treated for FTC in 6 large centers in Chile. We analyzed their ultrasonographic features and classified the nodules according to ATA risk of malignancy and TI-RADS score, as well as the cytological findings according to the Bethesda system. We described their clinical and histopathological findings at diagnosis and classified their risk of recurrence and mortality according to ATA 2015 recurrence risk category and the eighth edition of the AJCC/UICC staging system, respectively.
Median age was 48 years and 73.2% were females. The median diameter was 38.8 mm; only 9.5% of them were microtumors. According to ATA risk of malignancy, 86% of the nodules were low or intermediate suspicious, while 78% were category 3 or 4A nodules according to the TI-RADS. Regarding the Bethesda system, 65.9% had indeterminate cytology (20.6% category III and 45.3% category IV). At histological examination, most were minimally-invasive and angio-invasive tumors with less than 4 foci (54.7% and 28.4% respectively). More than 90% of FTC were unifocal and there was no lymphovascular or extrathyroidal invasion or lymph node involvement. Four patients (4.1%) had distant metastases at diagnosis. Most patients (95%) had stage I or II disease according to the AJCC/UICC staging system, while the risk of recurrence was low at 51.5% when using the ATA risk of recurrence scale.
At diagnosis, most FTCs were nodules of low or intermediate suspicion at ultrasound, nearly two thirds had indeterminate cytology according to the Bethesda system, and nearly 50% of them were of low risk of recurrence.
滤泡状甲状腺癌（FTC）比乳头状癌少见，但预后更差。关于 FTC 术前特征的现有证据存在争议。我们的目的是描述在智利接受治疗的 FTC 患者的临床、超声和组织病理学表现。
对智利 6 家大型中心治疗的 97 例 FTC 患者进行回顾性分析。我们分析了他们的超声特征，并根据美国甲状腺协会（ATA）恶性风险和 TI-RADS 评分对结节进行分类，以及根据 Bethesda 系统对细胞学检查结果进行分类。我们描述了他们在诊断时的临床和组织病理学发现，并根据 ATA 2015 年复发风险分类和第 8 版 AJCC/UICC 分期系统分别对其复发和死亡风险进行分类。
中位年龄为 48 岁，73.2%为女性。中位直径为 38.8mm；只有 9.5%的结节为微结节。根据 ATA 恶性风险，86%的结节为低度或中度可疑，而根据 TI-RADS，78%的结节为 3 类或 4A 类。根据 Bethesda 系统，65.9%的细胞学结果为不确定（20.6%为 3 类，45.3%为 4 类）。组织学检查显示，大多数为微小侵袭性和血管侵袭性肿瘤，病灶少于 4 个（分别为 54.7%和 28.4%）。超过 90%的 FTC 为单灶性，无血管淋巴管或甲状腺外侵犯或淋巴结受累。4 例患者（4.1%）在诊断时发生远处转移。根据 AJCC/UICC 分期系统，大多数患者（95%）为 I 期或 II 期疾病，而根据 ATA 复发风险分类，复发风险较低，为 51.5%。
在诊断时，大多数 FTC 为超声低或中度可疑结节，根据 Bethesda 系统，近三分之二的细胞学结果为不确定，近 50%的患者复发风险低。
