Controversial issues in the diagnosis and surgical treatment of patients with thyroid follicular neoplasia

Background. Preoperative morphological verification of thyroid neoplasms is the basis for determining the treatment tactics. With follicular tumors, the possibilities for fine-needle aspiration biopsy are limited, the tumor nature often cannot be determined by cytology, while the probability of malignant lesion existence is about 10–30%; this makes the choice of surgery volume rather difficult. For such cases, the search for methods of specifying differential diagnosis is extremely relevant, among which testing of somatic mutations is currently considered the most promising. Unfortunately, none of the molecular genetic methods has yet found widespread clinical use for this category of patients.

Material and methods. A single-center prospective study was conducted, which included patients with thyroid follicular neoplasia diagnosed preoperatively, who underwent various types of surgical treatment in the clinical hospital of the 1st MSMU named after IM Sechenov from 2015 to 2017. Results. Malignancy was not detected in 26 (15.5%) patients preoperatively. Intraoperatively, malignant lesions in the follicular neoplasia focus was suspected and confirmed in 13 (7.8%) patients, which led to hemithyroidectomy or thyroidectomy with lymphadenectomy. Follicular type of papillary cancer with lymph nodes metastases was confirmed in 3 cases.

Conclusion. Currently, there is a real risk of not recognizing thyroid carcinoma during the primary surgery for follicular neoplasia, which may necessitate a repeated extended surgery. In cases of follicular neoplasia (Bethesda IV), we recommend to consider hemithyroidectomy as the “gold standard” of treatment.

Keywords: follicular thyroid tumor, follicular neoplasia, thyroid cancer, fine-needle aspiration biopsy, somatic mutations, hemithyroidectomy, thyroidectomy lymphadenectomy

The authors declare no conflict of interest. Source of financing: not specified.

For citation: Gabaidze D.I., Ippolitov L.I. Controversial issues in the diagnosis and surgical treatment of patients with thyroid follicular neoplasia. Head and neck Russian Journal. 2019;7(2):70–74 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.