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Minimally Invasive Follicular Carcinoma

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Question

I am still confused on the staging and management of a minimally invasive follicular carcinoma. As an example, I have a patient who is 35 years old and had a 3.7cm minimally invasive follicular carcinoma resected with a total thyroidectomy. The remainder of the gland showed only thyroiditis. There was no vascular invasion noted. This patient went on to receive remnant ablation and now has a thyroglobulin level of <0.3 and a negative thyroglobulin antibody. A follow-up scan was negative. My question is was this all necessary? Would you stage this as a T2N0M0 follicular carcinoma, or is different staging terminology used for minimally invasive follicular ca. Also, would you have gone on to I131 ablation or is this not necessary and would you alter your long term follow-up in this patient from that normally given to patients who have T2M0N0 papillary or follicular carcinomas. Thanks for your help,

Karen Kartun, M.D.

Response

There certainly is growing evidence that such minimally invasive tumors without vascular invasion behave in a very benign manner. However, I remain cautious. A 3.7 minimally invasive CA is still a danger, and the size is a significant factor. I believe I would follow her as a “regular” cancer patient at this stage. She is apparently cured. Thus you probably will follow with TGs if you can (but what about her antibodies???), do periodic neck US, and I personally would do another scan in 2-3 years, and then reconsider the need for further scans.

L De Groot,MD