A pathologic re-review of follicular thyroid neoplasms: the impact of changing the threshold for the diagnosis of the follicular variant of papillary thyroid carcinoma.
Surgery
; 144(1): 80-5, 2008 Jul.
Article
en En
| MEDLINE
| ID: mdl-18571588
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 I(131) 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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias de la Tiroides
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Adenocarcinoma Papilar
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Adenocarcinoma Folicular
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Ética Clínica
/
Errores Diagnósticos
Tipo de estudio:
Diagnostic_studies
Aspecto:
Ethics
Límite:
Humans
Idioma:
En
Revista:
Surgery
Año:
2008
Tipo del documento:
Article
País de afiliación:
Canadá
Pais de publicación:
Estados Unidos