Widder S et al. – Reclassification of follicular neoplasm (FN) increased malignant lesions from 36% to 48%; although a changed diagnosis has no clinical ramifications in these pts, associated ethical issues are important Methods
Study of whether histopathologic criteria for follicular variant of papillary thyroid cancer (FVPTC) may change diagnosis of FN
Review of a 10-yr clinical cohort of 185 pts with a diagnosis of a follicular adenoma, follicular carcinoma (FC), or FVPTC
Re-examination of archived sections by 2 pathologists blinded to original diagnoses
Clinical follow-up and ultrasound for all pts with a diagnosis change
Results
Initial diagnoses: 118 benign, 56 FVPTC, 11 FC
On re-review, 46 (25%) pts had diagnosis change; 35 reclassified from benign to malignant diagnosis; 5 reclassified as minimally invasive FC, 4 occult PTC, and 26 (74%) FVPTC
Of the 26 FVPTC, only 10 (38%) had total thyroidectomy (TT)
Mean follow-up: 105 mo (range, 24-156)
No pts had evidence of recurrent or persistent disease
Reclassification to a benign diagnosis: 11 pts
Of 8 pts who had TT, 3 had I131 ablation therapy
A third independent thyroid pathologist reviewed slides for 46 pts and concurred with diagnosis change in 41 of 46 pts
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