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Thyroid pathology is notoriously fraught with high interobserver variability, and follicular-patterned tumors are among some of the most challenging to assess accurately and reproducibly. Given that encapsulated or well-circumscribed follicular-patterned tumors often have similar molecular profiles, that is, frequent RAS or RAS-like alterations, the diagnosis usually relies on histopathologic examination alone. Unfortunately, many of the features that are used for diagnosis and prognosis of these tumors have long been controversial and frequently debated topics, both due to their subjectivity and their evolving (or not yet resolved) definitions. In more recent years, the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features has added further complexity to this discussion. In particular, the criteria and significance of nuclear features of papillary thyroid carcinoma, architectural patterns, and invasive growth still pose significant diagnostic challenges and confusion. This review explores some of the challenges in evaluating encapsulated follicular-patterned tumors, focusing on those histologic elements.
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http://dx.doi.org/10.1016/j.path.2022.09.005 | DOI Listing |
EClinicalMedicine
August 2025
Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Background: Conventional diagnostic tools, including ultrasound, fine-needle aspiration cytology, and intraoperative frozen section pathology, may fail to reliably distinguish between benign and malignant FNs, leading to unnecessary or inadequate surgical interventions. We aimed to develop and validate a deep learning (DL) system for the preoperative diagnosis of follicular-patterned thyroid neoplasms (FNs) using routine ultrasound images, with the goal of improving diagnostic accuracy and reducing unnecessary procedures.
Methods: In this multicenter, retrospective study, we included 3817 patients (2877 [75.
Endocrinol Metab (Seoul)
June 2025
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
In 2024, the Korean Thyroid Association (KTA) introduced a revised Risk Stratification System (K-RSS) for differentiated thyroid cancer, building upon the modified RSS (M-RSS) proposed by the American Thyroid Association in 2015. The K-RSS emphasizes the cumulative impact of coexisting clinical and pathological features, acknowledging that multiple intermediate-risk factors collectively indicate a higher recurrence risk. Histologic classification follows the 2022 World Health Organization classification, consolidating encapsulated follicular-patterned thyroid carcinomas, including invasive encapsulated follicular variant papillary thyroid carcinoma, follicular thyroid carcinoma, and oncocytic carcinoma of the thyroid gland, and stratifying them by the extent of capsular and vascular invasion.
View Article and Find Full Text PDFKaohsiung J Med Sci
June 2025
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Over the past few years, follicular-patterned thyroid nodules with nuclear features of papillary thyroid carcinoma (PTC) have been further subclassified based on molecular profiling, histologic features, and clinical behavior. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) was established as a distinct entity in the 2017 4th edition of the WHO Classification of Tumors of Endocrine Organs due to its indolent clinical behavior and excellent prognosis. These tumors are characterized by a well-defined border, an exclusive follicular growth pattern, and PTC nuclear features.
View Article and Find Full Text PDFIntroduction: Mutations of RAS genes are detected in a spectrum of follicular-patterned thyroid tumors. Preoperative prediction of invasive cancers based on the presence of RAS mutation alone is challenging because non-invasive and invasive tumors tend to have similar sonographic and cytologic features. The aim of this study was to perform clinicopathologic and molecular analyses of RAS-mutant tumors, identify molecular and clinical markers associated with invasiveness, and determine their diagnostic and therapeutic potentials.
View Article and Find Full Text PDFKorean J Radiol
June 2025
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Objective: To compare the diagnostic outcomes of core needle biopsy (CNB) and fine-needle aspiration (FNA) using Bethesda IV as a test-positive criterion for diagnosing follicular-patterned neoplasms in a large multicenter cohort.
Materials And Methods: This retrospective study included 5463 thyroid nodules ≥1 cm from 4883 patients (4019 females, 864 males; mean age 53.8 years) that underwent FNA or CNB across 26 hospitals in Korea between June and September 2015.