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Follicular patterned lesions of the thyroid gland: a practical algorithmic approach
  1. Runjan Chetty1,2
  1. 1Department of Cellular Pathology, John Radcliffe Hospital/University of Oxford, Oxford, UK
  2. 2Nuffield Department of Clinical Laboratory Sciences, Biomedical Research Centre, John Radcliffe Hospital/University of Oxford, Oxford, UK
  1. Correspondence to Professor Runjan Chetty, Department of Cellular Pathology, Level 1, Academic Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK; runjan.chetty{at}


Follicular patterned lesions of the thyroid are problematic and interpretation is often subjective. While thyroid experts are comfortable with their own criteria and thresholds, those encountering these lesions sporadically have a degree of uncertainty with a proportion of cases. The purpose of this review is to highlight the importance of proper diligent sampling of an encapsulated thyroid lesion (in totality in many cases), examination for capsular and vascular invasion, and finally the assessment of nuclear changes that are pathognomonic of papillary thyroid carcinoma (PTC). Based on these established criteria, an algorithmic approach is suggested using known, accepted terminology. The importance of unequivocal, clear-cut nuclear features of PTC as opposed to inconclusive features is stressed. If the nuclear features in an encapsulated, non-invasive follicular patterned lesion fall short of those encountered in classical PTC, but nonetheless are still worrying or concerning, the term ‘uncertain malignant potential or behaviour, most likely benign’ is suggested. Indubitable, classical PTC nuclei (whether diffuse or restricted to a single high-power field) are diagnostic of a PTC be it classical, non-invasive or invasive follicular variant PTC. Capsular and vascular invasion remain the only reliable predictors of outcome, as non-invasive, encapsulated follicular variant PTC, even with diffuse PTC nuclear change, behaves in an indolent fashion.

  • Thyroid
  • follicular neoplasms
  • follicular variant of papillary thyroid cancer
  • papillary carcinoma
  • follicular variant
  • nuclear changes
  • GI neoplasms
  • molecular pathology
  • oesophagus
  • pancreas
  • adrenal gland
  • colorectal cancer
  • gall bladder
  • oncogenes
  • pancreas

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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