title: Follicular variant of papillary thyroid carcinoma: differences from conventional disease in cytologic findings and high-risk features.
abstract: OBJECTIVE
  The follicular variant (FV) of papillary thyroid carcinoma (PTC) is an important subtype that can be difficult to diagnose using preoperative cytologic analysis.
  
  
  OBJECTIVE
  To compare conventional and FV PTC with regard to preoperative cytologic diagnosis using a tiered thyroid cytologic reporting system, tumor size at diagnosis, presence of invasion, and implications on prognostic scores.
  
  
  METHODS
  This retrospective study was conducted in an academic teaching hospital and included 99 patients with conventional (n = 65) or FV (n = 34) PTC.
  
  
  METHODS
  Preoperative thyroid cytologic findings, originally reported using the tiered British Thy system, were recategorized according to the Bethesda classification system. Pathologic features recorded included tumor size, presence of extrathyroid extension (ETE), and metastases. Prognostic scores were calculated according to the MACIS system.
  
  
  METHODS
  Differences in patient demographics, preoperative cytologic findings, tumor pathologic features, and prognostic risk categories between conventional and FV PTC were studied.
  
  
  RESULTS
  There were no differences in patient age or sex. Cytologic findings from FV PTC were significantly more likely to be reported in a lower-risk category than those from conventional PTC for (1) malignant vs lower-risk category (22 [56%] vs 2 [8%]); (2) suspected malignant or malignant vs lower-risk category (26 [66%] vs 6 [23%]); and (3) follicular neoplasm or higher-risk category vs lower-risk category (34 [87%] vs 10 [38%]) (P < .001 for all 3 comparisons). There was also a significantly higher likelihood of false-negative cytologic findings among FV PTC cases (5 [19%] vs 1 [3%]) (P = .03). The mean size of FV PTC lesions (25.9 mm) at the time of pathologic diagnosis was significantly greater than that of conventional PTC lesions (15.5 mm) (P = .02). Even after exclusion of "coincidental" carcinomas, FV PTC tumors were significantly larger than conventional PTC tumors (31.7 vs 22.4 mm; P = .03). In contrast, FV PTC was significantly less likely to show ETE (0 of 34 vs 10 of 65; P = .01). There were no significant differences between FV PTC and conventional PTC in proportion of patients in intermediate- and high-risk prognostic groups combined (21 [62%] vs 38 [58%]) (P = .83) or in mean MACIS scores (4.68 and 4.38, respectively; P = .18).
  
  
  CONCLUSIONS
  Preoperative cytologic findings from FV PTC were more likely than those from conventional PTC to indicate a lower risk category, and FV PTC tumors were larger at time of diagnosis. On the other hand, owing to a lower incidence of ETE in conventional PTC, there was no difference in prognostic score at diagnosis.
authors.affiliation: Department of Otolaryngology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
authors.affiliation: Department of Otolaryngology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mohamed
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: Linda
authors.initials: L
authors.lastname: Feeley
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: Brendan
authors.initials: B
authors.lastname: Fitzgerald
authors.affiliation: Department of Pathology, Cork University Hospital, Cork, Ireland.
authors.forename: Julie
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: Department of Endocrinology, Cork University Hospital, Cork, Ireland.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tuthill
authors.affiliation: Department of Endocrinology, South Infirmary University Hospital, Cork, Ireland.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000367:Age Factors; D018265:Carcinoma, Papillary, Follicular / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D047368:Tumor Burden