Follow-up Strategy in Follicular Thyroid Cancer

Abstract

As with papillary thyroid cancer, the effort applied to the search for recurrent follicular thyroid cancer is determined by the prognostic risk of tumor recurrence and death from disease. The presence or absence of certain poor prognostic indicators is used to tailor the frequency and intensity of surveillance for tumor recurrence. As discussed below (see also Chapter 40), many of the same determinants of prognosis in papillary thyroid cancer are applicable to patients with follicular thyroid cancer. Based largely on tumor histology and findings at the time of surgery, patients with follicular thyroid cancer may be divided into two nonoverlapping subtypes: minimally invasive (the majority) and widely invasive tumors (the minority; 1). Patients with widely invasive follicular cancer have a higher incidence of cancer-related death than patients with papillary thyroid cancer (1,2). Conversely, patients with minimally invasive follicular thyroid cancer are at a relatively low risk for recurrence and cancer-related death (3–6). This chapter reviews the rationale used to determine appropriate follow-up for patients with follicular thyroid cancer and provides a current overview of the tools available to assist in this objective.