A patient undergoes hemithyroidectomy for a 2.5 cm follicular thyroid carcinoma. Histology shows capsular invasion only (no vascular invasion). According to current ATA 2015 guidelines risk stratification, this tumor is classified as:

• A Intermediate risk — follicular carcinoma with minor vascular invasion
• B Low risk — minimally invasive follicular carcinoma ✓
• C High risk — widely invasive follicular carcinoma
• D Intermediate risk — extensive vascular invasion

Explanation

ATA 2015 guidelines classify follicular thyroid carcinoma based on invasion pattern. Minimally invasive follicular carcinoma (MIFC) with capsular invasion only (no vascular invasion) is low risk with excellent prognosis. Encapsulated follicular carcinoma with limited vascular invasion (fewer than 4 vessels) is intermediate risk. Widely invasive or extensive vascular invasion (4 or more vessels) represents high risk. This distinction is critical as MIFC with capsular invasion only may not require completion thyroidectomy or RAI.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.