Dr.Guttler’s clinical opinion about suspicious for follicular micro-follicular neoplasms
1. The name should be micro follicular neoplasm not follicular neoplasm. It is the excess numbers of micro follicular groups that show the ability to invade blood vessels and capsule.
2.True microfollicular neoplasms have a 25% chance to be follicular carcinoma, but very loose criteria have resulted in too many called suspicious when they are not.
3. The use of a molecular classifier on suspicious for microfollicular neoplasm is helpful when the result is negative. Patients in my practice with negative classifier result are followed without surgery.
4.Positive mutations for BRAF,RET/PTC, are subject to total thyroidectomies, while RAS mutations are associated with follicular driven neoplasms that are unifocal and a lobectomy is the operation of choice as many are benign and if they are cancer they act like follicular carcinoma and if minimally invasive they do not need completion thyroidectomy.
5. Guttler’s law: Do not get talked into surgery before a complete evaluation of your nodule includes classifier and molecular marker studies obtained at the time of a repeat biopsy.