Abstract:
Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid
gland, accounting for up to 20% of all primary malignant tumors in iodine-replete areas. The
diagnostic work-up, staging, risk stratification, management, and follow-up strategies in patients
who have FTC are modeled after those of papillary thyroid carcinoma (PTC), even though FTC is
more aggressive. FTC has a greater propensity for haematogenous metastasis than PTC. Furthermore,
FTC is a phenotypically and genotypically heterogeneous disease. The diagnosis and identification
of markers of an aggressive FTC depend on the expertise and thoroughness of pathologists during
histopathological analysis. An untreated or metastatic FTC is likely to de-differentiate and become
poorly differentiated or undifferentiated and resistant to standard treatment. While thyroid lobectomy
is adequate for the treatment of selected patients who have low-risk FTC, it is not advisable for patients
whose tumor is larger than 4 cm in diameter or has extensive extra-thyroidal extension. Lobectomy is
also not adequate for tumors that have aggressive mutations. Although the prognosis for over 80% of
PTC and FTC is good, nearly 20% of the tumors behave aggressively. The introduction of radiomics,
pathomics, genomics, transcriptomics, metabolomics, and liquid biopsy have led to improvements
in the understanding of tumorigenesis, progression, treatment response, and prognostication of
thyroid cancer. The article reviews the challenges that are encountered during the diagnostic workup,
staging, risk stratification, management, and follow-up of patients who have FTC. How the
application of multi-omics can strengthen decision-making during the management of follicular
carcinoma is also discussed.
