Question about grossing thyroids

[horrendoma]

---

Members don't see this ad.

Hi
Wonder how you guys gross solitary encapsulated follicular lesions in the thyroid. I was taught to pass all of the capsule to r/o follicular carcinoma, but someone told me that you can just pass 6-7 cassettes of capsule strips, and if you don't find any carcinoma then, you aren't likely to find carcinoma if you go back and submit the entire capsule....

What do you guys think?

 

[deleted314957]

Hi
Wonder how you guys gross solitary encapsulated follicular lesions in the thyroid. I was taught to pass all of the capsule to r/o follicular carcinoma, but someone told me that you can just pass 6-7 cassettes of capsule strips, and if you don't find any carcinoma then, you aren't likely to find carcinoma if you go back and submit the entire capsule....

What do you guys think?

I would suggest you follow the recommendations of Dr's. Liolsi and Baloch as described in Chpt.13 of Sternberg's surg path text. If you look it up and read it it will stick better than being spoon fed.

 

[horrendoma]

I would suggest you follow the recommendations of Dr's. Liolsi and Baloch as described in Chpt.13 of Sternberg's surg path text. If you look it up and read it it will stick better than being spoon fed.

Maybe you misunderstood the thrust of my question. I know that minimally invasive follicular ca

Hmmm. All they've said is
- don't do multiple frozens, its useless. (We never do)
- lobectomy for minimally invasive follicular ca is curative anyway (so we shouldn't worry too hard about diagnosing it? What if a met pops up a decade later ? )
- Only the pathologist can diagnose minimally invasive follicular carcinoma by sampling the capsule (yes, yes, we sample the capsule. HOW MUCH TO SAMPLE, DAMMIT? EVERY SINGLE MILIMETER? OR go like ovarian tumours, 1 block per cm )

What I want to know is
- Is there any evidence based/statistical studies regarding the value of grossing the whole capsule vs just grossing a lot of it, in order to reconcile the two different opinions of schizophrenic attendings who on one day will scream at you for not passing the whole capsule, and on another day scream at you for having to sign out 45 slides of capsule strips with you

 

[Gene_]

- in order to reconcile the two different opinions of schizophrenic attendings who on one day will scream at you for not passing the whole capsule, and on another day scream at you for having to sign out 45 slides of capsule strips with you

When you are in practice, do whatever you think is appropriate based on the literature. When grossing for someone else, I think a good rule is that whenever you think to yourself, "This is a lot of cassettes", you should ask the pathologist what and how much they want submitted.

 

[KCShaw]

I don't keep up with the literature on this, so I can't answer the heart of your question. Personally, however, I was always taught to submit the entire capsule, period. This was pretty consistent among attendings where I trained, however, so it wasn't a problem.

This is the kind of discrepancy I would consider bringing to the AP chair, because you'd generally rather not have a significant difference in how you're handling the same specimen within the department and from the same surgeon.

 

[TMZ2007]

I've always put in the entire capsule in strips and then some percentage of the remainder of the tumor, and state the %. On bigger lesions (say 4-5 cm or so) that may end up being 20 blocks or more, I usually give a shout to the attending before submitting them, "You really want 30 blocks?" Everything < 3 cm or so or <20 blocks gets entirely submitted without question.

At a glance this seems to imply that full capsule examination picks up more carcinomas:
http://www.ncbi.nlm.nih.gov/pubmed/1373582

 

[TinyFish]

Also taught to submit the entire capsule here. Although I haven't really read any primary literature.