Objective To summarize recent advances in the preoperative differential diagnosis, pathological risk stratification, and standardized management of follicular thyroid carcinoma (FTC), aiming to inform clinical decision-making. Method Recent domestic and international literature regarding the preoperative diagnosis, pathological typing, surgical strategies, radioactive iodine (RAI) therapy, and systemic treatments for FTC was comprehensively reviewed and summarized. Results Regarding preoperative diagnosis, the integration of neoplasm-specific ultrasound risk stratification systems, multimodal imaging, radiomics integrated with artificial intelligence models, and molecular biomarkers—including genetic profiling via tissue and liquid biopsies—demonstrates utility in refining the preoperative risk stratification of follicular thyroid neoplasms. Nevertheless, definitive diagnosis of FTC remains contingent upon histopathological examination following surgical resection. Therapeutic strategies emphasize individualized, risk-based management aligned with the 2022 WHO Classification and the 2025 American Thyroid Association Guidelines, stratifying interventions based on tumor invasiveness and vascular involvement. Thyroid lobectomy is recommended as sufficient therapy for low-risk FTC (minimally invasive, non-vascularly invasive tumors), offering a favorable prognosis while minimizing surgical morbidity. For low-to-intermediate-risk FTC (<4 sites of vascular invasion), management necessitates a personalized approach incorporating patient age, tumor dimensions, and informed patient preferences. Total thyroidectomy with adjuvant RAI therapy is advocated for high-risk patients exhibiting extensive vascular invasion (≥4 sites), significant extrathyroidal extension, or distant metastases; subsequent management is tailored based on dynamic risk stratification. Thermal ablation is not endorsed as a primary curative modality for surgically eligible candidates. For progressive, unresectable, or RAI-refractory FTC, upfront molecular profiling and multidisciplinary tumor board review are imperative. Identification of actionable drivers (e.g., BRAF^V600E mutation, RET fusion, and NTRK fusion) warrants matched targeted therapies as first-line treatment. In the absence of specific targets, multikinase inhibitors such as lenvatinib or sorafenib remain the systemic therapy mainstay. Conclusion The clinical management of FTC has gradually shifted from treatment decisions based on a single indicator to a whole-course individualized management model encompassing preoperative risk stratification, standardized surgery and pathological examination, postoperative dynamic risk stratification surveillance, with molecular subtyping and targeted therapy integrated for advanced disease.

Citation： ZHAI Xinping, ZHENG Xun, WEI Tao. Advances in diagnosis and treatment of follicular thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(9): 1295-1306. doi: 10.7507/1007-9424.202606068 Copy

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