Differentiated thyroid cancer: Clinicopathologic staging
- R Michael Tuttle, MD
R Michael Tuttle, MD
- Professor of Medicine
- Memorial Sloan Kettering Cancer Center
Clinicopathologic staging of patients with cancer is valuable for many reasons, including the following:
●To estimate risk of recurrence and disease-specific mortality for an individual patient
●To tailor decisions regarding postoperative adjunctive therapy (such as the need for radioiodine [RAI] ablation and degree of thyroid-stimulating hormone [TSH] suppression) to the patient's risk for disease recurrence and mortality
●To make decisions regarding the frequency, modality, and intensity of follow-up based upon an individual patient's risk of recurrence and mortality
●To enable accurate communication regarding a patient among health care professionals
- Tuttle RM, Morris LF, Haughen BR, et al. Thyroid - Differentiated and Anaplastic Carcinoma. In: AJCC Cancer Staging Manual, 8th, Amin MB. (Ed), Springer, New York 2017. p.873.
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- Vaisman F, Tala H, Grewal R, Tuttle RM. In differentiated thyroid cancer, an incomplete structural response to therapy is associated with significantly worse clinical outcomes than only an incomplete thyroglobulin response. Thyroid 2011; 21:1317.
- Vaisman F, Shaha A, Fish S, Michael Tuttle R. Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 2011; 75:112.
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- Ghossein RA, Leboeuf R, Patel KN, et al. Tall cell variant of papillary thyroid carcinoma without extrathyroid extension: biologic behavior and clinical implications. Thyroid 2007; 17:655.
- Hiltzik D, Carlson DL, Tuttle RM, et al. Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients. Cancer 2006; 106:1286.
- STAGING FOR DIFFERENTIATED THYROID CANCER
- Staging systems for predicting disease-specific mortality
- - TNM system
- - MACIS system
- - National Thyroid Cancer Treatment Cooperative Study
- Staging systems used to predict initial risk of recurrence
- - ATA risk stratification
- Dynamic risk stratification
- OTHER PROGNOSTIC FACTORS
- Lymphocytic infiltration
- PET-positive tumors
- Histologic subtypes
- Molecular characteristics
- SUMMARY AND RECOMMENDATIONS