The Clinical Outline
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The Clinical Outline consists of 3 parts.
Page Contents
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Educational Contents
This section shows at-a-glance any new, clinically relevant content that may have been discussed or uncovered during any of our weekly seminars. New content will be added dynamically, in the form of video clips. Summaries in text will later be written up to facilitate devices with lower bandwidth that might have difficulty streaming video.
Areas of Discordance
When we first began developing TIRO, it was immediately clear that certain guidelines differ on a given topic. We resolved to handle this by identifying those differences and giving context to them. This section shows—in brief—the summarized areas of discordance within the text, shown in red. In addition to exposing the differences in the content, we have asked experts in the field to offer their commentary—to shed light on the reasons for any discordance.
Tables & Figures
Differentiated Thyroid Cancer
Tables & Figures
Table 4. Familial & Heritable Forms of Thyroid Cancer
Familial Adenomatosis Polyposis
Gene | APC |
Benign Thyroid Disease | 40% |
Cancer | 0.4–12% |
Cancer Types | CMV-PTC: 63% FV-PTC: 25% PTC: 12% |
PTEN-Hamartoma Tumor (Cowden)
Gene | PTEN |
Benign Thyroid Disease | 75% |
Cancer | 35% |
Cancer Types | PTC: 50% FV-PTC: 28% FTC: 14% |
Carney Complex Type 1
Gene | PRKARIA |
Benign Thyroid Disease | ≤ 75% |
Cancer | < 5% |
Cancer Types | PTC FTC |
RET-Associated
Gene | RET |
Benign Thyroid Disease | — |
Cancer | 100% |
Cancer Types | MTC |
DICER1
Gene | DICER1 |
Benign Thyroid Disease | ≤ 30% |
Cancer | — |
Cancer Types | FTC FV-PTC |
Bethesda System
Bethesda Category I
Meaning | Non Diagnostic |
Estimated Risk of Malignancy | 5–10% |
Bethesda Category II
Meaning | Benign |
Estimated Risk of Malignancy | 0–3% |
Bethesda Category III
Meaning | Atypia of Undetermined Significance (AUS) / Follicular Lesion of Undetermined Significance (FLUS) |
Estimated Risk of Malignancy | 10–30% |
Bethesda Category IV
Meaning | Suspicious for a Follicular (or Hürthle Cell) Neoplasm |
Estimated Risk of Malignancy | 25–40% |
Bethesda Category V
Meaning | Suspicious for Malignancy |
Estimated Risk of Malignancy | 50–75% |
Bethesda Category VI
Meaning | Malignant |
Estimated Risk of Malignancy | 97–99% |
Figure 1. ATA Pattern-Based Ultrasound Findings vs TIRADS Point-based System
Figure 2. ACR TI-RADS Classification of Thyroid Nodules
Tables & Figures
Figure 4. Levels of the Neck for Lymph Node Classification
Table 3. Anatomic Boundaries of the Neck Levels
Level I
Anterior |
Anterior belly of the contralateral digastric muscle. |
Posterior |
Stylohyoid muscle |
Superior |
Body of the mandible |
Inferior |
Hyoid |
Level II
Anterior |
Stylohyoid muscle |
Posterior |
Posterior SCM |
Superior |
Skull base |
Inferior |
Hyoid |
Level III
Anterior |
Sternohyoid muscle |
Posterior |
Stylohyoid muscle |
Superior |
Hyoid |
Inferior |
Horizontal plane defined by the cricoid cartilage. |
Level IV
Anterior |
Sternohyoid muscle |
Posterior |
Posterior SCM |
Superior |
Inferior border of the cricoid cartilage. |
Inferior |
Clavicle |
Level V
Anterior |
Posterior SCM |
Posterior |
Anterior border of trapezius. |
Superior |
Convergence of the SCM and trapezius. |
Inferior |
Clavicle |
Level VI
Anterior |
Anterior layer of the cervical fascia. |
Posterior |
Deep layer of the cervical fascia. |
Superior |
Hyoid superiorly |
Inferior |
Sternal notch |
Level VII
Anterior |
Sternum |
Posterior |
Deep layer of the cervical fascia. |
Superior |
Sternal notch |
Inferior |
Innominate on right and equivalent plane on the left. |
Initial Staging
Tables & Figures
Figure 10a. Definition of tumor size (T)
Figure 10b. Definition of regional lymph node (N)
Response to Therapy
Management Recommendations Based on Risk Stratification
Tables & Figures
Table 11. Risk Stratification System with Proposed Modifications (ATA 2009)
Risk Level
ATA Low Risk
- Papillary thyroid cancer (with all of the following):
- No local or distant metastases,
- All macroscopic tumor has been resected,
- No tumor invasion of loco-regional tissues or structures,
- The tumor does not have aggressive histology (e.g. tall cell, hobnail variant, columnar cell carcinoma),
- If I131 is given, there are no RAI-avid metastatic foci outside the thyroid bed on the first post-treatment whole-body RAI scan,
- No vascular invasion,
- Clinical N0 or ≤ 5 pathologic N1 micrometastases (< 0.2 cm in largest dimension).*
- Intrathyroidal, encapsulated follicular thyroid variant of papillary thyroid cancer.*
- Intrathyroidal, well-differentiated follicular thyroid cancer with capsular invasion and no or minimal (< 4 foci) vascular invasion.*
- Intrathyroidal, papillary microcarcinoma, unifocal or multifocal, including BRAFV600E mutated (if known).*
ATA Intermediate Risk
- Microscopic invasion of tumor into the perithyroidal soft tissues.
- RAI-avid metastatic foci in the neck on the first post-treatment whole-body RAI scan.
- Aggressive histology (e.g. tall cell, hobnail variant, columnar cell carcinoma).
- Papillary thyroid cancer with vascular invasion.
- Clinical N1 or > 5 pathologic N1 with all involved lymph nodes < 3 cm in largest dimension.*
- Multifocal papillary microcarcinoma with ETE and BRAFV600E mutated (if known).*
ATA High Risk
- Macroscopic invasion of tumor into the perithyroidal soft tissues (gross ETE).
- Incomplete tumor resection.
- Distant metastases.
- Postoperative serum thyroglobulin suggestive of distant metastases.
- Pathologic N1 with any metastatic lymph node ≥ 3 cm in largest dimension.*
- Follicular thyroid cancer with extensive vascular invasion (> 4 foci of vascular invasion).*
Figure 11. ATA Spectrum of Risk of Recurrence
Figure 5. management recommendations in ATA low risk DTC patients who have undergone total thyroidectomy
Figure 6. management recommendations in ATA low risk DTC patients who have undergone less than total thyroidectomy
Figure 7. management recommendations in ATA intermediate risk DTC patients who have undergone total thyroidectomy
Figure 8. management recommendations in ATA high risk DTC patients who have undergone total thyroidectomy and have no gross residual disease
Figure 9. management recommendations in patients with Follicular Neoplasms
Response to Therapy Based on Initial Management
Tables & Figures
Table 2a. Response to Therapy: Total Thyroidectomy & RRA (ATA compared to ESMO)
ATA // ESMO
Response to Therapy
Excellent
Imaging |
No relevant findings on imaging. |
TSH-Suppressed Tg |
< 0.2 ng/mL |
TSH-Stim TG |
< 1 ng/mL |
TgAB |
• Not specified (ATA) • Undetectable (ESMO) |
Biochem Incomplete
Imaging |
No relevant findings on imaging. |
TSH-Suppressed Tg |
1 ng/mL |
TSH-Stim TG |
10 ng/mL |
TgAB |
Rising TgAB levels |
Structural Incomplete
Imaging |
Evidence of structural or functional disease. * |
TSH-Suppressed Tg |
* |
TSH-Stim TG |
* |
TgAB |
* |
Indeterminate
Imaging |
Nonspecific findings on US/CT. — OR — Faint uptake in thyroid bed on RAI scanning. |
TSH-Suppressed Tg |
• Tg detectable, but < 1 ng/mL (ATA) • 0.2–1 ng/mL (ESMO) |
TSH-Stim TG |
• Stimulated Tg detectable, but < 10 ng/mL (ATA) • 1–10 ng/mL (ESMO) |
TgAB |
TgAB levels stable or declining in the absence of structural or functional disease. |
Table 2b. Response to Therapy: Total Thyroidectomy Alone
ESMO
Response to Therapy
Excellent
Imaging |
No relevant findings on imaging. |
TSH-Suppressed Tg |
< 0.2 ng/mL |
TSH-Stim TG |
Not Specified |
TgAB |
Undetectable |
Biochem Incomplete
Imaging |
No relevant findings on imaging. |
TSH-Suppressed Tg |
Tg > 5 ng/mL – OR – Rising Tg values with similar TSH levels. |
TSH-Stim TG |
— |
TgAB |
Rising TgAB levels |
Structural Incomplete
Imaging |
Evidence of structural or functional disease. * |
TSH-Suppressed Tg |
* |
TSH-Stim TG |
* |
TgAB |
* |
Indeterminate
Imaging |
Nonspecific findings on US/CT. — OR — Faint uptake in thyroid bed on RAI scanning. |
TSH-Suppressed Tg |
< 0.2–5 ng/mL |
TSH-Stim TG |
Not Specified |
TgAB |
TgAB levels stable or declining in the absence of structural or functional disease. |
Table 2c. Response to Therapy: Lobectomy Alone
ESMO
Response to Therapy
Excellent
Imaging |
No relevant findings on imaging. |
TSH-Suppressed Tg |
Stable |
TSH-Stim TG |
Stable |
TgAB |
Undetectable |
Biochem Incomplete
Imaging |
No relevant findings on imaging. |
TSH-Suppressed Tg |
Rising Tg values with similar TSH levels |
TSH-Stim TG |
TgAB |
Rising |
Structural Incomplete
Imaging |
Evidence of structural or functional disease. * |
TSH-Suppressed Tg |
* |
TSH-Stim TG |
* |
TgAB |
* |
Indeterminate
Imaging |
Nonspecific findings on US/CT. |
TSH-Suppressed Tg |
* |
TSH-Stim TG |
* |
TgAB |
* |
Genetic Alterations & Histologic Features
Tables & Figures
Table 7. Gene Alterations & Histology
Phenotype
Toxic Adenoma
Known Somatic Genetic Mutation / Alterations
- TSH-R
- GNAS
Benign Thyroid Nodules
Known Somatic Genetic Mutation / Alterations
- N-, H- and K-RAS
- EIF1AX
Noninvasive Follicular Tumor with Papillary-like Features (NIFTP)
Known Somatic Genetic Mutation / Alterations
- N-, H- and K-RAS
- BRAF K601E
Infiltrative Follicular Variant Papillary Thyroid Carcinoma (FVPTC)
Known Somatic Genetic Mutation / Alterations
- N-, H- and K-RAS
- BRAF V600E
Papillary Thyroid Carcinoma (PTC)
Known Somatic Genetic Mutation / Alterations
- RET/PTC
- BRAF V600E
- N-, H-, K-RAS
- TERT
Columnar Cell, Tall Cell, Hobnail Variant PTC
Known Somatic Genetic Mutation / Alterations
- BRAF V600E
Diffuse-sclerosing Variant PTC
Known Somatic Genetic Mutation / Alterations
- RET/PTC
Follicular Thyroid Carcinoma (FTC)
Known Somatic Genetic Mutation / Alterations
- N-, H- and K-RAS
- PAX8/PPAR
- PTEN
Hürthle Cell Carcinoma
Known Somatic Genetic Mutation / Alterations
- NRAS
- Genes in the PI3K-Akt Pathway
Poorly Differentiated Thyroid Carcinoma (PDTC)
Known Somatic Genetic Mutation / Alterations
- N-RAS (Insular)
- BRAF V600E
- PIK3CA
- RET/PTC
- TERT
Anaplastic Thyroid Carcinoma (ATC)
Known Somatic Genetic Mutation / Alterations
- N-RAS, BRAF V600E
- PIK3CA
- TP53
- β-catenin
- EIF1AX
Medullary Thyroid Carcinoma (MTC)
Known Somatic Genetic Mutation / Alterations
- RET (Germ Line Mutation in Inherited MTC, Somatic Mutation)
- N-, H- and K-RAS (Somatic Mutations)
Table 8. Histologic Subtypes of PTC
Subtype
Follicular-variant
Nuclear Features of PTC Present? |
Yes |
Characteristics |
• RAS mutation more common. • Follicular growth pattern. |
Prognosis |
10-year DSS 93% |
Follicular-variant Encapsulated, Invasive
Nuclear Features of PTC Present? |
— |
Characteristics |
• RAS mutation or PPARG rearrangement more common. • Low rate of LNM. |
Prognosis |
10-year DSS ~100% |
Follicular-variant Nonencapsulated / Infiltrative
Nuclear Features of PTC Present? |
— |
Characteristics |
BRAF V600E more common. |
Prognosis |
Equivalent to classic / conventional PTC |
Columnar Cell
Nuclear Features of PTC Present? |
No |
Characteristics |
• Papillae lined by columnar cells with nuclear stratification. • Large tumors with capsular invasion are associated with LNM and DM. |
Prognosis |
Variable |
Cribiform Morular
Nuclear Features of PTC Present? |
Occasionally |
Characteristics |
• Presence of morules—squamoid areas with intranuclear inclusions and nuclear clearing. • Associated with Familial Adenomatosis Polyposis Syndrome. |
Prognosis |
Equivalent to classic / conventional PTC |
Classic / Conventional
Nuclear Features of PTC Present? |
Yes |
Characteristics |
LNM Common |
Prognosis |
• 5-year DSS 97.4% • 10-year DSS 93% |
Diffuse Sclerosing
Nuclear Features of PTC Present? |
Yes |
Characteristics |
• Diffuse fibrosis. • Dense lymphoid infiltration. • Squamous metaplasia. |
Prognosis |
• 5-year DSS 96% • Equivalent to high-risk PTC |
Tall Cell
Nuclear Features of PTC Present? |
Yes |
Characteristics |
• Extrathyroidal extension and LNM possible. • > 30% cells are 2x tall as wide and eosinophilic cytoplasm. |
Prognosis |
5-year DSS 95.6% |
Hobnail
Nuclear Features of PTC Present? |
Yes |
Characteristics |
• Increased risk of DM. • > 30% have hobnail features (eccentric nuclei and tapering cytoplasm). • Syncytial or micropapillary clusters with apically placed nuclei. • BRAF V600E or p53 positive |
Prognosis |
5-year DSS 83% |
Tables & Figures
Table 9. Remnant Ablation Decision Making
Tumor Description
Tumor ≤ 1 cm
ATA Risk | Low |
Disease specific survival improved by RAI | No |
Disease free survival improved by RAI | No* |
RAI indicated | No |
Tumor > 1–4 cm
ATA Risk | Low |
Disease specific survival improved by RAI | No |
Disease free survival improved by RAI | Unclear data* |
RAI indicated | Not routinely |
Tumor > 4 cm
ATA Risk | Low |
Disease specific survival improved by RAI | Unclear data* |
Disease free survival improved by RAI | Unclear data* |
RAI indicated | Consider |
Micro ETE (Any tumor size)
ATA Risk | Low / Intermediate |
Disease specific survival improved by RAI | No |
Disease free survival improved by RAI | Unclear data* |
RAI indicated | Consider |
Central LN Mets
ATA Risk | Low / Intermediate |
Disease specific survival improved by RAI | No |
Disease free survival improved by RAI | Unclear data* |
RAI indicated | Consider |
Lateral or Mediastinal LN Mets
ATA Risk | Low / Intermediate |
Disease specific survival improved by RAI | No |
Disease free survival improved by RAI | Unclear data* |
RAI indicated | Consider |
Any Size Gross ETE
ATA Risk | High |
Disease specific survival improved by RAI | Yes |
Disease free survival improved by RAI | Yes* |
RAI indicated | Yes |
Distant Metastasis
ATA Risk | High |
Disease specific survival improved by RAI | Yes |
Disease free survival improved by RAI | Yes* |
RAI indicated | Yes |
Medullary Thyroid Cancer
Tables & Figures
Table 12. Most Common RET Mutations with Associated Risks
RET Mutation
Highest Risk Level (HST)
M918T
RET Exon | 16 |
Risk of Aggressive MTC | Highest |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | – |
High Risk Level (H)
C634F/G/R/S/W/Y
RET Exon | 11 |
Risk of Aggressive MTC | High |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | 20–30% |
A883F
RET Exon | 15 |
Risk of Aggressive MTC | High |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | – |
Moderate Risk Level (MOD)
G533C
RET Exon | 8 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | – |
C609F/G/R/S/Y
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C611F/G/S/Y/W
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C618F/R/S
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C620F/R/S
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C630R/Y
RET Exon | 11 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
D631Y
RET Exon | 11 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | – |
K666E
RET Exon | 11 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | – |
E768D
RET Exon | 13 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | – |
Incidence of Hyperparathyroidism | – |
L790F
RET Exon | 13 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | – |
V804L/M
RET Exon | 14 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | 10% |
S891A
RET Exon | 15 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | 10% |
R912P
RET Exon | 16 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | – |
Incidence of Hyperparathyroidism | – |
Tables & Figures
Figure 12. ATA Management of Patients with RET Germline Mutation Detected on Genetic Screening.
Table 12. Most Common RET Mutations with Associated Risks
RET Mutation
Highest Risk Level (HST)
M918T
RET Exon | 16 |
Risk of Aggressive MTC | Highest |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | – |
High Risk Level (H)
C634F/G/R/S/W/Y
RET Exon | 11 |
Risk of Aggressive MTC | High |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | 20–30% |
A883F
RET Exon | 15 |
Risk of Aggressive MTC | High |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | – |
Moderate Risk Level (MOD)
G533C
RET Exon | 8 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | – |
C609F/G/R/S/Y
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C611F/G/S/Y/W
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C618F/R/S
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C620F/R/S
RET Exon | 10 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
C630R/Y
RET Exon | 11 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10–30% |
Incidence of Hyperparathyroidism | 10% |
D631Y
RET Exon | 11 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 50% |
Incidence of Hyperparathyroidism | – |
K666E
RET Exon | 11 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | – |
E768D
RET Exon | 13 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | – |
Incidence of Hyperparathyroidism | – |
L790F
RET Exon | 13 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | – |
V804L/M
RET Exon | 14 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | 10% |
S891A
RET Exon | 15 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | 10% |
Incidence of Hyperparathyroidism | 10% |
R912P
RET Exon | 16 |
Risk of Aggressive MTC | Moderate |
Incidence of Pheochromocytoma | – |
Incidence of Hyperparathyroidism | – |
Anaplastic Thyroid Cancer
Tables & Figures
Table 13. T Staging for ATC
T Stage
T1
Description
< 2 cm
T2
Description
> 2 cm and < 4 cm
T3a
Description
> 4 cm
T3b
Description
Invasion of the strap muscles.
T4a
Description
Any size cancer with invasion of the larynx, trachea, esophagus, or the recurrent laryngeal nerve.
T4b
Description
Any size cancer with extension to the vertebrae or involvement of the carotid artery.
Table 16. Panel of Routine Immunohistochemical Markers
IHC Marker
Pan-cytokeratins
DTC | +++ |
PDTC | +++ |
ATC | +++/– |
MTC | +++ |
SCC | +++ |
Lymphoma | – |
Thyroglobulin
DTC | +++ |
PDTC | +/– |
ATC | – |
MTC | – |
SCC | – |
Lymphoma | – |
Thyroid-transcription factor 1
DTC | +++ |
PDTC | +/– |
ATC | –/+ |
MTC | +/– |
SCC | – |
Lymphoma | – |
BRAFV600E
DTC | +/– |
PDTC | –/+ |
ATC | –/+ |
MTC | – |
SCC | – |
Lymphoma | – |
PAX8
DTC | +++ |
PDTC | +++ |
ATC | +/– |
MTC | +/– |
SCC | – |
Lymphoma | +/–a |
Ki-67b
DTC | < 5% |
PDTC | 5–30% |
ATC | > 30% |
MTC | < 20% |
SCC | > 30% |
Lymphoma | variable |
Chromogranin
DTC | – |
PDTC | – |
ATC | – |
MTC | +++ |
SCC | – |
Lymphoma | – |
Calcitonin
DTC | – |
PDTC | – |
ATC | – |
MTC | +++/– |
SCC | – |
Lymphoma | – |
Carcinembryonic antigen
DTC | – |
PDTC | – |
ATC | – |
MTC | +++ |
SCC | – |
Lymphoma | – |
p53
DTC | – (rare +) |
PDTC | –/+ |
ATC | +/– |
MTC | – |
SCC | +/– |
Lymphoma | +/– |
CD45, other lymphoid markers
DTC | – |
PDTC | – |
ATC | – |
MTC | – |
SCC | – |
Lymphoma | +++ |
Table 17. Mutations & Clinical Implications.
Mutations
BRAFV600E
Clinical Implications
Commonly seen in DTC which may be precursor to ATC.
Incidence in ATC
40–70% of ATCs and often seen in ATC arising from PTC.
RAS
Clinical Implications
Commonly seen in DTC which may be precursor to ATC.
Incidence in ATC
—
TP53
Clinical implications
Considered late stage in the carcinogenesis process. More commonly found in ATC.
Incidence in ATC
Found in 50–70% of ATC.
TERT
Clinical Implications
Considered late stage in the carcinogenesis process. More commonly found in ATC.
Incidence in ATC
Seen in 65–75% of ATC.
P13K/AKT
Clinical Implications
Considered late stage in the carcinogenesis process.
Incidence in ATC
30–40% of ATC.
EIF1AX
Clinical Implications
Often present with RAS mutations.
Incidence in ATC
—
Figure 13. Treatment Algorithm of ATC
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