Analysis Tools

Anatomic Checklist for Thyroid Cancer

Intraoperative Gross Extrathyroid / Extranodal Disease

    MINIMUM DATA SET

    Basic Intraoperative Findings for AJCC Staging

    Additional Intraoperative Findings for Accurate ATA / ROR Classification

    Additional Clinicopathologic Information

    Anatomic Subsite Detail for Enhanced Reporting of Intraoperative Findings

    Anatomic Subsites for Laryngotracheal [LT] & Bone [B]

    Diagram of Laryngotracheal & Bone Anatomy

    Anatomic Subsite for Nerve [N]

    Diagram of Nerve Anatomy

    Anatomic Subsite for Pharyngoesophagus [PE]

    Diagram of Pharyngoesophagus Anatomy

    Anatomic Subsite for Muscle [M]

    Diagram of Muscle Anatomy

    Anatomic Subsite for Vascular [Vas]

    Diagram of Vasculature Anatomy

     

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    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).*

    * Proposed modifications, not present in the original 2009 initial risk stratification system.

    The publisher for this copyrighted material is Mary Ann Liebert, Inc. publishers.

    Table 5. AJCC Staging of Differentiated Thyroid Cancer (Disease Specific Mortality)

    Age at Diagnosis

    Younger than 55 Years
    TNMStage
    Group
    Any TAny NM0I
    Any TAny NM1II
    55 Years or Older
    TNMStage
    Group
    T1N0 / NXM0I
    T1N1M0II
    T2N0 / NXM0I
    T2N1M0II
    T3a / T3bAny NM0II
    T4aAny NM0III
    T4bAny NM0IV A
    Any TAny NM1IV B

    The information in Table 5 was adapted from the American Joint Committee on Cancer, 8th Ed. 2017