Pitoia, Fabián1; Urciuoli, Carolina2; Falcón, Florencia3; Smulever, Anabella2; Jerkovich, Fernando2; Paes de Lima, Andrea3
1 Head Thyroid Section, Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
2 Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
3 Department of pathology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
Objective: To assess the change in the risk of recurrence (RR) and in the response to therapy in patients with differentiated thyroid cancer (DTC) after the review of the historic histopathologic samples (HPS) considering specific features proposed by the Modified Risk Stratification System from the ATA 2009 .
Patients and methods: Sixty-three available HPS from DTC patients with low and intermediate RR who underwent total thyroidectomy and remnant ablation in our hospital were reviewed. The RR and the response to therapy were re-assessed considering the new histological features (vascular invasion, extent of extrathyroidal extension, volume of lymph node metastases, presence of extranodal extension and status of the resection margins).
Results: A change in the RR category was made in 16 of 63 cases (25,4%). Out of 46 patients initially classified as low RR, 2 of them were re-classified as intermediate RR, 4 patients as high RR and one as NIFTP. Out of 17 patients initially classified as intermediate RR, 3 were re-assigned to the low RR group, 5 as high RR and one as NIFTP. The percentages of structural incomplete response at final follow-up changed from 6.3 to 20% (p=0.53) in patients with intermediate RR and from 2.2 to 0% (p=1) in patients with low RR.
Discussion: A detailed report of specific features in the HPS of patients with DTC gives a more accurate RR classification and estimation of the response to treatment, although it seems not to be absolutely necessary for predicting the final response to treatment.
- Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L: 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The Ameriagancan Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133.