Classification And Staging

Based on risk group assignments, patients with DTC are generally separated into those with good to excellent prognoses versus those with poorer prognoses. This is important to guide the treatment strategy in order that patients with a low risk for cancer recurrence or death are managed in a less aggressive manner compared with those in the high-risk category.

Until recently, the proliferation of tumor staging systems for DTC led to much heterogeneity and difficulty in comparing the results across institutions. Therefore, acceptable rules for a staging system in DTC have been adopted by the American Joint Committee on Cancer (AJCC) and the Tumor-Node-Metastasis (TNM) Committee of the International Union Against Cancer (UICC) (Table 2-1). An interesting feature of the TNM staging system is the primacy of the patient's age at diagnosis: irrespective of the T and N categories, patients below 45 years and with no distant metastases have stage I disease, whereas those with distant metastases are classified as having stage II tumor. In patients aged 45 years and older, however, the staging system for papillary and follicular thyroid cancer follows the conventional paradigm and is similar to that adopted for patients with medullary thyroid

Figure 2-8. A histologic section of a papillary carcinoma demonstrating psammoma bodies (arrows) and fibrovascular stalks surrounded by epithelium (hematoxylin and eosin stain; x20 original magnification).

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