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Staging for Papillary Thyroid Cancer

  • Heather Stuart
  • Steven Rodgers
  • Janice L. PasiekaEmail author
Chapter

Abstract

Staging is an essential component of cancer care. It is necessary to estimate prognosis, develop treatment plans, facilitate communication, and establish a bases for research efforts. Various clinicopathologic features of papillary thyroid cancer have been used to create a large number of staging systems. These systems incorporate preoperative risk factors, intraoperative findings, and postoperative results to estimate mortality and to a lesser degree recurrence. Preoperatively environmental exposures, age, gender, and genetics contribute to risk assessment in addition to physical exam and ultrasonographic findings. Intraoperative thyroid gland and lymph node assessment is important for guiding management both intraoperatively and postoperatively. Finally, postoperative response to therapy is becoming a guiding principle in the dynamic staging of patients with papillary thyroid cancer. This chapter discusses the evolution of staging systems for papillary thyroid cancer as well as patient and tumor characteristics that are evaluated at different time intervals as part of the staging process.

Keywords

Papillary thyroid cancer Staging systems Proportional of variance explained Risk stratification Familial non-medullary thyroid cancer Prognostic factors Ultrasound Lymph node dissection Response to therapy Dynamic Staging 

References

  1. 1.
    Sherman SI, et al. Prospective multicenter study of thyroid carcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group. Cancer. 1998;83(5):1012–21.Google Scholar
  2. 2.
    Lang BH, et al. Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg. 2007;245(3):366–78.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988;104(6):947–53.PubMedGoogle Scholar
  4. 4.
    Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York; London: Springer; 2010. p. xiv–648.Google Scholar
  5. 5.
    Hay ID, et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114(6):1050–7; discussion 1057–8.PubMedGoogle Scholar
  6. 6.
    Hay ID, et al. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102(6):1088–95.PubMedGoogle Scholar
  7. 7.
    Pasieka JL, et al. Addition of nuclear DNA content to the AMES risk-group classification for papillary thyroid cancer. Surgery. 1992;112(6):1154–9; discussion 1159–60.PubMedGoogle Scholar
  8. 8.
    Schemper M, Henderson R. Predictive accuracy and explained variation in Cox regression. Biometrics. 2000;56(1):249–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Wong RM, Bresee C, Braunstein GD. Comparison with published systems of a new staging system for papillary and follicular thyroid carcinoma. Thyroid. 2013;23(5):566–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Hannequin P, Liehn JC, Delisle MJ. Multifactorial analysis of survival in thyroid cancer. Pitfalls of applying the results of published studies to another population. Cancer. 1986;58(8):1749–55.CrossRefPubMedGoogle Scholar
  11. 11.
    Vaccarella S, et al. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid. 2015;25:1127–36.CrossRefPubMedGoogle Scholar
  12. 12.
    Tanase K, et al. The TNM system (version 7) is the most accurate staging system for the prediction of loss of life expectancy in differentiated thyroid cancer. Clin Endocrinol (Oxf). 2016; 84:284–291.Google Scholar
  13. 13.
    Passler C, et al. Application of staging systems for differentiated thyroid carcinoma in an endemic goiter region with iodine substitution. Ann Surg. 2003;237(2):227–34.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Park YM, et al. Metastatic lymph node status in the central compartment of papillary thyroid carcinoma: a prognostic factor of locoregional recurrence. Head Neck. 2016;38 Suppl 1:E1172–6.Google Scholar
  15. 15.
    Ron E, et al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res. 1995;141(3):259–77.CrossRefPubMedGoogle Scholar
  16. 16.
    Tuttle RM, Vaisman F, Tronko MD. Clinical presentation and clinical outcomes in Chernobyl-related paediatric thyroid cancers: what do we know now? What can we expect in the future? Clin Oncol (R Coll Radiol). 2011;23(4):268–75.CrossRefGoogle Scholar
  17. 17.
    Schneider AB, Sarne DH. Long-term risks for thyroid cancer and other neoplasms after exposure to radiation. Nat Clin Pract Endocrinol Metab. 2005;1(2):82–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Cetta F, et al. Germline mutations of the APC gene in patients with familial adenomatous polyposis-associated thyroid carcinoma: results from a European cooperative study. J Clin Endocrinol Metab. 2000;85(1):286–92.PubMedGoogle Scholar
  19. 19.
    Herraiz M, et al. Prevalence of thyroid cancer in familial adenomatous polyposis syndrome and the role of screening ultrasound examinations. Clin Gastroenterol Hepatol. 2007;5(3):367–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Tomoda C, et al. Cribriform-morular variant of papillary thyroid carcinoma: clue to early detection of familial adenomatous polyposis-associated colon cancer. World J Surg. 2004;28(9):886–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Feng X, et al. Characteristics of benign and malignant thyroid disease in familial adenomatous polyposis patients and recommendations for disease surveillance. Thyroid. 2015;25(3):325–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Jarrar AM, et al. Screening for thyroid cancer in patients with familial adenomatous polyposis. Ann Surg. 2011;253(3):515–21.CrossRefPubMedGoogle Scholar
  23. 23.
    Richards ML. Familial syndromes associated with thyroid cancer in the era of personalized medicine. Thyroid. 2010;20(7):707–13.CrossRefPubMedGoogle Scholar
  24. 24.
    Mazeh H, Sippel RS. Familial nonmedullary thyroid carcinoma. Thyroid. 2013;23(9):1049–56.CrossRefPubMedGoogle Scholar
  25. 25.
    Mazeh H, et al. In patients with thyroid cancer of follicular cell origin, a family history of nonmedullary thyroid cancer in one first-degree relative is associated with more aggressive disease. Thyroid. 2012;22(1):3–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Park YJ, et al. The long-term outcomes of the second generation of familial nonmedullary thyroid carcinoma are more aggressive than sporadic cases. Thyroid. 2012;22(4):356–62.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Robenshtok E, et al. Clinical characteristics and outcome of familial nonmedullary thyroid cancer: a retrospective controlled study. Thyroid. 2011;21(1):43–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Gara SK, et al. Germline HABP2 mutation causing familial nonmedullary thyroid cancer. N Engl J Med. 2015;373(5):448–55.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hillenbrand A, et al. Familial nonmedullary thyroid carcinoma-clinical relevance and prognosis. A European multicenter study. ESES Vienna presentation. Langenbecks Arch Surg. 2010;395(7):851–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Shaha AR, Loree TR, Shah JP. Intermediate-risk group for differentiated carcinoma of thyroid. Surgery. 1994;116(6):1036–40; discussion 1040–1.PubMedGoogle Scholar
  31. 31.
    Tran Cao HS, et al. A critical analysis of the American Joint Committee on Cancer (AJCC) staging system for differentiated thyroid carcinoma in young patients on the basis of the Surveillance, Epidemiology, and End Results (SEER) registry. Surgery. 2012;152(2):145–51.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Nixon IJ, et al. Defining a valid age cutoff in staging of well-differentiated thyroid cancer. Ann Surg Oncol. 2016;23:410–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Jonklaas J, et al. The impact of age and gender on papillary thyroid cancer survival. J Clin Endocrinol Metab. 2012;97(6):E878–87.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Society AC. Estimated new cancer cases and deaths by sex for all sites, US, 2010. 2010; Available from: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026210.pdf
  35. 35.
    Cady B, et al. Risk factor analysis in differentiated thyroid cancer. Cancer. 1979;43(3):810–20.CrossRefPubMedGoogle Scholar
  36. 36.
    McCoy KL, et al. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery. 2007;142(6):837–44; discussion 844.e1–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Haugen BR, et al. 2015 American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Jarlov AE, et al. Observer variation in the clinical and laboratory evaluation of patients with thyroid dysfunction and goiter. Thyroid. 1998;8(5):393–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Kouvaraki MA, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946–54; discussion 954–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Stulak JM, et al. VAlue of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006;141(5):489–96.CrossRefPubMedGoogle Scholar
  41. 41.
    Fish SA, Langer JE, Mandel SJ. Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am. 2008;37(2):401–17, ix.CrossRefPubMedGoogle Scholar
  42. 42.
    Lee CY, et al. Preoperative laryngoscopy in thyroid surgery: do patients’ subjective voice complaints matter? Surgery. 2014;156(6):1477–82; discussion 1482–3.CrossRefPubMedGoogle Scholar
  43. 43.
    Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery. 2006;139(3):357–62.CrossRefPubMedGoogle Scholar
  44. 44.
    Surgeons B.A.o.E.a.T. Guidelines for the surgical management of endocrine disease and training requirements for endocrine surgery. 2003; Available from: http://www.baets.org.uk/wp-content/uploads/2013/02/BAETS-Guidelines-2003.pdf.
  45. 45.
    Carneiro-Pla D, et al. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery. 2014;156(6):1597–602; discussion 1602–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Sabaretnam M, et al. Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg. 2013;37(7):1740.CrossRefPubMedGoogle Scholar
  47. 47.
    Wong KP, et al. A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery. 2013;154(6):1158–64; discussion 1164–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Yeh MW, et al. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 2015;25(1):3–14.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Wiebel JL, et al. Evaluating positron emission tomography use in differentiated thyroid cancer. Thyroid. 2015;25:1026–32.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Roman S, Sosa JA. Aggressive variants of papillary thyroid cancer. Curr Opin Oncol. 2013;25(1):33–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Kazaure HS, Roman SA, Sosa JA. Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients. Ann Surg Oncol. 2012;19(6):1874–80.CrossRefPubMedGoogle Scholar
  52. 52.
    Kazaure HS, Roman SA, Sosa JA. Insular thyroid cancer: a population-level analysis of patient characteristics and predictors of survival. Cancer. 2012;118(13):3260–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Fugazzola L, et al. Correlation between B-RAFV600E mutation and clinico–pathologic parameters in papillary thyroid carcinoma: data from a multicentric Italian study and review of the literature. Endocr Relat Cancer. 2006;13(2):455–64.CrossRefPubMedGoogle Scholar
  54. 54.
    Xing M. BRAF mutation in thyroid cancer. Endocr Relat Cancer. 2005;12(2):245–62.CrossRefPubMedGoogle Scholar
  55. 55.
    Kim TH, et al. The association of the BRAF(V600E) mutation with prognostic factors and poor clinical outcome in papillary thyroid cancer: a meta-analysis. Cancer. 2012;118(7):1764–73.CrossRefPubMedGoogle Scholar
  56. 56.
    Xing M, et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer. JAMA. 2013;309(14):1493–501.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Lim JY, et al. Clinicopathologic implications of the BRAF(V600E) mutation in papillary thyroid cancer: a subgroup analysis of 3130 cases in a single center. Thyroid. 2013;23(11):1423–30.CrossRefPubMedGoogle Scholar
  58. 58.
    Niederer-Wust SM, et al. Impact of clinical risk scores and BRAF V600E mutation status on outcome in papillary thyroid cancer. Surgery. 2015;157(1):119–25.CrossRefPubMedGoogle Scholar
  59. 59.
    Lee WS, et al. BRAF mutation in papillary thyroid cancer: a cost-utility analysis of preoperative testing. Surgery. 2014;156(6):1569–77; discussion 1577–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Bongarzone I, et al. RET/NTRK1 rearrangements in thyroid gland tumors of the papillary carcinoma family: correlation with clinicopathological features. Clin Cancer Res. 1998;4(1):223–8.PubMedGoogle Scholar
  61. 61.
    Jhiang SM, et al. Targeted expression of the ret/PTC1 oncogene induces papillary thyroid carcinomas. Endocrinology. 1996;137(1):375–8.PubMedGoogle Scholar
  62. 62.
    Fagin JA, Mitsiades N. Molecular pathology of thyroid cancer: diagnostic and clinical implications. Best Pract Res Clin Endocrinol Metab. 2008;22(6):955–69.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Yip L, et al. Tumor genotype determines phenotype and disease-related outcomes in thyroid cancer: a study of 1510 patients. Ann Surg. 2015;262(3):519–25.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Nikiforov YE, et al. Impact of the multi-gene ThyroSeq next-generation sequencing assay on cancer diagnosis in thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance cytology. Thyroid. 2015;25:1217–23.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Kwak JY, et al. Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid. 2008;18(6):609–14.CrossRefPubMedGoogle Scholar
  66. 66.
    Park YM, et al. Intraoperative frozen section for the evaluation of extrathyroidal extension in papillary thyroid cancer. World J Surg. 2015;39(1):187–93.CrossRefPubMedGoogle Scholar
  67. 67.
    Matsuzu K, et al. Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1088 cases. World J Surg. 2014;38(1):68–79.CrossRefPubMedGoogle Scholar
  68. 68.
    Nixon IJ, et al. Thyroid lobectomy for treatment of well differentiated intrathyroidal malignancy. Surgery. 2012;151(4):571–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Wang LY, et al. Level VII is an important component of central neck dissection for papillary thyroid cancer. Ann Surg Oncol. 2013;20(7):2261–5.CrossRefPubMedGoogle Scholar
  70. 70.
    Gyorki DE, et al. Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol. 2013;20(7):2285–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Schneider DF, et al. Lymph node metastases do not impact survival in follicular variant papillary thyroid cancer. Ann Surg Oncol. 2015;22(1):158–63.CrossRefPubMedGoogle Scholar
  72. 72.
    Adam MA, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol. 2015;33(21):2370–5.CrossRefPubMedGoogle Scholar
  73. 73.
    Grebe SK, Hay ID. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am. 1996;5(1):43–63.PubMedGoogle Scholar
  74. 74.
    Sywak M, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140(6):1000–5; discussion 1005–7.CrossRefPubMedGoogle Scholar
  75. 75.
    Hughes DT, et al. Influence of prophylactic central lymph node dissection onpostoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148(6):1100–6; discussion 1006–7.CrossRefPubMedGoogle Scholar
  76. 76.
    Zetoune T, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. 2010;17(12):3287–93.CrossRefPubMedGoogle Scholar
  77. 77.
    Wang TS, et al. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol. 2013;20(11):3477–83.CrossRefPubMedGoogle Scholar
  78. 78.
    Hartl DM, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg. 2012;255(4):777–83.CrossRefPubMedGoogle Scholar
  79. 79.
    Rammal A, et al. Chyle leak: a rare complication post-hemithyroidectomy. case report and review of literature. Otolaryngol Pol. 2014;68(4):204–7.CrossRefPubMedGoogle Scholar
  80. 80.
    Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level VI neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg. 2015;141(7):599–606.CrossRefPubMedGoogle Scholar
  81. 81.
    Myers EN, Carrau RL. Operative otolaryngology head and neck surgery. Philadelphia: Saunders/Elsevier; 2008.Google Scholar
  82. 82.
    Roh JL, Kim JM, Park CI. Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol. 2008;15(4):1177–82.CrossRefPubMedGoogle Scholar
  83. 83.
    Farrag T, et al. Is routine dissection of level II-B and V-A necessary in patients with papillary thyroid cancer undergoing lateral neck dissection for FNA-confirmed metastases in other levels. World J Surg. 2009;33(8):1680–3.CrossRefPubMedGoogle Scholar
  84. 84.
    Randolph GW, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22(11):1144–52.CrossRefPubMedGoogle Scholar
  85. 85.
    Castagna MG, et al. Limited value of repeat recombinant human thyrotropin (rhTSH)-stimulated thyroglobulin testing in differentiated thyroid carcinoma patients with previous negative rhTSH-stimulated thyroglobulin and undetectable basal serum thyroglobulin levels. J Clin Endocrinol Metab. 2008;93(1):76–81.CrossRefPubMedGoogle Scholar
  86. 86.
    Kloos RT, Mazzaferri EL. A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab. 2005;90(9):5047–57.CrossRefPubMedGoogle Scholar
  87. 87.
    Pacini F, et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003;88(8):3668–73.CrossRefPubMedGoogle Scholar
  88. 88.
    Tuttle RM, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid. 2010;20(12):1341–9.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Sakorafas GH, Sampanis D, Safioleas M. Cervical lymph node dissection in papillary thyroid cancer: current trends, persisting controversies, and unclarified uncertainties. Surg Oncol. 2010;19(2):e57–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Heather Stuart
    • 1
    • 2
  • Steven Rodgers
    • 1
  • Janice L. Pasieka
    • 2
    • 3
    Email author
  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Surgery, Sections of General Surgery and Surgical OncologyUniversity of Calgary, Cunning School of MedicineCalgaryCanada
  3. 3.Department of Surgery and Oncology, Faculty of MedicineUniversity of Calgary, Foothills Medical CentreCalgaryCanada

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