Published in:
01-12-2020 | ASO Author Reflections
ASO Author Reflections: Revisiting the Prognostic Significance of Grade in Papillary Thyroid Carcinoma
Authors:
Allen S. Ho, MD, Wendy L. Sacks, MD, Zachary S. Zumsteg, MD
Published in:
Annals of Surgical Oncology
|
Special Issue 3/2020
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Excerpt
The management of papillary thyroid carcinoma (PTC) has undergone colossal change, driven largely by the understanding that most disease is low risk. A substantial percentage of PTC can now be managed without total thyroidectomy, without radioactive iodine, and without prophylactic central neck dissection. However, it is important not to overlook the fact that thyroid cancer still encompasses a spectrum of disease. Current guidelines have catalogued more than 20 pathologic features that define risk stratification criteria.
1 Interestingly, histologic grade is not included, despite its prominence as a factor in older prognostic acronyms (i.e., AGES, SAG, GAMES) validated by multiple institutions as highly influential regarding survival.
2 This exclusion also is curious given that less differentiated cancers (culminating in anaplastic thyroid carcinoma) intuitively appear to present with a greater incidence of aggressive regional and distant spread. The utility of external beam radiation therapy (EBRT) for less differentiated subtypes also has remained controversial.
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