Endocrine > Thyroid > Neoplasms

Staging Criteria for Thyroid Cancer

[Radiology 2008; Donahue KP, et al. Initial staging of differentiated thyroid carcinoma: continued utility of posttherapy 131I whole-body scintigraphy. 246: 887-894]

Age and Stage Size Location Metastases Survival % Papillary Survival % Follicular
Under 45 years

0

I Any Any 0
97 95
II Any
Any
(+)
 93  90
≥ 45 years          
I Less than 2 cm 0 0 97 95
II 2-4 cm 0 0 93 90
III Any size Spread to nodes around the thyroid- prelaryngeal and or Delphian pre and or paratracheal nodes (N1a) 0 83 69
  Tumor larger than 4 cm 0 0    
IVa Any size Spread to nodes lateral cervical or superior mediastinal nodes (N1b) 0    
  Any size tumor with local invasion into subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerves 0 0    
IVb Tumor invades mediastinum or prevertebral fascia or encases carotid artery Any 0 39 41
IVc Any Any (+)    

TNM Classification System for Differentiated Thyroid Cancer

[AJR 2009; Park JS, et al. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. 192: 66-72]


Category Description
Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor is ≤ 2cm in greatest dimension and is limited to the thyroid; T1a 1cm, but ≤ 2cm
T2 Tumor is >2 cm but ≤ 4cm in greatest dimension and is limited to the thyroid
T3 Tumor is > 4 cm in greatest dimension and limited to the thyroid or any tumor with minimal extrathyroid extension such as extension to the sternothyroid muscle or perithyroid soft tissues
T4a Tumor of any size extends beyond the thyroid capsule to invade subcutaneous tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve
T4b Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node mets
N1a Metastases to level VI (pretracheal, paratracheal, and prelaryngeal or Delphian nodes)
N1b Metastases to unilateral or bilateral cervical or superior mediastinal lymph nodes
Mx Distant metastases cannot be assessed
M0 No distant metastases
M1 Distant metastases

TNM Staging System [From: J Nucl Med 2012; Avram AM. Radioiodine scintigraphy with SPECT/CT: an important diagnostic tool for thyroid cancer staging and risk stratification. 53: 754-764]

Patients under 45 years of age

Stage
T
N
M
Stage I
Any T
Any N
M0
Stage II
Any T
Any N
M1

Patients 45 years or older

Stage
T
N
M
Stage I
T1
N0
M0
Stage II
T2
N0
M0
Stage III
T3
T1/T2/T3
N0
N1a
M0
M0
Stage IVA
T1/T2/T3
T4a
N1b
Any N
M0
M0
Stage IVB
T4b
Any N
M0
Stage IVC
Any T
Any N
M1

Thyroid Cancer Risk Assessment

TABLE 3

Thyroid Cancer Risk Stratification [From: J Nucl Med 2012; Avram AM. Radioiodine scintigraphy with SPECT/CT: an important diagnostic tool for thyroid cancer staging and risk stratification. 53: 754-764]


ATA Thyroid Cancer Risk Stratification
Very low risk
Unifocal or multifocal microcarcinomas (< 1cm)


MACIS score < 6, or TNM score: T1?2, N0, M0 (MACIS= (metastases, Age, Completeness of resection, invasiveness, size of tumor, staging system devloped at the Mayo Clinic)


In patients < 45 years old: tumors < 4 cm confined to the thyroid


Excludes tumors with aggressive histology* (tall cell, insular, columnar, diffuse sclerosing, trabecular solid, poorly differentiated variants of papillary carcinoma, Hurthle cell variant of follicular thyroid carcinoma) or vascular invasion
Low-risk (all criteria must be met)
In patients < 45 years old: MACIS < 6, or TNM score: any T any N, M0


In patients ≥ 45 years old: MACIS < 6, or TNM score: T2, N0, M0

No local or distant metastases

All macroscopic tumor has been resected

There is no tumor invasion of locoregional tissues or structures

The tumor does not have aggressive histology* or vascular invasion

If 131I is given, there is no 131I uptake outside the thyroid bed on the first post-therapy scan
Intermediate/Moderate risk (any criteria)
In patients < 45 years old: tumors > 4 cm; macroscopic (> 1cm) N1a or N1b; T1?3, N1b, M0


In patients ≥ 45 years old: T3, N0, M0 or T1?3, N1a, M0


MACIS score > 6


Minimally invasive (microscopic capsular, but not vascular invasion) FTC < 4 cm

Tumor with aggressive histology* or vascular invasion

Microscopic invasion of tumor into the perithyroidal soft tissues at initial surgery

Cervical lymph node metastases, or 131I uptake outside the thyroid bed on the post-therapy scan
High-risk (any criteria)
In patients < 45 years old: T4a?4b, any N, M0, or any T, any N, M1


In patients ≥ 45 years old: any T, N1a?1b, M0, AJCC Stages IVA, IVB, IVC


FTC > 4 cm, or macroscopic invasive FTC

Distant metastases

Macroscopic tumor invasion

Incomplete tumor resection

Thyroglobulinemia out of proportion to what is seen on the post-therapy scan

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