Aggressive Variants of Papillary Thyroid Cancer: Incidence, Characteristics and Predictors of Survival among 43,738 Patients

Kazaure, Hadiza S.; Roman, Sanziana A.; Sosa, Julie Ann

doi:10.1245/s10434-011-2129-x

Cited by 208 publications

(199 citation statements)

References 37 publications

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“…First described in 1985, DSV is characterized by papillary morphology, diffuse involvement of the thyroid gland, prominent fibrosis, abundant psammoma bodies, squamous metaplasia, and lymphocytic infiltration easily confused with thyroiditis (6)(7)(8). It accounts for approximately 2-6% of PTC, classically occurs in young women, and is reported to have increased rates of multifocality, bilaterality, extrathyroidal extension, recurrence, and nodal/distant metastasis (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). TCV, first described in 1976, accounts for 3-12% of all PTC, and is characterized by a population of cells at least twice as tall as they are wide, comprising 30-70% of total tumor cells (8,(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

“…TCV, first described in 1976, accounts for 3-12% of all PTC, and is characterized by a population of cells at least twice as tall as they are wide, comprising 30-70% of total tumor cells (8,(18)(19)(20)(21)(22). TCV has been reported to be larger than classic PTC on average, with higher rates of bilaterality, multifocality, extrathyroidal extension, recurrence, lymph-node/distant metastasis, and decreased survival (12,17,(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Introductionmentioning

confidence: 99%

“…Studies of aggressive variants of PTC largely consist of case reports and single-center case series, and two population-level studies that have been performed on the topic of DSV and TCV do not specifically address tumors £ 1 cm in size (17,30). Similarly, in studies of mPTC, the inclusion of aggressive morphologies is either variable or unclear, and it appears that no subset analysis of aggressive variants has been undertaken (4,5,31).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Aggressive Variants of Papillary Thyroid Microcarcinoma Are Associated with Extrathyroidal Spread and Lymph-Node Metastases: A Population-Level Analysis

Kuo

Goffredo

Sosa

et al. 2013

Thyroid

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Background: Tall cell variant (TCV) and diffuse sclerosing variant (DSV) of papillary thyroid cancer are aggressive subtypes, for which tumors £ 1 cm have not been exclusively studied. Methods: The SEER database ) was used to compare characteristics of TCV £ 1 cm (mTCV) and DSV £ 1 cm (mDSV) with classic papillary thyroid microcarcinoma (mPTC). Survival was analyzed with the KaplanMeier method and log-rank test, and risk factors for nodal metastases with chi-square analysis and binary logistic regression. Results: There were 97 mTCV, 90 mDSV, and 18,260 mPTC patients. mTCV incidence increased by 79.9% ( p = 0.153) over the study period, while mDSV incidence decreased by 10.3% ( p = 0.315). Compared to classic mPTC, mTCV tended to be larger on average (7.1 mm vs. 5.3 mm, p < 0.001), with higher rates of multifocality (47.2% vs. 34.0% respectively, p = 0.018) and lymph-node examination (63.9% vs. 39.2% respectively, p < 0.001), while in mDSV, nodal metastases were more frequent (57.1% vs. 33.1% respectively, p = 0.007). Both aggressive variants had higher rates of extrathyroidal extension (27.8% mTCV vs. 13.3% mDSV vs. 6.1% mPTC, p < 0.001). Aggressive variants also received radioactive iodine more frequently (39.2% mTCV vs. 40.0% mDSV vs. 29.1% mPTC, p < 0.001). However, they were not statistically more likely to receive thyroidectomy over lobectomy compared to classic mPTC. There were no significant differences in overall and disease-specific survival between the histologies. In mTCV, after adjustment, extrathyroidal extension was independently associated with size > 7 mm (odds ratio (OR) 4.4 [CI 1.5-13.6]) and nodal metastasis with multifocality ) and extrathyroidal extension . No statistically significant predictors of extrathyroidal extension or nodal metastasis in mDSV were observed. Conclusions: Aggressive variants of mPTC tend to exhibit more aggressive pathologic characteristics than classic mPTC, but survival appears to be similar. Treatment with total thyroidectomy and central lymphadenectomy may be warranted if the diagnosis can be made pre-or intraoperatively.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aggressive Variants of Papillary Thyroid Microcarcinoma Are Associated with Extrathyroidal Spread and Lymph-Node Metastases: A Population-Level Analysis

Kuo

Goffredo

Sosa

et al. 2013

Thyroid

Self Cite

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“…This uncertainty about classification of the tall-cell variant is common to many analyses that are nevertheless reported and show a worse prognosis associated with tall-cell variant. An example is an analysis where use of the Surveillance, Epidemiology, and End Results (SEER) database precludes any central review of pathology (24). This decision not to incorporate tall-cell variant does not greatly alter the summary measures of model performance in the present results because subtypes such as the tall-cell variant are rare.…”

Section: Potential Revision Of Staging Systemmentioning

confidence: 99%

“…However, there may be subtypes of differentiated thyroid cancer associated with poor prognosis, such as the tall-cell variant of papillary thyroid cancer (24,28,29). As mentioned, examination of subtypes of papillary cancer beyond a preliminary analysis was not pursued because of potential lack of standardization of the histologic classification, inability to submit pathology to central review, the rarity of tall-cell variant, and the anticipated lack of support for adding a second nonanatomical factor in addition to age.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis

McLeod

Jonklaas

Brierley

et al. 2015

Thyroid

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Background: Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. Objective: This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. Methods: A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R 2 ). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. Results: The best five alternate papillary cancer systems had age cut-points of 45-50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems ( p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50-55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system ( p = 0.003-0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years ( p = 0.197). Conclusions:No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation.

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Incidental Thyroid Nodules and Thyroid Cancer

Tufano

Noureldine

Angelos

2015

JAMA Otolaryngol Head Neck Surg

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The worldwide incidence of thyroid cancer is increasing substantially, almost exclusively attributable to small papillary thyroid cancers. Increased use of diagnostic imaging is considered the most likely explanation for this reported rise, but other factors may also be contributing. The increase in health care expenditures related to managing these presumably low-risk cancers, without a clear patient benefit, has resulted in a backlash against the early detection of thyroid cancer. Currently, there is no way to confidently predict which incidentally detected thyroid nodule may be the precursor to a more aggressive process. Predictions such as these would require more accurate characterization of the biology of individual thyroid cancers than is currently possible. With time, we might prove our ability to confidently differentiate low-risk from high-risk thyroid cancers, but until that happens, routine screening for thyroid cancer by imaging billed as a "health checkup" should not be performed. However, incidentally detected thyroid nodules should be reported, and a clear medical team management plan should be developed. Our ethical responsibility is to provide patients with objective, evidence-based information about their disease status, not to assume that we know what is best for them by selectively withholding information. In addition, providing patients with psychosocial assistance will help them process the information necessary to make informed decisions that will provide them with the most value when a small thyroid nodule or cancer is incidentally identified. Herein, we summarize the epidemiological data for disease incidence, discuss some controversies in disease management, and outline the key elements and ethical considerations of informed decision making as they apply to managing incidentally detected thyroid nodules and thyroid cancer.

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Aggressive Variants of Papillary Thyroid Cancer: Incidence, Characteristics and Predictors of Survival among 43,738 Patients

Abstract: DSV and TCV are rare, increasing in incidence, and have a worse prognosis than classic PTC. Patients with these variants should be treated aggressively with thyroidectomy and radioiodine, regardless of tumor size.

Cited by 208 publications

References 37 publications

Aggressive Variants of Papillary Thyroid Microcarcinoma Are Associated with Extrathyroidal Spread and Lymph-Node Metastases: A Population-Level Analysis

Aggressive Variants of Papillary Thyroid Microcarcinoma Are Associated with Extrathyroidal Spread and Lymph-Node Metastases: A Population-Level Analysis

Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis

Incidental Thyroid Nodules and Thyroid Cancer

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