Clinicopathological characteristics of DTC recurrence risk stratification

Low risk (low risk of recurrence)

 

Papillary thyroid cancer (meeting all of the following).
 
no regional lymph nodes or distant metastases no residual bulk tumor
no external invasion of the tumor
 
non-malignant histological subtype of high degree
 
no iodine uptake outside the thyroid bed on first postoperative whole-body nuclear scan no vascular invasion
cN0 or less than 5 small lymph node metastases (<0.2 cm in diameter)
 
Follicular subtype PTC, located within the thyroid, not breaching the envelope; tiny thyroid papillae

Carcinoma, in the thyroid, unifocal or multifocal, may have BRAF V600E mutation
 
FTC, located in the thyroid, well differentiated, with envelope invasion and no vascular invasion, or with only microvascular invasion

Intermediate risk (intermediate risk of recurrence)

 

Meets any 1 of the following.
 
Microinvasion of peri-thyroidal tissue
 
First postoperative nuclear imaging with iodine uptake in the neck lesion
 
subtype with high malignancy (hypercellular, columnar cell, diffuse sclerosis, etc.) with vascular invasion
cN1 or pN1 with more than 5 lymph node metastases and metastases less than 3 cm in diameter
 
Multifocal papillary microcarcinoma of the thyroid with or without BRAF V600E mutation

High risk (high risk of recurrence)

 

Meets any 1 of the following.
 
Obvious invasion of soft tissue tumor residue around the thyroid
distant metastasis
 
High postoperative serum Tg suggesting distant metastases
 
pN1 and metastatic lymph node metastases ≥3cm in diameter
 
Extensive vascular invasion of follicular thyroid cancer (>4 vascular invasions)