At the just concluded 2014 American Thyroid Association (ATA) Annual Meeting, Professor Bryan R. Haugen, Chair of the Thyroid Cancer Guidelines Working Group, revealed that the thyroid cancer guidelines were last updated in 2009 and that a new edition of the guidelines will be released in 2015, with the goal of developing new guidelines based on evidence-based medicine, which will increase the number of recommended entries from 80 to 101 in the 2009 edition , the number of references will increase from 437 to 996, with 17 Tabs and 8 Figs to help more clinicians!
Low risk patients
Papillary thyroid cancer
No local or distant metastasis
All tumors visible to the naked eye have been removed
No local tissue or structure with tumor invasion
No invasive pathologic histologic type (e.g., high cell, islet, columnar cell carcinoma)
No vascular invasion
Clinical stage N0 or pathologic stage N1 micrometastases (≤5 lymph nodes involved, tumor largest diameter <0.2 cm)< div="">
If 131I therapy has been given, no extra-thyroidal bed 131I uptake is detected on the first post-treatment 131I whole-body image
Intra-thyroidal, follicular subtype of papillary thyroid carcinoma
Intra-thyroid, differentiated follicular thyroid carcinoma with envelope infiltration only
Intra-thyroidal differentiated follicular thyroid carcinoma with minor vascular invasion
Intra-thyroid, microscopic papillary carcinoma, solitary or multifocal, including BRAF V600E mutation (if BRAF V600E mutation is known)
Intermediate risk patients
Microscopic finding of tumor with peri-thyroidal soft tissue invasion
Clinical stage N1 or pathologic stage N1 (>5 lymph nodes involved and all lymph nodes <3 cm maximum diameter)< div="">
131I uptake outside the thyroid bed on first post-treatment whole-body 131I imaging
Invasive pathologic histologic type (e.g., high-cell, islet-like, columnar cell carcinoma)
Vascular invasion of papillary thyroid carcinoma
Intrathyroidal, papillary thyroid carcinoma, primary tumor 1-4 cm in diameter, BRAF V600E mutation (if BRAF V600E mutation is known)
Multifocal micro papillary carcinoma with extraglandular invasion and BRAF V600E mutation (if BRAF V600E mutation is known)
High risk patients
Visible tumor invasion of soft tissue around the thyroid gland to the naked eye
Incomplete resection of the tumor
Presence of distant metastases
Pathological stage N1 with any metastatic lymph nodes ≥ 3 cm in maximum diameter
Abnormally high postoperative serum Tg level
Follicular thyroid cancer with extensive vascular infiltration (vascular invasion >4 lesions)