Criteria

Staging and risk stratification

Used to guide treatment of papillary, follicular, or oncocytic thyroid cancer. The staging systems for differentiated thyroid carcinoma disease-specific survival include the American Joint Committee on Cancer (AJCC) system and Metastasis, Age, Completeness of Resection, Invasion, and Size (MACIS).[64][65]​ The following are favourable prognostic factors:

  • Female sex

  • Age <55 years

  • Size of nodule <4 cm

  • No extrathyroidal extension

  • Absence of metastatic disease

  • Low-grade histology.

The 2015 American Thyroid Association (ATA) staging system is better at estimating the risk of persistent or recurrent disease.[1][66] This staging system defines three groups of patients with different risk of recurrence:[1]

  • Low-risk: intrathyroidal differentiated thyroid cancer; ≤5 lymph node micrometastases (<0.2 cm)

  • Intermediate-risk: aggressive histology, minor microscopic extrathyroidal extension, vascular invasion, or >5 involved lymph nodes (0.2 to 3.0 cm)

  • High-risk: gross extrathyroidal extension, incomplete tumour resection, distant metastases, or lymph nodes >3.0 cm).

Appropriate molecular risk stratification requires integration of the genetic abnormality into the proper clinical context.[66]

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