Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

Pitoia, Fabián; Jerkovich, Fernando; Urciuoli, Carolina; Falcón, Florencia; Lima, Andrea Páes de

doi:10.20945/2359-3997000000020

Acessibilidade / Reportar erro

Brasil

Archives of Endocrinology and Metabolism

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arch. Endocrinol. Metab. 62 (2) • Mar-Apr 2018 • https://doi.org/10.20945/2359-3997000000020 copy

Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To compare the historic risk of recurrence (RR) and response to therapy to risk stratification estimated with historical pathology reports (HPRs) and contemporary re-review of the pathological slides in patients with differentiated thyroid cancer (DTC).

Subjects and methods

Out of 210 DTC patients with low and intermediate RR who underwent total thyroidectomy and remnant ablation in our hospital, 63 available historic pathologic samples (HPS) were reviewed. The RR and the response to therapy were evaluated considering historical histological features (histological type, tumor size, capsular invasion, number of lymph node metastases) and then, reassessed after observing additional histological features (vascular invasion, extrathyroidal extension, size of lymph node metastases, presence of extranodal extension, and/or status of the resection margins).

Results

A change in the RR category was observed in 16 of 63 cases (25.4%). Out of 46 patients initially classified as low RR, 2 patients were reclassified as intermediate RR, 4 as high RR, and 1 as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Out of 17 patients initially classified as intermediate RR, 3 were reassigned to the low RR group, 5 as high RR, and 1 as NIFTP. The percentages of structural incomplete response at final follow-up changed from 2.2 to 0% (p = 1) in patients with low RR and from 6.3 to 20% (p = 0.53) in patients with intermediate RR.

Conclusion

A detailed report of specific features in the HPR of patients with DTC might give a more accurate RR classification and a better estimation of the response to treatment.

Keywords
Risk of recurrence; response to therapy; differentiated thyroid cancer; historic histopathologic review

Variable		Informed in initial report	Informed after HSR
Number of foci of vascular invasion (> 4)		Not informed	0/63 (0%)
Surgical margins involved		Not informed	7/63 (11.1%)
Metastatic lymph node size		Not informed
	< 0.2 cm		6/19 (31.6%)
	0.2-1 cm		5/19 (26.3%)
	> 1 cm < 3 cm		5/19 (26.3%)
	> 3 cm		3/19 (15.8%)
Extranodal extension		Not informed	3/19 (15.7%)
	> 3 lymph nodes		1/19 (5.2%)
Multifocality		18 (28.5%)	18 (28.5%)
Bilaterality		13 (20.6%)	13 (20.6%)
Necrosis		Not informed	0/63 (0%)
Extrathyroidal extension		16/63 (25.6%)
	Minimal	Not informed	24/63 (38%)
	Gross (> 1 cm)	Not informed	7/63 (11.1%)

MRSS ATA 2009	MRSS ATA 2009 after reviewing the HPS	Reason for changing the RR
Low RR (n = 46)	Low RR (n = 39)
	Intermediate RR (n = 2)	n = 1, PTC oncocytic variant (previously classic variant PTC)
	Intermediate RR (n = 2)	n = 1, extranodal extension in < 3 LN metastasis
	Intermediate-high RR (n = 4)	n = 3, microscopic invasion of surgical margins
	Intermediate-high RR (n = 4)	n = 1, 40% of tumor dedifferentiation
	NIFTP (n = 1)
Intermediate RR (n = 17)	Low RR (n = 3)	n = 1, classic PTC (previously PTC tall cell variant)
	Low RR (n = 3)	n = 2, all LN metastasis < 0.2 cm
	Intermediate RR (n = 8)
	Intermediate-high RR (n = 5)	n = 4, microscopic invasion of surgical margins (n = 3 of them with LN metastasis > 3 cm)
	Intermediate-high RR (n = 5)	n = 1, extranodal extension in > 3 LN metastases
	NIFTP (n = 1)

		Initial response to therapy (n = 61)^a a n = 2 patients reclassified as NIFTP were excluded from the analysis. They both had an initial excellent response.
		Excellent	Indeterminate	Biochemical incomplete	Structural incomplete
MRSS ATA 2009
	Low RR (n = 45)	27 (60%)	14 (31.1%)	1 (2.2%)	3 (6.7%)
	Intermediate RR (n = 16)	6 (37.5%)	4 (25%)	4 (25%)	2 (12.5%)
MRSS ATA 2009 after HPS review^a a n = 2 patients reclassified as NIFTP were excluded from the analysis. They both had an initial excellent response.
	Low RR (n = 42)	30 (71.4%)^b b Comparison between risk of recurrence classification before and after historic pathology slide review in low risk patients: excellent response (60% vs. 71.4%, p = 0.3668), structural incomplete response (6.7% vs. 2.4%, p = 0.6171).	10 (23.8%)	1 (2.4%)	1 (2.4%)^b b Comparison between risk of recurrence classification before and after historic pathology slide review in low risk patients: excellent response (60% vs. 71.4%, p = 0.3668), structural incomplete response (6.7% vs. 2.4%, p = 0.6171).
	Intermediate RR (n = 10)	4 (40%)^c c Comparison between risk of recurrence classification before and after historic pathology slide review in intermediate risk patients: excellent response (37.5% vs. 40%, p = 1), structural incomplete response (12.5% vs. 20%, p = 0.6254).	0 (0%)	4 (40%)	2 (20%)^c c Comparison between risk of recurrence classification before and after historic pathology slide review in intermediate risk patients: excellent response (37.5% vs. 40%, p = 1), structural incomplete response (12.5% vs. 20%, p = 0.6254).
	Intermediate-high RR (n = 9)	3 (33.3%)	1 (11.1%)	3 (33.3%)	2 (22.3%)

		Final response to therapy^a a 2 patients reclassified as NIFPT were excluded from the analysis. They had excellent response at final outcome (36 and 38 months of follow-up). (n = 61)
		Excellent	Indeterminate	Biochemical incomplete	Structural incomplete
MRSS ATA 2009
	Low RR (n = 45)	31 (68.9%)	12 (26.7%)	1 (2.2%)	1 (2.2%)
	Intermediate RR (n = 16)	7 (43.7%)	6 (37.5%)	2 (12.5%)	1 (6.3%)
MRSS ATA 2009 after HPS review^a a 2 patients reclassified as NIFPT were excluded from the analysis. They had excellent response at final outcome (36 and 38 months of follow-up).
	Low RR (n = 42)	31 (73.8%)^b b Comparison between risk of recurrence classification before and after historic pathology slide review in low risk patients: excellent response (68.9% vs. 73.8%, p = 0.6431), structural incomplete response (2.2% vs. 0%, p = 1).	10 (23.8%)	1 (2.4%)	0 (0%)^b b Comparison between risk of recurrence classification before and after historic pathology slide review in low risk patients: excellent response (68.9% vs. 73.8%, p = 0.6431), structural incomplete response (2.2% vs. 0%, p = 1).
	Intermediate RR (n = 10)	3 (30%)^c c Comparison between risk of recurrence classification before and after historic pathology slide review in intermediate risk patients: excellent response (43.5% vs. 30%, p = 0.6913), structural incomplete response (6.3% vs. 20%, p = 0.5304).	3 (30%)	2 (20%)	2 (20%)^c c Comparison between risk of recurrence classification before and after historic pathology slide review in intermediate risk patients: excellent response (43.5% vs. 30%, p = 0.6913), structural incomplete response (6.3% vs. 20%, p = 0.5304).
	Intermediate-high RR (n = 9)	3 (33.33%)	3 (33.33%)	3 (33.33%)	0 (0%)

Sociedade Brasileira de Endocrinologia e Metabologia Rua Botucatu, 572 - Conjuntos 81/83, 04023-061 São Paulo SP Brasil, Tel: (55 11) 5575-0311 - São Paulo - SP - Brazil
E-mail: aem.editorial.office@endocrino.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence to: Fabián Pitoia División Endocrinología Hospital de Clínicas, University of Buenos Aires Córdoba 2351, 5^th Floor, Buenos Aires 1001, Argentina fpitoia@intramed.net

Gender
	Female/Male	58 (92%)/5 (8%)
Age (years)
	Mean ± SEM	48.3 ± 16.1
	Median (range)	47 (21.2-76)
Histology
	PTC classic variant	47 (74.6%)
	PTC follicular variant	13 (20.6%)
	PTC oncocytic variant	2 (3.1%)
	PTC tall cell variant	1 (1.7%)
Cervical lymphadenectomy
	No	18 (28.5%)
	Central	40 (63.4%)
	Central and lateral	5 (9.1%)
Bilaterality, multifocality, and capsular invasion
	Bilateral	18 (28.5%)
	Multifocal	13 (20.6%)
	Capsular invasion	16 (25.3%)
TNM stage
	I	45 (71.4%)
	II	1 (1.7%)
	III	17 (26.9%)
MRSS ATA 2009 before HSR
	Low	46 (73%)
	Intermediate	17 (27%)
¹³¹I Cumulative Dose (mCi)
	Mean ± SEM	230 ± 116
	Median (range)	150 (100-350)

Low RR	Classical and follicular variant PTC Minor extrathyroidal extension < 4 foci of vascular invasion < 5 LN metastasis 0.2-3 cm All LN metastasis < 0.2 cm No evidence of extranodal extension
Intermediate RR	Aggressive histology (tall cell, columnar cell, Hürthle cell carcinomas, oncocytic PTC) > 5 LN metastasis 0.2-3 cm Extranodal extension in < 3 LN metastasis
Intermediate-high RR	≥ 4 foci of vascular invasion Extranodal extension in > 3 LN metastasis Any LN > 3 cm Surgical margins involved