Papillary / follicular (differentiated) thyroid cancer and recurrence (locoregional – distant
Differentiated (papillary / follicular) thyroid cancer (TC) in general has indolent characters and a relatively ‘benign’ biological behavior.
In some cases, however, this common neoplasm has certain clinicopathological characters which may indicate a dire prognosis.
Factors associated with a high risk for disease recurrence (both locoregional [in the neck] as well as distant metastases) and unfavorable outcome include:
Distant metastasis at the time of diagnosis
Tumor size > 4 cm
Gross extrathyroidal extension (macroscopic invasion of adjacent tissues / structures)
Incomplete surgical excision
Extensive vascular invasion
Presence of positive node > 3 cm
Extranodal tumor extension positive with > 3 lymph nodes involved
Age > 55 years
Follicular TC (as well as medullary TC)- metastasizes to distant sites more commonly than papillary thyroid cancer
Aggressive histological variants of differentiated TC (such as tall/columnar variant of papillary thyroid cancer and insular/trabecular variant of follicular TC)
Presence of BRAF-V600 mutation (should be evaluated in the context of other standard clinic-pathological risk factors)
The presence of these risk factors should be taken into consideration in the decision-making process regarding postoperative management and follow-up strategy.
J Clin Endocrinol Metab 2017; 102: 1254 Endocrine J 2019; 66: 127 Thyroid 2016; 26: 1
Papillary thyroid cancer - risk factors for recurrence