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Table 3. Initial Evaluation for Staging, Tests, and Procedures
Laboratory tests
• CBC with differential
• Comprehensive chemistry panel
(electrolytes, calcium, blood urea nitrogen, creatinine, glucose, and liver tests)
• Thyroid function tests (TSH, free thyroxine),TG/TG antibody
Imaging
•
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F FDG PET/CT (preferred, whole body)
a
• CT of neck, chest, abdomen, and pelvis with contrast or MRI (acceptable if PET
unavailable and as needed for surgical decision-making )
Recommended and if clinically indicated
b
• MRI of brain with and without contrast
Procedures
• Laryngoscopy, also esophagoscopy as indicated
• BRAF assessment by IHC and NGS testing of tumor
c
a
If PET/CT unavailable, bone scan may be useful to identify bone metastases.
b
Clinically indicated if the patient has symptoms suggestive of brain metastases (i.e. neurologic
deficit, headache, etc.).
c
BRAF IHC provides a rapid result and if positive NGS testing may not be necessary. If BRAF IHC
is negative, NGS should be performed as it is more sensitive.
