9
47. AJCC/UICC staging is recommended for all patients with DTC, based
on its utility in predicting disease mortality, and its requirement for
cancer registries. (SR-M)
48. A) The 2009 ATA Initial Risk Stratification System (Cooper DS et
al. Thyroid 2009;19:1167–1214) is recommended for DTC patients
treated with thyroidectomy, based on its utility in predicting risk of
disease recurrence and/or persistence. (SR-M)
B) Additional prognostic variables (such as the extent of lymph
node involvement, mutational status, and/or the degree of vascular
invasion in follicular thyroid cancer), not included in the 2009 ATA
Initial Risk Stratification system, may be used to further refine
risk stratification for DTC as described below (and in Fig 4) in the
Modified Initial Risk Stratification system. However, the incremental
benefit of adding these specific prognostic variables to the 2009
Initial Risk Stratification system has not been established. (WR-L)
C) While not routinely recommended for initial post-operative risk
stratification in DTC, the mutational status of BRAF, and potentially
other mutations such as TERT, have the potential to refine risk
estimates when interpreted in the context of other clinico-pathologic
risk factors. (WR-M)
Table 4. Best Response to Therapy
Excellent response No clinical, biochemical or structural evidence of disease.
Biochemical incomplete
response
Abnormal thyroglobulin or rising anti-thyroglobulin
antibody levels in the absence of localizable disease.
Structural incomplete
response
Persistent or newly identified locoregional or distant
metastases.
Indeterminate response Non-specific biochemical or structural findings which
cannot be confidently classified as either benign or
malignant. is includes patients with stable or declining
anti-thyroglobulin antibody levels without definitive
structural evidence of disease.
