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Differentiated Thyroid Cancer

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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.

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