Thyroid nodule classification: Difference between revisions

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| colspan="2" |'''TIRADS 6'''
| colspan="2" |'''TIRADS 6'''
|Biopsy proven malignancy
|Biopsy proven malignancy
|
|
|}
==Classification based on TNM==
Differentiated and anaplastic thyroid carcinoma TNM staging AJCC UICC 2017
{| class="wikitable"
|-
| colspan="9" |Papillary, follicular, poorly differentiated, Hurthle cell and anaplastic thyroid carcinoma
|-
| colspan="5" |Primary tumor (T)
| colspan="2" |Regional lymph nodes (N)
| colspan="2" |Distant metastasis (M)
|-
|'''T category'''
| colspan="4" |'''T criteria'''
|'''N category'''
|'''N criteria'''
|'''M category'''
|'''M criteria'''
|-
|TX
| colspan="4" |Primary tumor cannot be assessed
|NX
|Regional lymph nodes cannot be assessed
|M0
|No distant metastasis
|-
|T0
| colspan="4" |No evidence of primary tumor
|N0
|No evidence of locoregional lymph node metastasis
|M1
|Distant metastasis
|-
|T1
| colspan="4" |Tumor ≤2 cm in greatest dimension limited to the thyroid
|N0a
|One or more cytologically or histologically confirmed benign lymph nodes
|
|
|-
|T1a
| colspan="4" |Tumor ≤1 cm in greatest dimension limited to the thyroid
|N0b
|No radiologic or clinical evidence of locoregional lymph node metastasis
|
|
|-
|T1b
| colspan="4" |Tumor >1 cm but ≤2 cm in greatest dimension limited to the thyroid
|N1
|Metastasis to regional nodes
|
|
|-
|T2
| colspan="4" |Tumor >2 cm but ≤4 cm in greatest dimension limited to the thyroid
|N1a
|Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal/Delphian, or upper mediastinal) lymph nodes. This can be unilateral or bilateral disease.
|
|
|-
|T3
| colspan="4" |Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles
|N1b
|Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II, III, IV, or V) or retropharyngeal lymph nodes
|
|
|-
|T3a
| colspan="4" |Tumor >4 cm limited to the thyroid
|
|
|
|
|-
|T3b
| colspan="4" |Gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid, thyrohyoid, or omohyoid muscles) from a tumor of any size
|
|
|
|
|-
|T4
| colspan="4" |Includes gross extrathyroidal extension
|
|
|
|
|-
|T4a
| colspan="4" |Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve from a tumor of any size
|
|
|
|
|-
|T4b
| colspan="4" |Gross extrathyroidal extension invading prevertebral fascia or encasing the carotid artery or mediastinal vessels from a tumor of any size
|
|
|
|
|
|

Revision as of 21:02, 28 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Classification

 
 
 
 
 
 
 
Thyroid nodule classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bethesda classification system
 
 
 
TNM staging AJCC UICC 2017
 
 
 
TIRAD classification system
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on thyroid cytopathology
 
 
 
For differentiated and anaplastic thyroid carcinoma
 
 
 
Based on sonographhic features
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Benign
•Nondiagnostic or Unsatisfactory
•Follicular lesion of undetermined significance
•Atypia of undetermined significance
•Follicular neoplasm
•Suspicious for a follicular neoplasm
•Malignant
 
 
 
Papillary, follicular, poorly differentiated, Hurthle cell and anaplastic thyroid carcinoma:
•Primary tumor (T)
•Regional lymph nodes (N)
•Distant metastasis (M)
 
 
 
•TIRADS 1=Normal thyroid gland
•TIRADS 2=Benign lesions
•TIRADS 3=Probably benign lesions
•TIRADS 4= Contain 1-4 suspicious features
•TIRADS 5=Contain all five suspicious features
•TIRADS 6=Biopsy proven malignancy


Bethesda System for Reporting Thyroid Cytopathology

[1]

classification FNA cytology Predicted risk of malignancy
Benign
  • Macrofollicular
  • Adenomatoid/hyperplastic nodules
  • Colloid adenomas (most common)
  • Nodular goiter
  • Lymphocytic thyroiditis
  • Granulomatous thyroiditis
0–3 %
Nondiagnostic or Unsatisfactory 1–4 %
Follicular lesion of undetermined significance
  • Mixed macro- and microfollicular nodules
5–15 %
Atypia of undetermined significance
  • Atypical cells
Follicular neoplasm
  • Microfollicular nodules
    • Hurthle cell lesions
15–30 %
Suspicious for a follicular neoplasm
  • Suspicious for Hurthle cell neoplasm
60–75 %
Malignant
  • PTC (most common)
  • MTC
  • Anaplastic carcinoma
  • High-grade metastatic cancers
97–99 %

Classification of neoplastic thyroid nodules based on their origin:

Origin histologic subtypes Subclass
Nonmedullary thyroid cancers (NMTCs) 95% of tumors thyroid epithelial cells papillary (85%) 95% are sporadic tumors

5% may be related to inherited genetics due to familial origin

  • Classic varient
  • tall cell variant
  • insular varient
  • columnar variant
  • Hürthle or oxyphilic variant
  • solid or trabecular variant
  • clear cell variant
  • diffuse sclerosing variant
  • cribriform morular variant
  • hobnail variant
follicular (11%)
  • Benign follicular adenoma
  • Minimally invasive follicular carcinoma
  • Widely invasive follicular carcinoma
  • Encapsulated follicular variant of papillary thyroid cancer
  • Infiltrative variant of papillary thyroid cancer
Hürthle cell (3%)
anaplastic (1%)
Medullary thyroid cancers (MTCs) 5% of all thyroid malignancies calcitonin-producing parafollicular cells 20% they are familial and occur as part of the multiple endocrine neoplasia (MEN) syndromes

Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 10% that have follicular histology, and 3% that are Hu¨rthle cell or oxyphil tumors

Thyroid nodule classification based on the sonographhic features:

Classification system has been proposed by Horvath et al, with a modified recommendation from Jin Kwak et al.[2]

TIRADS 1 Normal thyroid gland
TIRADS 2 Benign lesions
  • Avascular anechoic lesion with echogenic specks (colloid type I)
  • vascular heteroechoic non-expansile, non-encapsulated nodules with peripheral halo (colloid type II)
  • isoechoic or heteroechoic, non-encapsulated, expansile vascular nodules (colloid type III)
0% risk of malignancy
TIRADS 3 Probably benign lesions
  • Nodule property:
    • Hyperechoic, iso-echoic or hypoechoic nodules, with partially formed capsule and peripheral vascularity, usually in setting of Hashimoto's thyroiditis (Hashimoto's pseudonodule)
<5% risk of malignancy
TIRADS 4 4a One suspicious feature
  • Suspicious lesions:
    • solid component
      • high stiffness of nodule on elastography if available
    • markedly hypoechoic nodule
    • microlobulations or irregular margins
    • microcalcifications
    • taller-than-wider shape
5-10% risk of malignancy
4b Two suspicious features 10-80% risk of malignancy
4c Three/four suspicious features
TIRADS 5 All five suspicious features Probably malignant lesions (more than 80% risk of malignancy) >80% risk of malignancy
TIRADS 6 Biopsy proven malignancy

References

  1. Cibas ES, Ali SZ (2009). "The Bethesda System for Reporting Thyroid Cytopathology". Thyroid. 19 (11): 1159–65. doi:10.1089/thy.2009.0274. PMID 19888858.
  2. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M (2009). "An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management". J. Clin. Endocrinol. Metab. 94 (5): 1748–51. doi:10.1210/jc.2008-1724. PMID 19276237.

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