BACKGROUND: Poorly differentiated thyroid cancer (PDTC) presents the endocrinologist and surgeon with challenges of recognition and treatment given the lack of consensus on histopathologic definition and limited literature on surgical and nonsurgical treatment. METHODS: We offer an operational pathologic definition for PDTC, which should help guide future work in this area. Poorly differentiated thyroid cancer should include insular and trabecular variants but should not include solid type lesions (included by other workers) or more differentiated tumors that may have poor prognosis such as tall cell, columnar, diffuse sclerosing, and oncocytic lesions. Systematic evidence-based literature reviews focusing on two questions were carried out: (1) is PDTC associated with an intermediate prognosis relative to anaplastic and WDTC? and (2) What are the postoperative treatment options for poorly differentiated thyroid cancer? CONCLUSIONS: We have found level IV evidence that PDTC is intermediate between WDTC and anaplastic cancers in terms of prognosis. It represents a disease where appropriate administration of aggressive treatment not typically necessary for routine WDTC and not effective for anaplastic disease may uniquely result in substantial benefit. Limited level IV data show conflicting results regarding 131I treatment benefit. Given lack of morbidity and potential for benefit, we recommend that 131I therapy be considered in all patients postoperatively. Recommendation regarding external beam radiotherapy (XRT) is based primarily on extrapolation from studies in forms of poor-prognosis WDTC where substantial data exist regarding treatment benefit. We recommend that external beam treatment be considered in all patients with PDTC with T3 tumors without distant metastasis, all patients with T4 tumors, and all patients with regional lymph node involvement.
BACKGROUND: Poorly differentiated thyroid cancer (PDTC) presents the endocrinologist and surgeon with challenges of recognition and treatment given the lack of consensus on histopathologic definition and limited literature on surgical and nonsurgical treatment. METHODS: We offer an operational pathologic definition for PDTC, which should help guide future work in this area. Poorly differentiated thyroid cancer should include insular and trabecular variants but should not include solid type lesions (included by other workers) or more differentiated tumors that may have poor prognosis such as tall cell, columnar, diffuse sclerosing, and oncocytic lesions. Systematic evidence-based literature reviews focusing on two questions were carried out: (1) is PDTC associated with an intermediate prognosis relative to anaplastic and WDTC? and (2) What are the postoperative treatment options for poorly differentiated thyroid cancer? CONCLUSIONS: We have found level IV evidence that PDTC is intermediate between WDTC and anaplastic cancers in terms of prognosis. It represents a disease where appropriate administration of aggressive treatment not typically necessary for routine WDTC and not effective for anaplastic disease may uniquely result in substantial benefit. Limited level IV data show conflicting results regarding 131I treatment benefit. Given lack of morbidity and potential for benefit, we recommend that 131I therapy be considered in all patients postoperatively. Recommendation regarding external beam radiotherapy (XRT) is based primarily on extrapolation from studies in forms of poor-prognosis WDTC where substantial data exist regarding treatment benefit. We recommend that external beam treatment be considered in all patients with PDTC with T3 tumors without distant metastasis, all patients with T4 tumors, and all patients with regional lymph node involvement.
Authors: Paula Soares; Vítor Trovisco; Ana Sofia Rocha; Tália Feijão; Ana Paula Rebocho; Elsa Fonseca; Inês Vieira de Castro; José Cameselle-Teijeiro; Manuel Cardoso-Oliveira; Manuel Sobrinho-Simões Journal: Virchows Arch Date: 2004-04-17 Impact factor: 4.064
Authors: S Pilotti; P Collini; L Mariani; M Placucci; I Bongarzone; P Vigneri; S Cipriani; F Falcetta; R Miceli; M A Pierotti; F Rilke Journal: Am J Surg Pathol Date: 1997-12 Impact factor: 6.394
Authors: Marco Volante; Stefania Landolfi; Luigi Chiusa; Nicola Palestini; Manuela Motta; Alessandra Codegone; Bruno Torchio; Mauro G Papotti Journal: Cancer Date: 2004-03-01 Impact factor: 6.860
Authors: Tihana Ibrahimpasic; Bin Xu; Iñigo Landa; Snjezana Dogan; Sumit Middha; Venkatraman Seshan; Shyam Deraje; Diane L Carlson; Jocelyn Migliacci; Jeffrey A Knauf; Brian Untch; Michael F Berger; Luc Morris; R Michael Tuttle; Timothy Chan; James A Fagin; Ronald Ghossein; Ian Ganly Journal: Clin Cancer Res Date: 2017-06-20 Impact factor: 12.531
Authors: Henning Dralle; Thomas J Musholt; Jochen Schabram; Thomas Steinmüller; Andreja Frilling; Dietmar Simon; Peter E Goretzki; Bruno Niederle; Christian Scheuba; Thomas Clerici; Michael Hermann; Jochen Kußmann; Kerstin Lorenz; Christoph Nies; Peter Schabram; Arnold Trupka; Andreas Zielke; Wolfram Karges; Markus Luster; Kurt W Schmid; Dirk Vordermark; Hans-Joachim Schmoll; Reinhard Mühlenberg; Otmar Schober; Harald Rimmele; Andreas Machens Journal: Langenbecks Arch Surg Date: 2013-03-03 Impact factor: 3.445
Authors: Abbas Samadi; Peter Loo; Rithwi Mukerji; Gemma O'Donnell; Xiaqin Tong; Barbara N Timmermann; Mark S Cohen Journal: Surgery Date: 2009-12 Impact factor: 3.982
Authors: Abbas K Samadi; Joseph Bazzill; Xuan Zhang; Rob Gallagher; Hauping Zhang; Rao Gollapudi; Kelly Kindscher; Barbara Timmermann; Mark S Cohen Journal: Surgery Date: 2012-12 Impact factor: 3.982
Authors: Matthew W Rosenbaum; Benjamin J Gigliotti; Sara I Pai; Sareh Parangi; Heather Wachtel; Mari Mino-Kenudson; Viswanath Gunda; William C Faquin Journal: Endocr Pathol Date: 2018-03 Impact factor: 3.943