Pitoia Fabián, Jerkovich Fernando, Urciuoli Carolina, Falcón Florencia, Lima Andrea Páes de
Division of Endocrinology, University of Buenos Aires, Buenos Aires, Argentina.
Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina.
Arch Endocrinol Metab. 2018 Apr 5;62(2):157-163. doi: 10.20945/2359-3997000000020. Print 2018 Mar-Apr.
To compare the historic risk of recurrence (RR) and response to therapy to risk stratification estimated with historical pathology reports (HPRs) and contemporary re-review of the pathological slides in patients with differentiated thyroid cancer (DTC).
Out of 210 DTC patients with low and intermediate RR who underwent total thyroidectomy and remnant ablation in our hospital, 63 available historic pathologic samples (HPS) were reviewed. The RR and the response to therapy were evaluated considering historical histological features (histological type, tumor size, capsular invasion, number of lymph node metastases) and then, reassessed after observing additional histological features (vascular invasion, extrathyroidal extension, size of lymph node metastases, presence of extranodal extension, and/or status of the resection margins).
A change in the RR category was observed in 16 of 63 cases (25.4%). Out of 46 patients initially classified as low RR, 2 patients were reclassified as intermediate RR, 4 as high RR, and 1 as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Out of 17 patients initially classified as intermediate RR, 3 were reassigned to the low RR group, 5 as high RR, and 1 as NIFTP. The percentages of structural incomplete response at final follow-up changed from 2.2 to 0% (p = 1) in patients with low RR and from 6.3 to 20% (p = 0.53) in patients with intermediate RR.
A detailed report of specific features in the HPR of patients with DTC might give a more accurate RR classification and a better estimation of the response to treatment.
比较分化型甲状腺癌（DTC）患者的历史复发风险（RR）以及对治疗的反应与根据历史病理报告（HPR）和当代病理切片重新评估所估计的风险分层。
在我院接受全甲状腺切除术和残余甲状腺消融术的210例RR低和中等的DTC患者中，回顾了63份可用的历史病理样本（HPS）。考虑历史组织学特征（组织学类型、肿瘤大小、包膜侵犯、淋巴结转移数量）评估RR和对治疗的反应，然后在观察到其他组织学特征（血管侵犯、甲状腺外扩展、淋巴结转移大小、结外扩展的存在和/或手术切缘状态）后重新评估。
63例中有16例（25.4%）的RR类别发生了变化。在最初分类为低RR的46例患者中，2例重新分类为中等RR，4例为高RR，1例为具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）。在最初分类为中等RR的17例患者中，3例重新分配到低RR组，5例为高RR，1例为NIFTP。低RR患者在最终随访时结构不完全缓解的百分比从2.2%变为0%（p = 1），中等RR患者从6.3%变为20%（p = 0.53）。
DTC患者HPR中特定特征的详细报告可能会给出更准确的RR分类和对治疗反应的更好估计。
