Predictors of Thyroid Tumor Aggressiveness

Blake Cady, MD

The antecedents of attempts to predict thyroid cancer behavior date back to the 1930s, when the concept of "lateral aberrant thyroid"12 was established, because thyroid tissue appearing in lymph nodes in the neck was known to be associated with an innocent clinical behavior pattern in a vast majority of cases. As a result, these cases were considered to be not cancer but an arrested embryonic migration phenomenon, until Crile convincingly demonstrated small primary papillary cancers in such cases.3 That was also an era when 15% to 20% of all thyroid cancers were of an anaplastic variety that was almost uniformly and rapidly fatal4; median survival associated with anaplastic cancers was only 3 or 4 months, and all but a few patients were dead within 6 months. This wide range of clinical behavior from cancers arising from the same thyroid follicular cell was noteworthy, even then, in displaying the extremes of tumor biologic behavior.

Currently, of course, we have several well worked-out and easily clinically applicable indicators of risk group assignment to predict accurately the biologic behavior of cancers of the thyroid gland.5"14 Arriving at these unique, clinically discernible risk estimations is a simple process in thyroid cancer, whereas clinical predictors of outcome are much less accurate and effective in other human cancers, particularly in defining a preponderance of patients at very low risk. It is important for surgeons to recognize the striking differences in behavior of thyroid cancers originating from an identical cell so that appropriate surgical techniques can be applied to patients to minimize morbidity and to restore and maintain normal life in the vast majority of patients currently being treated for differentiated thyroid carcinoma.

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