Imaging in Tumor Staging
The American Joint Committee on Cancer (AJCC) and Union
International Contre le Cancer (UICC) Tumor-Node-Metastasis (TNM)
staging system is recommended for pediatric thyroid carcinoma (GRADE:
A; SOR: 1.21, very strong recommendation). Use of this post-operative
staging system is recommended by the American Thyroid Association
(ATA).9 The AJCC/UICC-TNM staging system incorporates
size of tumor and extrathyroidal extension, regional lymph node status,
and distant metastasis, and its main purpose is to define an
anatomic-based classification of the extent of disease, to guide further
management (Table 1).
Based on the AJCC/UICC-TNM classification system, ATA guidelines
classify children with thyroid carcinoma into risk groups (Table 2).Stratification of patients into ATA risk groups is recommended
as this allows estimation of disease-free survival (Table 2), identifies
patients at risk for residual/persistent cervical lymphadenopathy, and
guides further management by identifying patients that may require
further imaging to define distant metastasis and that may require131I therapy. (GRADE: B; SOR 1.36, very strong
recommendation)