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Grading system for medullary thyroid carcinoma; an institutional experience.

Peter Podany1, Karleen Meiklejohn2, James Garritano3

  • 1Department of Pathology, Yale School of Medicine, New Haven, CT, United States of America.

Annals of Diagnostic Pathology
|February 3, 2023
PubMed
Summary

A new grading system for Medullary thyroid carcinoma (MTC) effectively stratifies patient risk. This two-tier system, based on morphology, showed significant differences in overall survival for low-grade (LG) versus high-grade (HG) MTC.

Keywords:
GradingHigh-gradeLow-gradeMedullary thyroid carcinomaNecrosisThyroid

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Area of Science:

  • Endocrinology
  • Oncology
  • Pathology

Background:

  • Medullary thyroid carcinoma (MTC) is a rare but aggressive thyroid malignancy.
  • A recently proposed two-tier grading system (GS) for MTC aims to improve risk stratification.
  • The generalizability and application of this GS require validation in diverse patient cohorts.

Purpose of the Study:

  • To evaluate the generalizability and application of a novel two-tier grading system for Medullary thyroid carcinoma (MTC).
  • To assess the correlation between the proposed grading system and clinicopathological features and patient outcomes.

Main Methods:

  • A cohort of 59 Medullary thyroid carcinoma (MTC) cases were retrospectively analyzed.
  • Cases were assigned to either low-grade (LG) or high-grade (HG) categories based on mitotic count and necrosis.
  • Morphologic criteria included mitosis (<5/2 mm² for LG, ≥5/2 mm² for HG) and presence of necrosis.

Main Results:

  • Of 59 MTC cases, 88% were classified as LG and 12% as HG.
  • High-grade (HG) MTC demonstrated significant associations with vascular invasion, distant metastasis, nuclear pleomorphism, and prominent nucleoli.
  • Tumor grade and necrosis were significantly associated with overall survival (HR=22.7, p<0.01 and HR=11.1, p=0.008, respectively) after adjusting for demographics.

Conclusions:

  • The application of the two-tier grading system to an MTC cohort revealed statistically significant differences in overall survival between low-grade and high-grade groups.
  • Incorporating this grading system into pathology reports provides valuable prognostic information for risk stratification in Medullary thyroid carcinoma.
  • The grading system enhances communication of risk beyond traditional staging.