An anatomic checklist for accurate staging of grossly invasive thyroid cancer

The final surgical pathology report follows the patient throughout their cancer journey. For locoregionally advanced cancers, lack of surgeon-pathologist communication can lead to understaging, adversely impacting management. Our study aims to improve the accuracy of staging grossly invasive thyroid cancer by introducing an anatomic checklist, enhancing surgeon-pathologist communication.

We studied 35 consecutive patients with either gross extrathyroidal or extranodal extension, 29 of whom underwent primary resections requiring AJCC staging. Surgeon A initially only dictated an operative report. Surgeon B transmitted an anatomic checklist to the pathologist in addition to the standard operative note. Final pathology reports were reviewed for AJCC staging accuracy. Surgeon A transitioned to submission of an anatomic checklist for his final six cases.

13 of the 14 final pathology reports without a checklist were understaged. All 15 cases with a surgeon completed anatomic checklist were accurately staged. There was a statistically significant improvement in the accuracy of staging reported in the final pathology reports when an anatomic checklist was submitted as compared to when it was not (P < 0.01, Fisher exact test, two-tailed). All final pathology reports for recurrent cases without a checklist failed to define the anatomic parts that were resected. The time to complete the checklist was less than 90 s.

A surgeon-completed anatomic checklist allows pathologists to more accurately stage grossly invasive thyroid cancers. This rapidly completed form eliminates the need for pathologists to analyze the operative note and facilitates both risk of recurrence and AJCC stage determination.