Thyroid Cancer Staging: Historical Evolution and Analysis From Macrocarcinoma to Microcarcinoma

The classification of thyroid cancer diagnosis and treatment has evolved dramatically since the Union for International Cancer Control (UICC) published the first staging system in 1968. A careful review of the eight published editions of well-differentiated thyroid cancer (WDTC) staging by the UICC and the American Joint Committee on Cancer (AJCC) was performed. Each edition was analyzed to clearly understand which development published and accepted by specialists treating thyroid cancer justified considering a new updated edition. This study presents a comprehensive review of the remarkable evolution of thyroid cancer staging, highlighting the various changes in several areas throughout the years and editions. There were surprising changes within the eight publications: the tumor size was progressively reduced from 4 cm in the first AJCC volume to less than 1 cm in the seventh and eighth UICC and AJCC editions, classifying these small, WDTCs known up to now as "microcarcinomas." Extrathyroidal extension was accepted after the third edition; this description certainly plays a key role in today's decisions to manage this tumor as a prognostic factor. The age specification of 45 years prevailed for seven consecutive publications until it was raised to 55 years in the eighth thyroid cancer staging system. Without a doubt, this iconic change allowed physicians around the world to give their 45-year-old thyroid cancer patients a more encouraging panorama of the disease with the new classification. Over the course of nearly 57 years, thyroid cancer staging has undergone remarkable changes, reaching a level of certainty that not only provides recommendations for safer treatments with less surgery and adjunctive measures but also improves survival rates and patient safety.