Validating the 2022 WHO classification in thyroid carcinomas: Prospective evidence for predicting iodine resistance

Area of Science:

• Oncology
• Pathology
• Endocrinology

Background:

• Advanced-stage thyroid carcinomas pose challenges in predicting treatment response.
• Radioactive iodine refractory (RAIR) disease requires accurate prognostic indicators for effective management.

Purpose of the Study:

• To validate the 2022 WHO classification for predicting RAIR disease in advanced thyroid carcinomas.
• To identify histological factors associated with RAIR disease progression.

Main Methods:

• Prospective cohort analysis of 253 patients with advanced thyroid carcinomas (TNM 2010).
• Histological review using 2022 WHO criteria and Cox survival analyses.
• ROC curve evaluation to compare predictive performance.

Main Results:

• The 2022 WHO classification demonstrated superior predictive performance (AUC: 0.81) compared to the 2004 WHO (AUC: 0.60).
• 17.7% of patients developed RAIR disease.
• Tumour necrosis was identified as an independent predictive factor for RAIR disease.

Conclusions:

• The 2022 WHO classification enhances RAIR disease prediction, particularly by identifying high-grade carcinomas.
• Systematic reporting of high-grade factors, especially tumour necrosis, is crucial for improved patient management.