ATA 2009 Risk Stratification System with Proposed Modifications.2
Risk Level | Clinico-pathological Features |
---|---|
ATA Low Risk | Papillary Thyroid Cancer (with all of the following):
Clinical N0 or ≤5 pathologic N1 micrometastases (<0.2 cm in largest dimension)* Intrathyroidal, encapsulated follicular variant of papillary thyroid cancer* Intrathyroidal, well-differentiated follicular thyroid cancer with capsular invasion and no or minimal (<4 foci) vascular invasion* Intrathyroidal, papillary microcarcinoma, unifocal or multifocal, including V600E BRAF mutated (if known)* |
ATA Intermediate Risk | Microscopic invasion of tumor into the perithyroidal soft tissues RAI avid metastatic foci in the neck on the first post-treatment whole-body RAI scan Aggressive histology (e.g. tall cell, hobnail variant, columnar cell carcinoma) Papillary thyroid cancer with vascular invasion Clinical N1 or >5 pathologic N1 with all involved lymph nodes <3 cm in largest dimension* Multifocal papillary microcarcinoma with extrathyroidal extension and V600E BRAF mutated (if known)* |
ATA High Risk | Macroscopic invasion of tumor into the perithyroidal soft tissues (gross extrathyroidal extension) Incomplete tumor resection Distant metastases Postoperative serum thyroglobulin suggestive of distant metastases Pathologic N1 with any metastatic lymph node ≥3 in largest dimension* Follicular thyroid cancer with extensive vascular invasion (>4 foci of vascular invasion)* |
Table from the ATA thyroid cancer guidelines.2 Used with permission from the American Thyroid Association.