Grading system for medullary thyroid carcinoma; an institutional experience |
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| Affiliation: | 1. Department of Pathology, Yale School of Medicine, New Haven, CT, United States of America;2. Currently affiliated with Memorial Sloan Kettering Cancer Center, New York, United States of America;3. Applied Mathematics Program, Yale University, New Haven, CT, United States of America;4. Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, United States of America;5. Department of Medicine (Endocrinology), Yale School of Medicine, New Haven, CT, United States of America;1. Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, NY, New York, United States of America;2. Department of Pathology and Laboratory Medicine, New York-Presbyterian/Weill Cornell Medicine, NY, New York, United States of America;3. The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America;4. Discovery Life Sciences, Powell, OH, United States of America;1. Department of Pathology, Baskent University, Faculty of Medicine, Bahcelievler, Ankara, Turkey;2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baskent University, Faculty of Medicine, Bahcelievler, Ankara, Turkey;1. Pathology section, Dubai hospital, United Arab Emirates;2. Histology unit, Dubai hospital, United Arab Emirates;1. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States;2. University Hospitals, Case Western Reserve University, Cleveland, OH, United States |
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| Abstract: | ObjectiveMedullary thyroid carcinoma (MTC) is a rare type of thyroid malignancy. Recently, a two-tier grading system (GS) for MTC has been suggested. We conducted this study to evaluate the generalizability, as well as application of recently proposed GS to our cohort of Medullary thyroid carcinoma (MTC) cases.MethodsWe assigned grades to MTC cases and divided them into two groups by using morphologic criteria only as suggested by recent studies: low-grade (LG, <5 mitosis per 2 mm2, and no necrosis) and high-grade (HG, ≥5 mitosis per 2mm2 or necrosis).ResultsA total of 59 MTC cases were evaluated and of those 52 (88 %) were LG and 7 (12 %) were HG. Vascular invasion (VI) (p = 0.017), distant metastasis (DM) (p < 0.0001), nuclear pleomorphism (NP) (p = 0.017) and prominent nucleoli (p = 0.03) were prominently noted in the HG group. After controlling for demographics using multivariate cox regression, tumor grade and necrosis remained significantly associated with the overall survival (HR = 22.7, p < 0.01 and HR = 11.1, p = 0.008, respectively). Upon comparing the cases with and without nodal disease, we found that nodal disease is more strongly associated with NP (p = 0.029), tumor fibrosis (p = 0.0001), VI (p = 0.001) and DM (p = 0.005).ConclusionsWe applied the two-tier GS for MTC to our cohort of cases and found statistically significant differences in the overall survival among the two groups. Adding the grading to the pathology report communicates additional information regarding risk stratification in MTC. |
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