ArticleModern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc2020
Grading of medullary thyroid carcinoma on the basis of tumor necrosis and high mitotic rate is an independent predictor of poor outcome.
Article in Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 66 citations in OpenAlex.
- MYELOstudy: lymph node stage of aggressiveness in medullary thyroid cancer-a retrospective multi-center study analysis.Updates in surgery · 2026Article
- Grading medullary thyroid carcinoma on fine needle aspiration biopsy specimens: a comparative study between manual counting and a deep learning platform.Journal of the American Society of Cytopathology · 2026Article
- Diagnostic Utility of Ki-67 Index on Cell Block Material for Grading Medullary Thyroid Carcinoma.Diagnostic cytopathology · 2026Article
- Preoperative Diagnostic Value of Spectral CT for Predicting Perineural Invasion in Esophageal Cancer.Cancer medicine · 2025Article
- Low Ki-67 labeling index is a clinically useful predictive factor for recurrence-free survival in patients with papillary thyroid carcinoma.Journal of pathology and translational medicine · 2025Article
- The Role of Chronic Inflammation in Pediatric Cancer.Cancers · 2025Review
- Epidemiology, Clinical Presentation, and Diagnosis of Medullary Thyroid Carcinoma.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer · 2025Review
- Histopathology of C Cells and Medullary Thyroid Carcinoma.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer · 2025Review
- The road ahead: a brief guide to navigating the 2022 WHO classification of endocrine and neuroendocrine tumours.Journal of clinical pathology · 2024Review
- [Incidentally discovered ectopic tissue in the central neck region (level VI) of the neck - A case series, retrospective analysis and literature review].Magyar onkologia · 2024Review
- A Comprehensive Review and Insights into the New Entity of Differentiated High-Grade Thyroid Carcinoma.Current oncology (Toronto, Ont.) · 2024Review
- Molecular Pathology of Thyroid Tumors: Essential Points to Comprehend Regarding the Latest WHO Classification.Biomedicines · 2024Review
- International medullary thyroid carcinoma grading system: an Indian tertiary care centre experience.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2024Article
- Association of the Genomic Profile of Medullary Thyroid Carcinoma with Tumor Characteristics and Clinical Outcomes in an International Multicenter Study.Thyroid : official journal of the American Thyroid Association · 2024Article
- Management of medullary thyroid cancer based on variation of carcinoembryonic antigen and calcitonin.Frontiers in endocrinology · 2024Review
- Natural History and Predictive Factors of Outcome in Medullary Thyroid Microcarcinoma.The Journal of clinical endocrinology and metabolism · 2023Article
- Exploration of Digital Image Analysis for Ki67 Quantification in the Grading of Medullary Thyroid Carcinoma: A Pilot Study with 85 Cases.Head and neck pathology · 2023Article
- Independent Validation of the International Grading System for Medullary Thyroid Carcinoma: A Single Institution Experience.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2023Article
- Review
- Update on C-Cell Neuroendocrine Neoplasm: Prognostic and Predictive Histopathologic and Molecular Features of Medullary Thyroid Carcinoma.Endocrine pathology · 2023Review
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
Medullary thyroid carcinoma (MTC) is a rare nonfollicular cell-derived tumor. A robust grading system may help better stratify patients at risk for recurrence and death from disease. In total, 144 MTC between 1988 and 2018 were subjected to a detailed histopathologic evaluation. Clinical and pathologic data were correlated with disease specific survival (DSS), local recurrence free survival (LRFS) and distant metastasis free survival (DMFS). Median age was 53 years (range: 3-88). Median tumor size was 1.8 cm (range: 0.2-11). Lymph node metastases were present in 84 (58%) cases while distant metastases at presentation were found in 9 (6%) patients. Seven (5%) had ≥5 mitoses/10 HPFs. Tumor necrosis was present in 30 cases (20%) while lymphovascular invasion occurred in 41 (28%) of tumors. Extra-thyroidal extension was found in 44 (31%) and positive margins were seen in 19 (14%). There was a strong correlation between increasing tumor size and tumor necrosis (p < 0.001). Median follow up was 39 months. In univariate analysis, male gender, higher American Joint Committee on Cancer (AJCC) stage group, larger tumor size, tumor necrosis, high mitotic index (≥5/10 HPF), nodal status, size of largest nodal metastasis, and elevated postoperative serum calcitonin predicted worse DSS, LRFS, and DMFS (p < 0.05). Extra-thyroidal extension correlated with DSS and DMFS while positive margins and distant metastasis at presentation imparted worse DSS (p < 0.05). In multivariate analysis, tumor necrosis and mitotic activity (5 mitosis/10 HPFs as the cutoff) were the only independent predictors for DSS (p = 0.008 and 0.026, respectively). Tumor necrosis was the sole independent prognostic factor for LRFS and DMFS (p = 0.001 and 0.003, respectively). The presence of tumor necrosis and high mitotic rate are powerful independent prognostic factors in MTC and outperform serum calcitonin and stage. We propose a grading system based on tumor necrosis and mitotic activity to better stratify MTC patients for counseling, post-resection surveillance, and therapy.
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