Imaging in Tumor Staging
The American Joint Committee on Cancer (AJCC) and Union International Contre le Cancer (UICC) Tumor-Node-Metastasis (TNM) staging system is recommended for pediatric thyroid carcinoma (GRADE: A; SOR: 1.21, very strong recommendation). Use of this post-operative staging system is recommended by the American Thyroid Association (ATA).9 The AJCC/UICC-TNM staging system incorporates size of tumor and extrathyroidal extension, regional lymph node status, and distant metastasis, and its main purpose is to define an anatomic-based classification of the extent of disease, to guide further management (Table 1).
Based on the AJCC/UICC-TNM classification system, ATA guidelines classify children with thyroid carcinoma into risk groups (Table 2).Stratification of patients into ATA risk groups is recommended as this allows estimation of disease-free survival (Table 2), identifies patients at risk for residual/persistent cervical lymphadenopathy, and guides further management by identifying patients that may require further imaging to define distant metastasis and that may require131I therapy. (GRADE: B; SOR 1.36, very strong recommendation)