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Papillary Thyroid Cancers with Focal Tall Cell Change are as Aggressive as Tall Cell Variants and Should Not be Considered as Low-Risk Disease

  • Endocrine Tumors
  • Published:
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Abstract

Background

The tall cell variant of papillary thyroid carcinoma (PTC) is as an aggressive histological variant. The proportion of tall cells needed to influence prognosis is debated.

Methods

Patients with PTC and tall cells, defined as having a height-to-width ratio of ≥ 3:1, seen at a high-volume center between 2001 and 2015, were reviewed. Specimens were classified as (1) focal tall cell change, containing < 30% of tall cells; (2) tall cell variant, ≥ 30% of tall cells; and (3) control cases selected from infiltrative classical PTCs without adverse cytologic features. Univariate, sensitivity, and multivariate analyses were performed with persistent/recurrent disease as the primary outcome.

Results

We identified 96 PTCs with focal tall cell change, 35 with the tall cell variant and 104 control cases. Factors associated with poor clinical prognosis were significantly greater in those with focal tall cell change and tall cell variants. Regarding primary outcome, hazard ratios were 2.3 (95% confidence interval [CI] 1.0–5.7) for focal tall cell change, and 3.4 (95% CI 1.2–8.7) for tall cell variants compared with controls. Five-year disease-free survival was higher for the control group (92.7%, CI 87.4–98.0) compared with focal tall cell change (76.3%, CI 66.1–86.5) and the tall cell variant (62.2%, CI 43.2–81.2). When stratified in groups consisting of tall cell proportions (< 10%, 10–19%, 20–29% and ≥ 30%), identification of ≥ 10% tall cell change was associated with worse outcome (p = 0.002).

Conclusions

PTCs with ≥ 10% tall cell change have worse prognosis than those without tall cells. Our data indicate that thyroid cancer management guidelines should consider PTCs with focal tall cell change outside of the low-risk classification.

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Acknowledgment

This project was supported by the Foundation ‘De Drie Lichten’ in The Netherlands (PJB).

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Author notes

  1. Ozgur Mete and Jesse D. Pasternak were co-senior authors on this work.

Authors and Affiliations

  1. Department of Surgery, University Health Network, Toronto, ON, Canada

    Pim J. Bongers MD, Raoul Verzijl MD, Mattan Lustgarten Bsc, Karen Devon MD, FRCSC, Lorne E. Rotstein MD, FACS, FRCSC & Jesse D. Pasternak MD, MPH, FRCSC

  2. Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Pim J. Bongers MD, Wouter P. Kluijfhout MD, PhD & Menno R. Vriens MD, PhD

  3. ZGT Academy, Hospital Group Twente, Almelo, The Netherlands

    Marloes Vermeer PhD

  4. Department of Otolaryngology-Head Neck Surgery, University Health Network, Toronto, Canada

    David P. Goldstein MD, FRCSC, MSc

  5. Department of Surgical Oncology, University Health Network, Toronto, Canada

    David P. Goldstein MD, FRCSC, MSc

  6. Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada

    David P. Goldstein MD, FRCSC, MSc

  7. Department of Pathology, University Health Network, Toronto, ON, Canada

    Sylvia L. Asa MD, PhD, FRCPC, FCAP & Ozgur Mete MD, FRCPC

  8. Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, ON, Canada

    James D. Brierley MS, MB, FRCR, FRCPC & Richard W. Tsang MD, FRCPC

  9. Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Shereen Ezzat MD, FRCPC, FACP

  10. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Ozgur Mete MD, FRCPC

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  1. Pim J. Bongers MD
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  2. Wouter P. Kluijfhout MD, PhD
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Corresponding authors

Correspondence to Ozgur Mete MD, FRCPC or Jesse D. Pasternak MD, MPH, FRCSC.

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Disclosures

Pim J. Bongers, Wouter P. Kluijfhout, Raoul Verzijl, Mattan Lustgarten, Marloes Vermeer, David P. Goldstein, Karen Devon, Lorne E. Rotstein, Sylvia L. Asa, James D. Brierley, Richard W. Tsang, Shereen Ezzat, Menno R. Vriens, Ozgur Mete, and Jesse D. Pasternak have no disclosures to declare.

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Bongers, P.J., Kluijfhout, W.P., Verzijl, R. et al. Papillary Thyroid Cancers with Focal Tall Cell Change are as Aggressive as Tall Cell Variants and Should Not be Considered as Low-Risk Disease. Ann Surg Oncol 26, 2533–2539 (2019). https://doi.org/10.1245/s10434-019-07444-2

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  • DOI: https://doi.org/10.1245/s10434-019-07444-2

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