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World Journal of Surgery

, Volume 31, Issue 5, pp 934–945 | Cite as

An evidence-based review of poorly differentiated thyroid cancer

  • Enoch M. Sanders Jr.
  • Virginia A. LiVolsi
  • James Brierley
  • Jennifer Shin
  • Gregory W. Randolph
Article

Abstract

Background

Poorly differentiated thyroid cancer (PDTC) presents the endocrinologist and surgeon with challenges of recognition and treatment given the lack of consensus on histopathologic definition and limited literature on surgical and nonsurgical treatment.

Methods

We offer an operational pathologic definition for PDTC, which should help guide future work in this area. Poorly differentiated thyroid cancer should include insular and trabecular variants but should not include solid type lesions (included by other workers) or more differentiated tumors that may have poor prognosis such as tall cell, columnar, diffuse sclerosing, and oncocytic lesions. Systematic evidence-based literature reviews focusing on two questions were carried out: (1) is PDTC associated with an intermediate prognosis relative to anaplastic and WDTC? and (2) What are the postoperative treatment options for poorly differentiated thyroid cancer?

Conclusions

We have found level IV evidence that PDTC is intermediate between WDTC and anaplastic cancers in terms of prognosis. It represents a disease where appropriate administration of aggressive treatment not typically necessary for routine WDTC and not effective for anaplastic disease may uniquely result in substantial benefit. Limited level IV data show conflicting results regarding 131I treatment benefit. Given lack of morbidity and potential for benefit, we recommend that 131I therapy be considered in all patients postoperatively. Recommendation regarding external beam radiotherapy (XRT) is based primarily on extrapolation from studies in forms of poor-prognosis WDTC where substantial data exist regarding treatment benefit. We recommend that external beam treatment be considered in all patients with PDTC with T3 tumors without distant metastasis, all patients with T4 tumors, and all patients with regional lymph node involvement.

Keywords

Thyroid Cancer Papillary Carcinoma Differentiate Thyroid Cancer Differentiate Thyroid Carcinoma Anaplastic Thyroid Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Enoch M. Sanders Jr.
    • 1
    • 2
  • Virginia A. LiVolsi
    • 3
  • James Brierley
    • 4
  • Jennifer Shin
    • 1
    • 2
  • Gregory W. Randolph
    • 1
    • 2
    • 5
  1. 1.Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonUSA
  2. 2.Department of Otology and LaryngologyHarvard Medical SchoolBostonUSA
  3. 3.Department of PathologyUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Radiation OncologyPrincess Margaret HospitalTorontoCanada
  5. 5.Department of SurgeryMassachusetts General HospitalBostonUSA

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