Int J Thyroidol.  2024 May;17(1):68-96. 10.11106/ijt.2024.17.1.68.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 5. Evaluation of Recurrence Risk Postoperatively and Initial Risk Stratification in Differentiated Thyroid Cancer 2024

• Lee EK
• Song YS
• Kang HC
• Kim SW
• Na DG
• Moon SJ
• Lim DJ
• Jung KY
• Chung YJ
• Jung CK
• Park YJ
• Korean Thyroid Association Guideline Committee on the Managements of Thyroid Nodule and Cancer

• KMID: 2556507
• DOI: http://doi.org/10.11106/ijt.2024.17.1.68

Abstract

The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging classification of thyroid cancer can predict death but cannot determine the type and frequency of follow-up testing. Risk stratification is a concept proposed by the American Thyroid Association that uses additional prognostic factors that are not included in the AJCC/UICC classification, such as number or size of metastatic lymph nodes, genetic mutations, and vascular invasion in follicular cancer, to further refine the prognosis of thyroid cancer. The risk of recurrence was categorized as low, intermediate, and high risk, and the need for total thyroidectomy, radioiodine therapy, or thyroid-stimulating hormone suppression was determined depending on each risk level. This approach has been accepted worldwide, and the previous recommendations of the Korean Thyroid Association followed a similar line of thinking but these have been modified in the revised 2024 guidelines. For the revised initial risk stratification, after careful review of the results of the recent meta-analyses and large observational studies and after a multidisciplinary meeting, four major changes were made: 1) thyroid cancer was reclassified according to the World Health Organization (WHO) 2022 tumor classification system; 2) recurrence risk was stratified by combining encapsulated follicular variant papillary thyroid cancer, follicular thyroid cancer, and oncocytic thyroid cancer, which have similar recurrence risk and associated factors, into follicular-patterned tumor; 3) low-risk groups were defined as those with a known recurrence rate of ≤5%, high-risk groups were upgraded to those with a known recurrence rate of ≥30%, and intermediate-risk groups were those with a recurrence risk of 5–30%; and 4) the intermediate risk group had the recurrence rate presented according to various clinicopathological factors, mainly based on reports from Korea. Thus, it is recommended to evaluate the initial risk group by predicting the recurrence rate by combining each clinical factor in individual patients, rather than applying the recurrence rate caused by single risk factor.

Keyword

Differentiated thyroid cancer; Risk assessment; Prognosis; Recurrence; Guideline; Korean Thyroid Association

Reference

References

1. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual 8th ed. Springer;8th ed. 2017.

2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2016; 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26(1):1–133. DOI: 10.1089/thy.2015.0020. PMID: 26462967. PMCID: PMC4739132.

3. Yin DT, Yu K, Lu RQ, Li X, Xu J, Lei M, et al. 2016; Clinicopathological significance of TERT promoter mutation in papillary thyroid carcinomas: a systematic review and meta-analysis. Clin Endocrinol (Oxf). 85(2):299–305. DOI: 10.1111/cen.13017. PMID: 26732020.

4. Yang J, Gong Y, Yan S, Chen H, Qin S, Gong R. 2020; Association between TERT promoter mutations and clinical behaviors in differentiated thyroid carcinoma: a systematic review and meta-analysis. Endocrine. 67(1):44–57. DOI: 10.1007/s12020-019-02117-2. PMID: 31655978. PMCID: PMC6969012.

5. Zhao L, Wang L, Jia X, Hu X, Pang P, Zhao S, et al. 2020; The coexistence of genetic mutations in thyroid carcinoma predicts histopathological factors associated with a poor prognosis: a systematic review and network meta-analysis. Front Oncol. 10:540238. DOI: 10.3389/fonc.2020.540238. PMID: 33240806. PMCID: PMC7682272.

6. Park H, Heo J, Ki CS, Shin JH, Oh YL, Son YI, et al. 2023; Selection criteria for completion thyroidectomy in follicular thyroid carcinoma using primary tumor size and TERT promoter mutational status. Ann Surg Oncol. 30(5):2916–25. DOI: 10.1245/s10434-022-13089-5. PMID: 36637642. PMCID: PMC9838536.

7. Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, et al. 2016; 2016 revised Korean Thyroid Association management guidelines for patients with thyroid nodules and thyroid cancer. Int J Thyroidol. 9:59–126. DOI: 10.11106/ijt.2016.9.2.59.

8. Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, et al. 2019; Thyroid cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 30(12):1856–83. DOI: 10.1093/annonc/mdz400. PMID: 31549998.

9. Elisei R, Viola D, Torregrossa L, Giannini R, Romei C, Ugolini C, et al. 2012; The BRAF(V600E) mutation is an independent, poor prognostic factor for the outcome of patients with low-risk intrathyroid papillary thyroid carcinoma: single-institution results from a large cohort study. J Clin Endocrinol Metab. 97(12):4390–8. DOI: 10.1210/jc.2012-1775. PMID: 23066120.

10. Ito Y, Kudo T, Kihara M, Takamura Y, Kobayashi K, Miya A, et al. 2012; Prognosis of low-risk papillary thyroid carcinoma patients: its relationship with the size of primary tumors. Endocr J. 59(2):119–25. DOI: 10.1507/endocrj.EJ11-0288. PMID: 22068114.

11. Ji YB, Song CM, Kim D, Sung ES, Lee DW, Chung MS, et al. 2019; Efficacy of hemithyroidectomy in papillary thyroid carcinoma with minimal extrathyroidal extension. Eur Arch Otorhinolaryngol. 276(12):3435–42. DOI: 10.1007/s00405-019-05598-z. PMID: 31414221.

12. Kim SK, Park I, Woo JW, Lee JH, Choe JH, Kim JH, et al. 2017; Total thyroidectomy versus lobectomy in conventional papillary thyroid microcarcinoma: analysis of 8,676 patients at a single institution. Surgery. 161(2):485–92. DOI: 10.1016/j.surg.2016.07.037. PMID: 27593085.

13. Kim H, Kim K, Bae JS, Kim JS. 2022; Clinical assessment of T2 papillary thyroid carcinoma: a retrospective study conducted at a single tertiary institution. Sci Rep. 12(1):13548. DOI: 10.1038/s41598-022-17979-2. PMID: 35941209. PMCID: PMC9360027.

14. Shin CH, Roh JL, Song DE, Cho KJ, Choi SH, Nam SY, et al. 2020; Prognostic value of tumor size and minimal extrathyroidal extension in papillary thyroid carcinoma. Am J Surg. 220(4):925–31. DOI: 10.1016/j.amjsurg.2020.02.020. PMID: 32081409.

15. Tam S, Boonsripitayanon M, Amit M, Fellman BM, Li Y, Busaidy NL, et al. 2018; Survival in differentiated thyroid cancer: comparing the AJCC cancer staging seventh and eighth editions. Thyroid. 28(10):1301–10. DOI: 10.1089/thy.2017.0572. PMID: 30141373.

16. Kim TH, Kim YN, Kim HI, Park SY, Choe JH, Kim JH, et al. 2017; Prognostic value of the eighth edition AJCC TNM classification for differentiated thyroid carcinoma. Oral Oncol. 71:81–6. DOI: 10.1016/j.oraloncology.2017.06.004. PMID: 28688696.

17. Song E, Lee YM, Oh HS, Jeon MJ, Song DE, Kim TY, et al. 2019; A relook at the T stage of differentiated thyroid carcinoma with a focus on gross extrathyroidal extension. Thyroid. 29(2):202–8. DOI: 10.1089/thy.2018.0300. PMID: 30358515.

18. Ganly I, Wang L, Tuttle RM, Katabi N, Ceballos GA, Harach HR, et al. 2015; Invasion rather than nuclear features correlates with outcome in encapsulated follicular tumors: further evidence for the reclassification of the encapsulated papillary thyroid carcinoma follicular variant. Hum Pathol. 46(5):657–64. DOI: 10.1016/j.humpath.2015.01.010. PMID: 25721865. PMCID: PMC4981329.

19. Vivero M, Kraft S, Barletta JA. 2013; Risk stratification of follicular variant of papillary thyroid carcinoma. Thyroid. 23(3):273–9. DOI: 10.1089/thy.2012.0369. PMID: 23025507.

20. Ghossein R, Ganly I, Tuttle RM, Xu B. 2023; Large (>4 cm) intrathyroidal encapsulated well-differentiated follicular cell-derived carcinoma without vascular invasion may have negligible risk of recurrence even when treated with lobectomy alone. Thyroid. 33(5):586–92. DOI: 10.1089/thy.2023.0032. PMID: 36884299. PMCID: PMC10171951.

21. Liu J, Singh B, Tallini G, Carlson DL, Katabi N, Shaha A, et al. 2006; Follicular variant of papillary thyroid carcinoma: a clinicopathologic study of a problematic entity. Cancer. 107(6):1255–64. DOI: 10.1002/cncr.22138. PMID: 16900519.

22. Baloch ZW, Shafique K, Flanagan M, Livolsi VA. 2010; Encapsulated classic and follicular variants of papillary thyroid carcinoma: comparative clinicopathologic study. Endocr Pract. 16(6):952–9. DOI: 10.4158/EP10060.OR. PMID: 20497934.

23. Yamazaki H, Sugino K, Katoh R, Matsuzu K, Masaki C, Akaishi J, et al. 2021; Outcomes for minimally invasive follicular thyroid carcinoma in relation to the change in age stratification in the AJCC 8th edition. Ann Surg Oncol. 28(7):3576–83. DOI: 10.1245/s10434-020-09397-3. PMID: 33237449.

24. Ito Y, Hirokawa M, Masuoka H, Yabuta T, Kihara M, Higashiyama T, et al. 2013; Prognostic factors of minimally invasive follicular thyroid carcinoma: extensive vascular invasion significantly affects patient prognosis. Endocr J. 60(5):637–42. DOI: 10.1507/endocrj.EJ12-0419. PMID: 23327839.

25. Stenson G, Nilsson IL, Mu N, Larsson C, Lundgren CI, Juhlin CC, et al. 2016; Minimally invasive follicular thyroid carcinomas: prognostic factors. Endocrine. 53(2):505–11. DOI: 10.1007/s12020-016-0876-y. PMID: 26858184. PMCID: PMC4949299.

26. Asari R, Koperek O, Scheuba C, Riss P, Kaserer K, Hoffmann M, et al. 2009; Follicular thyroid carcinoma in an iodine- replete endemic goiter region: a prospectively collected, retrospectively analyzed clinical trial. Ann Surg. 249(6):1023–31. DOI: 10.1097/SLA.0b013e3181a77b7b. PMID: 19474675.

27. Baloch ZW, Asa SL, Barletta JA, Ghossein RA, Juhlin CC, Jung CK, et al. 2022; Overview of the 2022 WHO classification of thyroid neoplasms. Endocr Pathol. 33(1):27–63. DOI: 10.1007/s12022-022-09707-3. PMID: 35288841.

28. Ibrahimpasic T, Ghossein R, Shah JP, Ganly I. 2019; Poorly differentiated carcinoma of the thyroid gland: current status and future prospects. Thyroid. 29(3):311–21. DOI: 10.1089/thy.2018.0509. PMID: 30747050. PMCID: PMC6437626.

29. Ibrahimpasic T, Ghossein R, Carlson DL, Nixon I, Palmer FL, Shaha AR, et al. 2014; Outcomes in patients with poorly differentiated thyroid carcinoma. J Clin Endocrinol Metab. 99(4):1245–52. DOI: 10.1210/jc.2013-3842. PMID: 24512493.

30. Lee DY, Won JK, Lee SH, Park DJ, Jung KC, Sung MW, et al. 2016; Changes of clinicopathologic characteristics and survival outcomes of anaplastic and poorly differentiated thyroid carcinoma. Thyroid. 26(3):404–13. DOI: 10.1089/thy.2015.0316. PMID: 26541309.

31. Hescot S, Al Ghuzlan A, Henry T, Sheikh-Alard H, Lamartina L, Borget I, et al. 2022; Prognostic of recurrence and survival in poorly differentiated thyroid cancer. Endocr Relat Cancer. 29(11):625–34. DOI: 10.1530/ERC-22-0151. PMID: 36040800.

32. Xu B, David J, Dogan S, Landa I, Katabi N, Saliba M, et al. 2022; Primary high-grade non-anaplastic thyroid carcinoma: a retrospective study of 364 cases. Histopathology. 80(2):322–37. DOI: 10.1111/his.14550. PMID: 34449926. PMCID: PMC9425734.

33. Dinets A, Gorobeiko M, Hoperia V, Lovin A, Tarasenko S. 2023; Papillary thyroid carcinoma coexisting with benign thyroid and parathyroid pathology: clinical and pathomorphological features. Int J Endocrinol (Ukraine). 19(4):274–8. DOI: 10.22141/2224-0721.19.4.2023.1285.

34. Tong J, Ruan M, Jin Y, Fu H, Cheng L, Luo Q, et al. 2022; Poorly differentiated thyroid carcinoma: a clinician's perspective. Eur Thyroid J. 11(2):e220021. DOI: 10.1530/ETJ-22-0021. PMID: 35195082. PMCID: PMC9010806.

35. Wong KS, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, et al. 2019; Prognostic significance of extent of invasion in poorly differentiated thyroid carcinoma. Thyroid. 29(9):1255–61. DOI: 10.1089/thy.2019.0263. PMID: 31397224.

36. Wong KS, Dong F, Telatar M, Lorch JH, Alexander EK, Marqusee E, et al. 2021; Papillary thyroid carcinoma with high- grade features versus poorly differentiated thyroid carcinoma: an analysis of clinicopathologic and molecular features and outcome. Thyroid. 31(6):933–40. DOI: 10.1089/thy.2020.0668. PMID: 33143568.

37. Haddad RI, Bischoff L, Salgado SA, Applewhite M, Bernet V, Blomain E, et al. NCCN clinical practice guidelines in oncology (NCCN Guidelines®): Thyroid carcinoma. version 1.2024. Available from: URL: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.

38. Gallardo E, Medina J, Sanchez JC, Viudez A, Grande E, Porras I, et al. 2020; SEOM clinical guideline thyroid cancer (2019). Clin Transl Oncol. 22(2):223–35. DOI: 10.1007/s12094-019-02284-8. PMID: 32006340.

39. Coca-Pelaz A, Shah JP, Hernandez-Prera JC, Ghossein RA, Rodrigo JP, Hartl DM, et al. 2020; Papillary thyroid cancer- aggressive variants and impact on management: a narrative review. Adv Ther. 37(7):3112–28. DOI: 10.1007/s12325-020-01391-1. PMID: 32488657. PMCID: PMC7467416.

40. Shi X, Liu R, Basolo F, Giannini R, Shen X, Teng D, et al. 2016; differential clinicopathological risk and prognosis of major papillary thyroid cancer variants. J Clin Endocrinol Metab. 101(1):264–74. DOI: 10.1210/jc.2015-2917. PMID: 26529630. PMCID: PMC4701842.

41. Zimmer D, Plitt G, Prendes B, Ku J, Silver N, Lamarre E, et al. 2023; Utilizing dynamic risk stratification in patients with tall cell variant papillary thyroid cancer. Laryngoscope. 133(9):2430–8. DOI: 10.1002/lary.30725. PMID: 37159105.

42. Vuong HG, Long NP, Anh NH, Nghi TD, Hieu MV, Hung LP, et al. 2018; Papillary thyroid carcinoma with tall cell features is as aggressive as tall cell variant: a meta-analysis. Endocr Connect. 7(12):R286–R93. DOI: 10.1530/EC-18-0333. PMID: 30352403. PMCID: PMC6240142.

43. Limberg J, Ullmann TM, Stefanova D, Buicko JL, Finnerty BM, Zarnegar R, et al. 2021; Does aggressive variant histology without invasive features predict overall survival in papillary thyroid cancer?: a national cancer database analysis. Ann Surg. 274(3):e276–e81. DOI: 10.1097/SLA.0000000000003632. PMID: 31599802.

44. Wang X, Cheng W, Liu C, Li J. 2016; Tall cell variant of papillary thyroid carcinoma: current evidence on clinicopathologic features and molecular biology. Oncotarget. 7(26):40792–9. DOI: 10.18632/oncotarget.8215. PMID: 27008708. PMCID: PMC5130045.

45. Ho AS, Luu M, Barrios L, Chen I, Melany M, Ali N, et al. 2020; Incidence and mortality risk spectrum across aggressive variants of papillary thyroid carcinoma. JAMA Oncol. 6(5):706–13. DOI: 10.1001/jamaoncol.2019.6851. PMID: 32134428. PMCID: PMC7059113.

46. Kazaure HS, Roman SA, Sosa JA. 2012; Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients. Ann Surg Oncol. 19(6):1874–80. DOI: 10.1245/s10434-011-2129-x. PMID: 22065195.

47. Bongers PJ, Kluijfhout WP, Verzijl R, Lustgarten M, Vermeer M, Goldstein DP, et al. 2019; 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(8):2533–9. DOI: 10.1245/s10434-019-07444-2. PMID: 31115855.

48. Shafique K, Baloch ZW. 2019; Risk stratification of papillary thyroid carcinoma and its variants; from clinicopathologic features to molecular profiling. Diagn Histopathol. 25(5):143–53. DOI: 10.1016/j.mpdhp.2019.02.001.

49. Jiang C, Cheng T, Zheng X, Hong S, Liu S, Liu J, et al. 2018; Clinical behaviors of rare variants of papillary thyroid carcinoma are associated with survival: a population-level analysis. Cancer Manag Res. 10:465–72. DOI: 10.2147/CMAR.S157823. PMID: 29563836. PMCID: PMC5849916.

50. Wang S, Xiong Y, Zhao Q, Song H, Yi P, Liu C. 2019; Columnar cell papillary thyroid carcinoma prognosis: findings from the SEER database using propensity score matching analysis. Am J Transl Res. 11(9):6262–70.

51. Nath MC, Erickson LA. 2018; Aggressive variants of papillary thyroid carcinoma: hobnail, tall cell, columnar, and solid. Adv Anat Pathol. 25(3):172–9. DOI: 10.1097/PAP.0000000000000184. PMID: 29351089.

52. Abazari MA, Soltani M, Moradi Kashkooli F, Raahemifar K. 2022; Synthetic 18F-FDG PET image generation using a combination of biomathematical modeling and machine learning. Cancers (Basel). 14(11):2786. DOI: 10.3390/cancers14112786. PMID: 35681767. PMCID: PMC9179454.

53. Donaldson LB, Yan F, Morgan PF, Kaczmar JM, Fernandes JK, Nguyen SA, et al. 2021; Hobnail variant of papillary thyroid carcinoma: a systematic review and meta-analysis. Endocrine. 72(1):27–39. DOI: 10.1007/s12020-020-02505-z. PMID: 33025563. PMCID: PMC8111367.

54. Ambrosi F, Righi A, Ricci C, Erickson LA, Lloyd RV, Asioli S. 2017; Hobnail variant of papillary thyroid carcinoma: a literature review. Endocr Pathol. 28(4):293–301. DOI: 10.1007/s12022-017-9502-7. PMID: 29019044.

55. Lee JS, Lee JS, Yun HJ, Kim SM, Chang H, Lee YS, et al. 2023; Aggressive subtypes of papillary thyroid carcinoma smaller than 1 cm. J Clin Endocrinol Metab. 108(6):1370–5. DOI: 10.1210/clinem/dgac739. PMID: 36546348. PMCID: PMC10188299.

56. Alswailem M, Alghamdi B, Alotaibi A, Aljomiah A, Al-Hindi H, Murugan AK, et al. 2023; Molecular genetics of diffuse sclerosing papillary thyroid cancer. J Clin Endocrinol Metab. 108(9):e704–e11. DOI: 10.1210/clinem/dgad185. PMID: 36995892.

57. Cavaco D, Martins AF, Cabrera R, Vilar H, Leite V. 2022; Diffuse sclerosing variant of papillary thyroid carcinoma: outcomes of 33 cases. Eur Thyroid J. 11(1):e210020. DOI: 10.1530/ETJ-21-0020. PMID: 34981753. PMCID: PMC9142808.

58. Kim SY, Shin SJ, Lee DG, Yun HJ, Kim SM, Chang H, et al. 2023; Clinicopathological and genetic characteristics of patients of different ages with diffuse sclerosing variant papillary thyroid carcinoma. Cancers (Basel). 15(12):3101. DOI: 10.3390/cancers15123101. PMID: 37370711. PMCID: PMC10296723.

59. Vuong HG, Kondo T, Pham TQ, Oishi N, Mochizuki K, Nakazawa T, et al. 2017; Prognostic significance of diffuse sclerosing variant papillary thyroid carcinoma: a systematic review and meta-analysis. Eur J Endocrinol. 176(4):433–41. DOI: 10.1530/EJE-16-0863. PMID: 28183787.

60. Crayton H, Wu K, Leong D, Bhimani N, Gild M, Glover A. 2023; Diffuse sclerosing variant papillary thyroid carcinoma has worse survival than classic papillary thyroid carcinoma: a meta-analysis. Endocr Relat Cancer. 30(6):e220348. DOI: 10.1530/ERC-22-0348. PMID: 36952650.

61. Moreno Egea A, Rodriguez Gonzalez JM, Sola Perez J, Soria Cogollos T, Parrilla Paricio P. 1993; Prognostic value of the tall cell variety of papillary cancer of the thyroid. Eur J Surg Oncol. 19(6):517–21.

62. Terry JH, St John SA, Karkowski FJ, Suarez JR, Yassa NH, Platica CD, et al. 1994; Tall cell papillary thyroid cancer: incidence and prognosis. Am J Surg. 168(5):459–61. DOI: 10.1016/S0002-9610(05)80099-6. PMID: 7977973.

63. Segal K, Friedental R, Lubin E, Shvero J, Sulkes J, Feinmesser R. 1995; Papillary carcinoma of the thyroid. Otolaryngol Head Neck Surg. 113(4):356–63. DOI: 10.1016/S0194-59989570068-4. PMID: 7567004.

64. Johnson TL, Lloyd RV, Thompson NW, Beierwaltes WH, Sisson JC. 1988; Prognostic implications of the tall cell variant of papillary thyroid carcinoma. Am J Surg Pathol. 12(1):22–7. DOI: 10.1097/00000478-198801000-00003. PMID: 3337337.

65. Ghossein RA, Leboeuf R, Patel KN, Rivera M, Katabi N, Carlson DL, et al. 2007; Tall cell variant of papillary thyroid carcinoma without extrathyroid extension: biologic behavior and clinical implications. Thyroid. 17(7):655–61. DOI: 10.1089/thy.2007.0061. PMID: 17696836.

66. Michels JJ, Jacques M, Henry-Amar M, Bardet S. 2007; Prevalence and prognostic significance of tall cell variant of papillary thyroid carcinoma. Hum Pathol. 38(2):212–9. DOI: 10.1016/j.humpath.2006.08.001. PMID: 17097131.

67. Leung AK, Chow SM, Law SC. 2008; Clinical features and outcome of the tall cell variant of papillary thyroid carcinoma. Laryngoscope. 118(1):32–8. DOI: 10.1097/MLG.0b013e318156f6c3. PMID: 18025951.

68. Beninato T, Scognamiglio T, Kleiman DA, Uccelli A, Vaca D, Fahey TJ 3rd, et al. 2013; Ten percent tall cells confer the aggressive features of the tall cell variant of papillary thyroid carcinoma. Surgery. 154(6):1331–6. discussion 6DOI: 10.1016/j.surg.2013.05.009. PMID: 24238051.

69. Regalbuto C, Malandrino P, Frasca F, Pellegriti G, Le Moli R, Vigneri R, et al. 2013; The tall cell variant of papillary thyroid carcinoma: clinical and pathological features and outcomes. J Endocrinol Invest. 36(4):249–54.

70. Prendiville S, Burman KD, Ringel MD, Shmookler BM, Deeb ZE, Wolfe K, et al. 2000; Tall cell variant: an aggressive form of papillary thyroid carcinoma. Otolaryngol Head Neck Surg. 122(3):352–7. DOI: 10.1016/S0194-5998(00)70047-7. PMID: 10699809.

71. Russo M, Malandrino P, Moleti M, Vermiglio F, Violi MA, Marturano I, et al. 2017; Tall cell and diffuse sclerosing variants of papillary thyroid cancer: outcome and predicting value of risk stratification methods. J Endocrinol Invest. 40(11):1235–41. DOI: 10.1007/s40618-017-0688-9. PMID: 28528434.

72. Song E, Jeon MJ, Oh HS, Han M, Lee YM, Kim TY, et al. 2018; Do aggressive variants of papillary thyroid carcinoma have worse clinical outcome than classic papillary thyroid carcinoma? Eur J Endocrinol. 179(3):135–42. DOI: 10.1530/EJE-17-0991. PMID: 29875289.

73. Scholfield DW, Fitzgerald CW, Alzumaili B, Eagan A, Xu B, Martinez G, et al. 2023; Diffuse sclerosing papillary thyroid carcinoma: clinicopathological characteristics and prognostic implications compared with classic and tall cell papillary thyroid cancer. Ann Surg Oncol. 30(8):4761–70. DOI: 10.1245/s10434-023-13589-y. PMID: 37154968.

74. Wenig BM, Thompson LD, Adair CF, Shmookler B, Heffess CS. 1998; Thyroid papillary carcinoma of columnar cell type: a clinicopathologic study of 16 cases. Cancer. 82(4):740–53. DOI: 10.1002/(SICI)1097-0142(19980215)82:4<740::AID-CNCR18>3.0.CO;2-Y.

75. Chen JH, Faquin WC, Lloyd RV, Nose V. 2011; Clinicopathological and molecular characterization of nine cases of columnar cell variant of papillary thyroid carcinoma. Mod Pathol. 24(5):739–49. DOI: 10.1038/modpathol.2011.2. PMID: 21358618.

76. Cho J, Shin JH, Hahn SY, Oh YL. 2018; Columnar cell variant of papillary thyroid carcinoma: ultrasonographic and clinical differentiation between the indolent and aggressive types. Korean J Radiol. 19(5):1000–5. DOI: 10.3348/kjr.2018.19.5.1000. PMID: 30174490. PMCID: PMC6082763.

77. Asioli S, Erickson LA, Sebo TJ, Zhang J, Jin L, Thompson GB, et al. 2010; Papillary thyroid carcinoma with prominent hobnail features: a new aggressive variant of moderately differentiated papillary carcinoma. A clinicopathologic, immunohistochemical, and molecular study of eight cases. Am J Surg Pathol. 34(1):44–52. DOI: 10.1097/PAS.0b013e3181c46677. PMID: 19956062.

78. Lubitz CC, Economopoulos KP, Pawlak AC, Lynch K, Dias-Santagata D, Faquin WC, et al. 2014; Hobnail variant of papillary thyroid carcinoma: an institutional case series and molecular profile. Thyroid. 24(6):958–65. DOI: 10.1089/thy.2013.0573. PMID: 24417340. PMCID: PMC4046200.

79. Amacher AM, Goyal B, Lewis JS Jr, El-Mofty SK, Chernock RD. 2015; Prevalence of a hobnail pattern in papillary, poorly differentiated, and anaplastic thyroid carcinoma: a possible manifestation of high-grade transformation. Am J Surg Pathol. 39(2):260–5. DOI: 10.1097/PAS.0000000000000329. PMID: 25321328.

80. Teng L, Deng W, Lu J, Zhang J, Ren X, Duan H, et al. 2017; Hobnail variant of papillary thyroid carcinoma: molecular profiling and comparison to classical papillary thyroid carcinoma, poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma. Oncotarget. 8(13):22023–33. DOI: 10.18632/oncotarget.15786. PMID: 28423545. PMCID: PMC5400643.

81. Spyroglou A, Kostopoulos G, Tseleni S, Toulis K, Bramis K, Mastorakos G, et al. 2022; Hobnail papillary thyroid carcinoma, a systematic review and meta-analysis. Cancers (Basel). 14(11):2785. DOI: 10.3390/cancers14112785. PMID: 35681765. PMCID: PMC9179392.

82. Malandrino P, Russo M, Regalbuto C, Pellegriti G, Moleti M, Caff A, et al. 2016; Outcome of the diffuse sclerosing variant of papillary thyroid cancer: a meta-analysis. Thyroid. 26(9):1285–92. DOI: 10.1089/thy.2016.0168. PMID: 27349273.

83. Nikiforov YE, Erickson LA, Nikiforova MN, Caudill CM, Lloyd RV. 2001; Solid variant of papillary thyroid carcinoma: incidence, clinical-pathologic characteristics, molecular analysis, and biologic behavior. Am J Surg Pathol. 25(12):1478–84. DOI: 10.1097/00000478-200112000-00002. PMID: 11717536.

84. Vuong HG, Odate T, Duong UNP, Mochizuki K, Nakazawa T, Katoh R, et al. 2018; Prognostic importance of solid variant papillary thyroid carcinoma: a systematic review and meta-analysis. Head Neck. 40(7):1588–97. DOI: 10.1002/hed.25123. PMID: 29509280.

85. Vural C, Kiraz U, Turan G, Ozkara SK, Sozen M, Cetinarslan B. 2021; Solid variant of papillary thyroid carcinoma: an analysis of 28 cases with current literature. Ann Diagn Pathol. 52:151737. DOI: 10.1016/j.anndiagpath.2021.151737. PMID: 33838489.

86. Xu B, Viswanathan K, Zhang L, Edmund LN, Ganly O, Tuttle RM, et al. 2022; The solid variant of papillary thyroid carcinoma: a multi-institutional retrospective study. Histopathology. 81(2):171–82. DOI: 10.1111/his.14668. PMID: 35474588.

87. Diker-Cohen T, Hirsch D, Shimon I, Bachar G, Akirov A, Duskin-Bitan H, et al. Impact of minimal extra-thyroid extension in differentiated thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2018; [Online ahead of print]. DOI: 10.1210/jc.2018-00081. PMID: 29506045.

88. Castagna MG, Forleo R, Maino F, Fralassi N, Barbato F, Palmitesta P, et al. 2018; Small papillary thyroid carcinoma with minimal extrathyroidal extension should be managed as ATA low-risk tumor. J Endocrinol Invest. 41(9):1029–35. DOI: 10.1007/s40618-018-0854-8. PMID: 29470826.

89. He Q, Ji F, Fu X, Li Z, Qiu X. 2022; "Micro" extrathyroidal extension in risk stratification for papillary thyroid carcinoma: should it be in the intermediate-risk or high-risk group? A single-center retrospective study. Cancer Manag Res. 14:3181–90. DOI: 10.2147/CMAR.S390468. PMID: 36415538. PMCID: PMC9675991.

90. Nixon IJ, Ganly I, Patel S, Palmer FL, Whitcher MM, Tuttle RM, et al. 2011; The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer. Surgery. 150(6):1242–9. DOI: 10.1016/j.surg.2011.09.007. PMID: 22136847. PMCID: PMC4151609.

91. Kang IK, Kim K, Bae JS, Kim JS. 2021; Is completion thyroidectomy necessary in patients with papillary thyroid carcinoma who underwent lobectomy? Korean J Head Neck Oncol. 37(2):25–31. DOI: 10.21593/kjhno/2021.37.2.25.

92. Xu M, Xi Z, Zhao Q, Yang W, Tan J, Yi P, et al. 2023; Causal inference between aggressive extrathyroidal extension and survival in papillary thyroid cancer: a propensity score matching and weighting analysis. Front Endocrinol (Lausanne). 14:1149826. DOI: 10.3389/fendo.2023.1149826. PMID: 37293504. PMCID: PMC10244725.

93. Zhang L, Liu J, Wang P, Xue S, Li J, Chen G. 2020; Impact of gross strap muscle invasion on outcome of differentiated thyroid cancer: systematic review and meta-analysis. Front Oncol. 10:1687. DOI: 10.3389/fonc.2020.01687. PMID: 33102203. PMCID: PMC7546766.

94. Liu Z, Huang Y, Chen S, Hu D, Wang M, Zhou L, et al. 2019; Minimal extrathyroidal extension affects the prognosis of differentiated thyroid cancer: is there a need for change in the AJCC classification system? PLoS One. 14(6):e0218171. DOI: 10.1371/journal.pone.0218171. PMID: 31199822. PMCID: PMC6568405.

95. Abraham E, Roshan D, Tran B, Wykes J, Campbell P, Ebrahimi A. 2019; The extent of extrathyroidal extension is a key determinant of prognosis in T4a papillary thyroid cancer. J Surg Oncol. 120(6):1016–22. DOI: 10.1002/jso.25683. PMID: 31452204.

96. Kim Y, Kim YS, Bae JS, Kim JS, Kim K. 2022; Is gross extrathyroidal extension to strap muscles (T3b) only a risk factor for recurrence in papillary thyroid carcinoma? A propensity score matching study. Cancers (Basel). 14(10):2370. DOI: 10.3390/cancers14102370. PMID: 35625974. PMCID: PMC9139627.

97. Jang A, Jin M, Kim WW, Jeon MJ, Sung TY, Song DE, et al. 2022; Prognosis of patients with 1-4 cm papillary thyroid cancer who underwent lobectomy: focus on gross extrathyroidal extension invading only the strap muscles. Ann Surg Oncol. 29(12):7835–42. DOI: 10.1245/s10434-022-12155-2. PMID: 35907995.

98. Lyu YS, Pyo JS, Cho WJ, Kim SY, Kim JH. 2021; Clinicopathological significance of papillary thyroid carcinoma located in the isthmus: a meta-analysis. World J Surg. 45(9):2759–68. DOI: 10.1007/s00268-021-06178-1. PMID: 34117511.

99. Park JO, Kim JH, Joo YH, Kim SY, Kim GJ, Kim HB, et al. 2023; Guideline for the surgical management of locally invasive differentiated thyroid cancer from the Korean Society of Head and Neck Surgery. Clin Exp Otorhinolaryngol. 16(1):1–19. DOI: 10.21053/ceo.2022.01732. PMID: 36634669. PMCID: PMC9985989.

100. Yin DT, Yu K, Lu RQ, Li X, Xu J, Lei M. 2016; Prognostic impact of minimal extrathyroidal extension in papillary thyroid carcinoma. Medicine (Baltimore). 95(52):e5794. DOI: 10.1097/MD.0000000000005794. PMID: 28033304. PMCID: PMC5207600.

101. Hay ID, Johnson TR, Thompson GB, Sebo TJ, Reinalda MS. 2016; Minimal extrathyroid extension in papillary thyroid carcinoma does not result in increased rates of either cause- specific mortality or postoperative tumor recurrence. Surgery. 159(1):11–9. DOI: 10.1016/j.surg.2015.05.046. PMID: 26514317.

102. Harries V, McGill M, Yuan A, Wang LY, Tuttle RM, Shaha AR, et al. 2022; Does macroscopic extrathyroidal extension to the strap muscles alone affect survival in papillary thyroid carcinoma? Surgery. 171(5):1341–7. DOI: 10.1016/j.surg.2021.08.041. PMID: 34600743. PMCID: PMC8960478.

103. Zuhur SS, Aggul H, Avci U, Erol S, Tuna MM, Uysal S, et al. 2024; The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study. Endocrine. 83(3):700–7. DOI: 10.1007/s12020-023-03533-1. PMID: 37736822.

104. Park JS, Chang JW, Liu L, Jung SN, Koo BS. 2017; Clinical implications of microscopic extrathyroidal extension in patients with papillary thyroid carcinoma. Oral Oncol. 72:183–7. DOI: 10.1016/j.oraloncology.2017.02.008. PMID: 28222967.

105. Beom Heo D, Piao Y, Hee Lee J, Ju SH, Yi HS, Su Kim M, et al. 2022; Completion thyroidectomy may not be required for papillary thyroid carcinoma with multifocality, lymphovascular invasion, extrathyroidal extension to the strap muscles, or five or more central lymph node micrometastasis. Oral Oncol. 134:106115. DOI: 10.1016/j.oraloncology.2022.106115. PMID: 36108524.

106. Fukushima M, Ito Y, Hirokawa M, Miya A, Shimizu K, Miyauchi A. 2010; Prognostic impact of extrathyroid extension and clinical lymph node metastasis in papillary thyroid carcinoma depend on carcinoma size. World J Surg. 34(12):3007–14. DOI: 10.1007/s00268-010-0776-x. PMID: 20824274.

107. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. 2006; Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg. 30(5):780–6. DOI: 10.1007/s00268-005-0270-z. PMID: 16411013.

108. Hotomi M, Sugitani I, Toda K, Kawabata K, Fujimoto Y. 2012; A novel definition of extrathyroidal invasion for patients with papillary thyroid carcinoma for predicting prognosis. World J Surg. 36(6):1231–40. DOI: 10.1007/s00268-012-1518-z. PMID: 22402972.

109. Danilovic DLS, Castroneves LA, Suemoto CK, Elias LO, Soares IC, Camargo RY, et al. 2020; Is there a difference between minimal and gross extension into the strap muscles for the risk of recurrence in papillary thyroid carcinomas? Thyroid. 30(7):1008–16. DOI: 10.1089/thy.2019.0753. PMID: 32059626.

110. Li G, Li R, Song L, Chen W, Jiang K, Tang H, et al. 2020; Implications of extrathyroidal extension invading only the strap muscles in papillary thyroid carcinomas. Thyroid. 30(1):57–64. DOI: 10.1089/thy.2018.0801. PMID: 31830859.

111. Amit M, Boonsripitayanon M, Goepfert RP, Tam S, Busaidy NL, Cabanillas ME, et al. 2018; Extrathyroidal extension: does strap muscle invasion alone influence recurrence and survival in patients with differentiated thyroid cancer? Ann Surg Oncol. 25(11):3380–8. DOI: 10.1245/s10434-018-6563-x. PMID: 30022274.

112. Park SY, Kim HI, Kim JH, Kim JS, Oh YL, Kim SW, et al. 2018; Prognostic significance of gross extrathyroidal extension invading only strap muscles in differentiated thyroid carcinoma. Br J Surg. 105(9):1155–62. DOI: 10.1002/bjs.10830. PMID: 29663333.

113. Wang LY, Nixon IJ, Patel SG, Palmer FL, Tuttle RM, Shaha A, et al. 2016; Operative management of locally advanced, differentiated thyroid cancer. Surgery. 160(3):738–46. DOI: 10.1016/j.surg.2016.04.027. PMID: 27302105. PMCID: PMC5126966.

114. Sanabria A, Kowalski LP, Nixon IJ, Simo R. 2021; Microscopic positive surgical margins in thyroid carcinoma: a proposal for thyroid oncology teams. Langenbecks Arch Surg. 406(3):563–9. DOI: 10.1007/s00423-021-02095-y. PMID: 33555410.

115. Ito Y, Fukushima M, Yabuta T, Tomoda C, Inoue H, Kihara M, et al. 2009; Local prognosis of patients with papillary thyroid carcinoma who were intra-operatively diagnosed as having minimal invasion of the trachea: a 17-year experience in a single institute. Asian J Surg. 32(2):102–8. DOI: 10.1016/S1015-9584(09)60019-1. PMID: 19423457.

116. Gronlund MP, Jensen JS, Hahn CH, Gronhoj C, Buchwald CV. 2021; Risk factors for recurrence of follicular thyroid cancer: a systematic review. Thyroid. 31(10):1523–30. DOI: 10.1089/thy.2020.0921. PMID: 34102860.

117. Lo TE, Canto AU, Maningat PD. 2015; Risk factors for recurrence in filipinos with well-differentiated thyroid cancer. Endocrinol Metab (Seoul). 30(4):543–50. DOI: 10.3803/EnM.2015.30.4.543. PMID: 26485470. PMCID: PMC4722410.

118. Tzavara I, Vlassopoulou B, Alevizaki C, Koukoulis G, Tzanela M, Koumoussi P, et al. 1999; Differentiated thyroid cancer: a retrospective analysis of 832 cases from Greece. Clin Endocrinol (Oxf). 50(5):643–54. DOI: 10.1046/j.1365-2265.1999.00715.x. PMID: 10468931.

119. Enomoto K, Enomoto Y, Uchino S, Yamashita H, Noguchi S. 2013; Follicular thyroid cancer in children and adolescents: clinicopathologic features, long-term survival, and risk factors for recurrence. Endocr J. 60(5):629–35. DOI: 10.1507/endocrj.EJ12-0372. PMID: 23327804.

120. Kim WG, Kim TY, Kim TH, Jang HW, Jo YS, Park YJ, et al. 2014; Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data. Korean J Intern Med. 29(3):325–33. DOI: 10.3904/kjim.2014.29.3.325. PMID: 24851067. PMCID: PMC4028522.

121. Zhang T, He L, Wang Z, Dong W, Sun W, Zhang P, et al. 2023; Risk factors for death of follicular thyroid carcinoma: a systematic review and meta-analysis. Endocrine. 82(3):457–66. DOI: 10.1007/s12020-023-03466-9. PMID: 37804444. PMCID: PMC10618390.

122. O'Neill CJ, Vaughan L, Learoyd DL, Sidhu SB, Delbridge LW, Sywak MS. 2011; Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion. Eur J Surg Oncol. 37(2):181–5. DOI: 10.1016/j.ejso.2010.11.005. PMID: 21144693.

123. Lang W, Choritz H, Hundeshagen H. 1986; Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings. Am J Surg Pathol. 10(4):246–55. DOI: 10.1097/00000478-198604000-00003. PMID: 3706611.

124. Huang CC, Hsueh C, Liu FH, Chao TC, Lin JD. 2011; Diagnostic and therapeutic strategies for minimally and widely invasive follicular thyroid carcinomas. Surg Oncol. 20(1):1–6. DOI: 10.1016/j.suronc.2009.06.006. PMID: 19596568.

125. Yamazaki H, Katoh R, Sugino K, Matsuzu K, Masaki C, Akaishi J, et al. Encapsulated angioinvasive follicular thyroid carcinoma: prognostic impact of the extent of vascular invasion. Ann Surg Oncol. 2022; [Online ahead of print]. DOI: 10.1245/s10434-022-11401-x. PMID: 35169976.

126. Lee YM, Lee YH, Song DE, Kim WB, Sung TY, Yoon JH, et al. 2017; Prognostic impact of further treatments on distant metastasis in patients with minimally invasive follicular thyroid carcinoma: verification using inverse probability of treatment weighting. World J Surg. 41(1):138–45. DOI: 10.1007/s00268-016-3608-9. PMID: 27272481.

127. Matsuura D, Yuan A, Wang L, Ranganath R, Adilbay D, Harries V, et al. 2022; Follicular and Hurthle cell carcinoma: comparison of clinicopathological features and clinical outcomes. Thyroid. 32(3):245–54. DOI: 10.1089/thy.2021.0424. PMID: 35078345. PMCID: PMC9206490.

128. Leong D, Gill AJ, Turchini J, Waller M, Clifton-Bligh R, Glover A, et al. 2023; The prognostic impact of extent of vascular invasion in follicular thyroid carcinoma. World J Surg. 47(2):412–20. DOI: 10.1007/s00268-022-06696-6. PMID: 36031639.

129. Ito Y, Hirokawa M, Masuoka H, Higashiyama T, Kihara M, Onoda N, et al. 2022; Prognostic factors for follicular thyroid carcinoma: the importance of vascular invasion. Endocr J. 69(9):1149–56. DOI: 10.1507/endocrj.EJ22-0077. PMID: 35491160.

130. D'Avanzo A, Treseler P, Ituarte PH, Wong M, Streja L, Greenspan FS, et al. 2004; Follicular thyroid carcinoma: histology and prognosis. Cancer. 100(6):1123–9. DOI: 10.1002/cncr.20081. PMID: 15022277.

131. Jin M, Kim ES, Kim BH, Kim HK, Yi HS, Jeon MJ, et al. 2020; Clinical implication of World Health Organization classification in patients with follicular thyroid carcinoma in South Korea: a multicenter cohort study. Endocrinol Metab (Seoul). 35(3):618–27. DOI: 10.3803/EnM.2020.742. PMID: 32981304. PMCID: PMC7520579.

132. Kim HJ, Sung JY, Oh YL, Kim JH, Son YI, Min YK, et al. 2014; Association of vascular invasion with increased mortality in patients with minimally invasive follicular thyroid carcinoma but not widely invasive follicular thyroid carcinoma. Head Neck. 36(12):1695–700. DOI: 10.1002/hed.23511. PMID: 24115217.

133. Ito Y, Hirokawa M, Fujishima M, Masuoka H, Higashiyama T, Kihara M, et al. 2021; Prognostic significance of vascular invasion and cell-proliferation activity in widely invasive follicular carcinoma of the thyroid. Endocr J. 68(8):881–8. DOI: 10.1507/endocrj.EJ21-0064. PMID: 33746136.

134. Xu B, Wang L, Tuttle RM, Ganly I, Ghossein R. 2015; Prognostic impact of extent of vascular invasion in low-grade encapsulated follicular cell-derived thyroid carcinomas: a clinicopathologic study of 276 cases. Hum Pathol. 46(12):1789–98. DOI: 10.1016/j.humpath.2015.08.015. PMID: 26482605. PMCID: PMC4981341.

135. Yamazaki H, Sugino K, Katoh R, Matsuzu K, Kitagawa W, Nagahama M, et al. 2023; New insights on the importance of the extent of vascular invasion in widely invasive follicular thyroid carcinoma. World J Surg. 47(11):2767–75. DOI: 10.1007/s00268-023-07127-w. PMID: 37516689.

136. Roti E, degli Uberti EC, Bondanelli M, Braverman LE. 2008; Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol. 159(6):659–73. DOI: 10.1530/EJE-07-0896. PMID: 18713843.

137. Park JH, Yoon JH. 2019; Lobectomy in patients with differentiated thyroid cancer: indications and follow-up. Endocr Relat Cancer. 26(7):R381–R93. DOI: 10.1530/ERC-19-0085. PMID: 31018176.

138. Gardner RE, Tuttle RM, Burman KD, Haddady S, Truman C, Sparling YH, et al. 2000; Prognostic importance of vascular invasion in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 126(3):309–12. DOI: 10.1001/archotol.126.3.309. PMID: 10722002.

139. Nishida T, Katayama S, Tsujimoto M. 2002; The clinicopathological significance of histologic vascular invasion in differentiated thyroid carcinoma. Am J Surg. 183(1):80–6. DOI: 10.1016/S0002-9610(01)00843-1. PMID: 11869709.

140. Falvo L, Catania A, D'Andrea V, Marzullo A, Giustiniani MC, De Antoni E. 2005; Prognostic importance of histologic vascular invasion in papillary thyroid carcinoma. Ann Surg. 241(4):640–6. DOI: 10.1097/01.sla.0000157317.60536.08. PMID: 15798466. PMCID: PMC1357068.

141. Wreesmann VB, Nixon IJ, Rivera M, Katabi N, Palmer F, Ganly I, et al. 2015; Prognostic value of vascular invasion in well- differentiated papillary thyroid carcinoma. Thyroid. 25(5):503–8. DOI: 10.1089/thy.2015.0052. PMID: 25748079. PMCID: PMC4968276.

142. Reilly J, Faridmoayer E, Lapkus M, Pastewski J, Sun F, Elassar H, et al. 2022; Vascular invasion predicts advanced tumor characteristics in papillary thyroid carcinoma. Am J Surg. 223(3):487–91. DOI: 10.1016/j.amjsurg.2021.11.038. PMID: 34952686.

143. Suh YJ, Kwon H, Kim SJ, Choi JY, Lee KE, Park YJ, et al. 2015; Factors affecting the locoregional recurrence of conventional papillary thyroid carcinoma after surgery: a retrospective analysis of 3381 patients. Ann Surg Oncol. 22(11):3543–9. DOI: 10.1245/s10434-015-4448-9. PMID: 25743326.

144. de Castro TP, Waissmann W, Simoes TC, de Mello RC, Carvalho DP. 2016; Predictors for papillary thyroid cancer persistence and recurrence: a retrospective analysis with a 10-year follow-up cohort study. Clin Endocrinol (Oxf). 85(3):466–74. DOI: 10.1111/cen.13032. PMID: 26834009.

145. Sorrenti S, Carbotta G, Di Matteo FM, Catania A, Pironi D, Tartaglia F, et al. 2020; Evaluation of clinicopathological and molecular parameters on disease recurrence of papillary thyroid cancer patient: a retrospective observational study. Cancers (Basel). 12(12):3637. DOI: 10.3390/cancers12123637. PMID: 33291668. PMCID: PMC7761952.

146. Furlan JC, Bedard YC, Rosen IB. 2004; Clinicopathologic significance of histologic vascular invasion in papillary and follicular thyroid carcinomas. J Am Coll Surg. 198(3):341–8. DOI: 10.1016/j.jamcollsurg.2003.11.012. PMID: 14992733.

147. Cao J, Hu JL, Chen C, Wang QL, Fang XH, Zhang Y, et al. 2016; Vascular invasion is an independent prognostic factor for distant recurrence-free survival in papillary thyroid carcinoma: a matched-case comparative study. J Clin Pathol. 69(10):872–7. DOI: 10.1136/jclinpath-2015-203547. PMID: 27010434.

148. Chereau N, Tresallet C, Noullet S, Godiris-Petit G, Tissier F, Leenhardt L, et al. 2016; Does the T1 subdivision correlate with the risk of recurrence of papillary thyroid cancer? Langenbecks Arch Surg. 401(2):223–30. DOI: 10.1007/s00423-016-1399-y. PMID: 26957089.

149. Mai KT, Khanna P, Yazdi HM, Perkins DG, Veinot JP, Thomas J, et al. 2002; Differentiated thyroid carcinomas with vascular invasion: a comparative study of follicular, Hurthle cell and papillary thyroid carcinoma. Pathology. 34(3):239–44. DOI: 10.1080/00313020220131291. PMID: 12109784.

150. Mete O, Asa SL. 2011; Pathological definition and clinical significance of vascular invasion in thyroid carcinomas of follicular epithelial derivation. Mod Pathol. 24(12):1545–52. DOI: 10.1038/modpathol.2011.119. PMID: 21804527.

151. Kim JM, Kim TY, Kim WB, Gong G, Kim SC, Hong SJ, et al. 2006; Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma. Laryngoscope. 116(11):2081–5. DOI: 10.1097/01.mlg.0000242118.79647.a9. PMID: 17075398.

152. Lee E, Jung W, Woo JS, Lee JB, Shin BK, Kim HK, et al. 2014; Tumor sprouting in papillary thyroid carcinoma is correlated with lymph node metastasis and recurrence. Korean J Pathol. 48(2):117–25. DOI: 10.4132/KoreanJPathol.2014.48.2.117. PMID: 24868224. PMCID: PMC4026802.

153. Amin SN, Shinn JR, Naguib MM, Netterville JL, Rohde SL. 2020; Risk factors and outcomes of postoperative recurrent well-differentiated thyroid cancer: a single institution's 15-year experience. Otolaryngol Head Neck Surg. 162(4):469–75. DOI: 10.1177/0194599820904923. PMID: 32069184.

154. Mazzaferri EL. 2007; Management of low-risk differentiated thyroid cancer. Endocr Pract. 13(5):498–512. DOI: 10.4158/EP.13.5.498. PMID: 17872353.

155. Kim KJ, Kim SM, Lee YS, Chung WY, Chang HS, Park CS. 2015; Prognostic significance of tumor multifocality in papillary thyroid carcinoma and its relationship with primary tumor size: a retrospective study of 2,309 consecutive patients. Ann Surg Oncol. 22(1):125–31. DOI: 10.1245/s10434-014-3899-8. PMID: 25092159.

156. Wang F, Yu X, Shen X, Zhu G, Huang Y, Liu R, et al. 2017; The prognostic value of tumor multifocality in clinical outcomes of papillary thyroid cancer. J Clin Endocrinol Metab. 102(9):3241–50. DOI: 10.1210/jc.2017-00277. PMID: 28582521. PMCID: PMC5587077.

157. La Greca A, Xu B, Ghossein R, Tuttle RM, Sabra MM. 2017; Patients with multifocal macroscopic papillary thyroid carcinoma have a low risk of recurrence at early follow-up after total thyroidectomy and radioactive iodine treatment. Eur Thyroid J. 6(1):31–9. DOI: 10.1159/000448752. PMID: 28611946. PMCID: PMC5465646.

158. Jeon YW, Gwak HG, Lim ST, Schneider J, Suh YJ. 2019; Long-term prognosis of unilateral and multifocal papillary thyroid microcarcinoma after unilateral lobectomy versus total thyroidectomy. Ann Surg Oncol. 26(9):2952–8. DOI: 10.1245/s10434-019-07482-w. PMID: 31264119.

159. Kim H, Kwon H. 2023; Bilaterality as a risk factor for recurrence in papillary thyroid carcinoma. Cancers (Basel). 15(22):5414. DOI: 10.3390/cancers15225414. PMID: 38001674. PMCID: PMC10670155.

160. Harries V, Wang LY, McGill M, Xu B, Tuttle RM, Wong RJ, et al. 2020; Should multifocality be an indication for completion thyroidectomy in papillary thyroid carcinoma? Surgery. 167(1):10–7. DOI: 10.1016/j.surg.2019.03.031. PMID: 31515125. PMCID: PMC6904525.

161. Kim HJ, Sohn SY, Jang HW, Kim SW, Chung JH. 2013; Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J Surg. 37(2):376–84. DOI: 10.1007/s00268-012-1835-2. PMID: 23135422.

162. Omi Y, Haniu K, Kamio H, Fujimoto M, Yoshida Y, Horiuchi K, et al. 2022; Pathological multifocality is not a prognosis factor of papillary thyroid carcinoma: a single-center, retrospective study. World J Surg Oncol. 20(1):394. DOI: 10.1186/s12957-022-02869-8. PMID: 36510206. PMCID: PMC9743747.

163. Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, et al. 2005; Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 90(10):5723–9. DOI: 10.1210/jc.2005-0285. PMID: 16030160.

164. Kim JM. 2021; The clinical importance of multifocality on tumor recurrence in papillary thyroid carcinoma. Gland Surg. 10(1):273–8. DOI: 10.21037/gs-20-603. PMID: 33633983. PMCID: PMC7882335.

165. Choi WR, Roh JL, Gong G, Cho KJ, Choi SH, Nam SY, et al. 2019; Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence. Oral Oncol. 94:106–10. DOI: 10.1016/j.oraloncology.2019.05.023. PMID: 31178204.

166. Geron Y, Benbassat C, Shteinshneider M, Or K, Markus E, Hirsch D, et al. 2019; Multifocality is not an independent prognostic factor in papillary thyroid cancer: a propensity score-matching analysis. Thyroid. 29(4):513–22. DOI: 10.1089/thy.2018.0547. PMID: 30799769.

167. Kim Y, Roh JL, Gong G, Cho KJ, Choi SH, Nam SY, et al. 2017; Risk factors for lateral neck recurrence of N0/N1a papillary thyroid cancer. Ann Surg Oncol. 24(12):3609–16. DOI: 10.1245/s10434-017-6057-2. PMID: 28822118.

168. Li X, Zhao C, Hu D, Yu Y, Gao J, Zhao W, et al. 2013; Hemithyroidectomy increases the risk of disease recurrence in patients with ipsilateral multifocal papillary thyroid carcinoma. Oncol Lett. 5(4):1412–6. DOI: 10.3892/ol.2013.1202. PMID: 23599804. PMCID: PMC3629150.

169. Jarząb B, Dedecjus M, Lewiński M, Adamczewski Z, Bakuła-Zalewska E, Bałdys-Waligórska A, et al. 2022; Diagnosis and treatment of thyroid cancer in adult patients - Recommendations of Polish Scientific Societies and the National Oncological Strategy. 2022 Update [Diagnostyka i leczenie raka tarczycy u chorych dorosłych - Rekomendacje Polskich Towarzystw Naukowych oraz Narodowej Strategii Onkologicznej. Aktualizacja na rok 2022]. Endokrynol Pol. 73(2):173–300. DOI: 10.5603/EP.a2022.0028. PMID: 35593680.

170. Cranshaw IM, Carnaille B. 2008; Micrometastases in thyroid cancer. An important finding? Surg Oncol. 17(3):253–8. DOI: 10.1016/j.suronc.2008.04.005. PMID: 18504121.

171. Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A. 2004; A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery. 135(2):139–48. DOI: 10.1016/S0039-6060(03)00384-2. PMID: 14739848.

172. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. 2012; The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 22(11):1144–52. DOI: 10.1089/thy.2012.0043. PMID: 23083442.

173. Kim HI, Hyeon J, Park SY, Ahn HS, Kim K, Han JM, et al. 2019; Impact of extranodal extension on risk stratification in papillary thyroid carcinoma. Thyroid. 29(7):963–70. DOI: 10.1089/thy.2018.0541. PMID: 31025609. PMCID: PMC6648218.

174. Chidambaranathan N, Thiagarajan S, Gurukeerthi B, Sathe P, Samel P, Ramalingam N, et al. 2024; The significance of the presence of extranodal extension in the metastatic node of differentiated thyroid cancer: a proposal for modification in the American Thyroid Association (ATA) risk stratification. Eur Arch Otorhinolaryngol. 281(4):1923–31. DOI: 10.1007/s00405-023-08438-3. PMID: 38189969.

175. Hwangbo Y, Kim JM, Park YJ, Lee EK, Lee YJ, Park DJ, et al. 2017; Long-term recurrence of small papillary thyroid cancer and its risk factors in a Korean multicenter study. J Clin Endocrinol Metab. 102(2):625–33.

176. Nam SH, Roh JL, Gong G, Cho KJ, Choi SH, Nam SY, et al. 2018; Nodal factors predictive of recurrence after thyroidectomy and neck dissection for papillary thyroid carcinoma. Thyroid. 28(1):88–95. DOI: 10.1089/thy.2017.0334. PMID: 29117854.

177. Lee YC, Na SY, Park GC, Han JH, Kim SW, Eun YG. 2017; Occult lymph node metastasis and risk of regional recurrence in papillary thyroid cancer after bilateral prophylactic central neck dissection: a multi-institutional study. Surgery. 161(2):465–71. DOI: 10.1016/j.surg.2016.07.031. PMID: 27574773.

178. Zheng CM, Ji YB, Song CM, Ge MH, Tae K. 2018; Number of metastatic lymph nodes and ratio of metastatic lymph nodes to total number of retrieved lymph nodes are risk factors for recurrence in patients with clinically node negative papillary thyroid carcinoma. Clin Exp Otorhinolaryngol. 11(1):58–64. DOI: 10.21053/ceo.2017.00472. PMID: 29032663. PMCID: PMC5831665.

179. Ryu IS, Song CI, Choi SH, Roh JL, Nam SY, Kim SY. 2014; Lymph node ratio of the central compartment is a significant predictor for locoregional recurrence after prophylactic central neck dissection in patients with thyroid papillary carcinoma. Ann Surg Oncol. 21(1):277–83. DOI: 10.1245/s10434-013-3258-1. PMID: 24006096.

180. Urken ML, Haser GC, Likhterov I, Wenig BM. 2016; The impact of metastatic lymph nodes on risk stratification in differentiated thyroid cancer: have we reached a higher level of understanding? Thyroid. 26(4):481–8. DOI: 10.1089/thy.2015.0544. PMID: 26892765.

181. Veronese N, Luchini C, Nottegar A, Kaneko T, Sergi G, Manzato E, et al. 2015; Prognostic impact of extra-nodal extension in thyroid cancer: a meta-analysis. J Surg Oncol. 112(8):828–33. DOI: 10.1002/jso.24070. PMID: 26493240.

182. Lee CW, Roh JL, Gong G, Cho KJ, Choi SH, Nam SY, et al. 2015; Risk factors for recurrence of papillary thyroid carcinoma with clinically node-positive lateral neck. Ann Surg Oncol. 22(1):117–24. DOI: 10.1245/s10434-014-3900-6. PMID: 25034816.

183. Mansour J, Sagiv D, Alon E, Talmi Y. 2018; Prognostic value of lymph node ratio in metastatic papillary thyroid carcinoma. J Laryngol Otol. 132(1):8–13. DOI: 10.1017/S0022215117002250. PMID: 29122022.

184. Jeon MJ, Yoon JH, Han JM, Yim JH, Hong SJ, Song DE, et al. 2013; The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma. Eur J Endocrinol. 168(2):219–25. DOI: 10.1530/EJE-12-0744. PMID: 23161752.

185. Chang YW, Kim HS, Jung SP, Kim HY, Lee JB, Bae JW, et al. 2016; Pre-ablation stimulated thyroglobulin is a better predictor of recurrence in pathological N1a papillary thyroid carcinoma than the lymph node ratio. Int J Clin Oncol. 21(5):862–8. DOI: 10.1007/s10147-016-0956-2. PMID: 26837274.

186. Park YM, Wang SG, Shin DH, Kim IJ, Son SM, Lee BJ. 2016; Lymph node status of lateral neck compartment in patients with N1b papillary thyroid carcinoma. Acta Otolaryngol. 136(3):319–24. DOI: 10.3109/00016489.2015.1116045. PMID: 26635131.

187. Kang IK, Park J, Bae JS, Kim JS, Kim K. 2023; Lymph node ratio predicts recurrence in patients with papillary thyroid carcinoma with low lymph node yield. Cancers (Basel). 15(11):2947. DOI: 10.3390/cancers15112947. PMID: 37296909. PMCID: PMC10252081.

188. Hu Y, Wang Z, Dong L, Zhang L, Xiuyang L. 2024; The prognostic value of lymph node ratio for thyroid cancer: a meta-analysis. Front Oncol. 14:1333094. DOI: 10.3389/fonc.2024.1333094. PMID: 38384804. PMCID: PMC10879587.

189. Lee J, Lee SG, Kim K, Yim SH, Ryu H, Lee CR, et al. 2019; Clinical value of lymph node ratio integration with the 8(th) edition of the UICC TNM classification and 2015 ATA risk stratification systems for recurrence prediction in papillary thyroid cancer. Sci Rep. 9(1):13361. DOI: 10.1038/s41598-019-50069-4. PMID: 31527831. PMCID: PMC6746784.

190. Seok J, Ryu CH, Park SY, Lee CY, Lee YK, Hwangbo Y, et al. 2021; Factors affecting central node metastasis and metastatic lymph node ratio in papillary thyroid cancer. Otolaryngol Head Neck Surg. 165(4):519–27. DOI: 10.1177/0194599821991465. PMID: 33560176.

191. Pelttari H, Valimaki MJ, Loyttyniemi E, Schalin-Jantti C. 2010; Post-ablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma: a 16-year follow-up study. Eur J Endocrinol. 163(5):757–63. DOI: 10.1530/EJE-10-0553. PMID: 20813788.

192. Webb RC, Howard RS, Stojadinovic A, Gaitonde DY, Wallace MK, Ahmed J, et al. 2012; The utility of serum thyroglobulin measurement at the time of remnant ablation for predicting disease-free status in patients with differentiated thyroid cancer: a meta-analysis involving 3947 patients. J Clin Endocrinol Metab. 97(8):2754–63. DOI: 10.1210/jc.2012-1533. PMID: 22639291.

193. Giovanella L, Ceriani L, Suriano S, Ghelfo A, Maffioli M. 2008; Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 69(4):659–63. DOI: 10.1111/j.1365-2265.2008.03244.x. PMID: 18363882.

194. Giovanella L, Ceriani L, Ghelfo A, Keller F. 2005; Thyroglobulin assay 4 weeks after thyroidectomy predicts outcome in low-risk papillary thyroid carcinoma. Clin Chem Lab Med. 43(8):843–7. DOI: 10.1515/CCLM.2005.142. PMID: 16201895.

195. Phan HT, Jager PL, van der Wal JE, Sluiter WJ, Plukker JT, Dierckx RA, et al. 2008; The follow-up of patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation. Eur J Endocrinol. 158(1):77–83. DOI: 10.1530/EJE-07-0399. PMID: 18166820.

196. Vaisman A, Orlov S, Yip J, Hu C, Lim T, Dowar M, et al. 2010; Application of post-surgical stimulated thyroglobulin for radioiodine remnant ablation selection in low-risk papillary thyroid carcinoma. Head Neck. 32(6):689–98. DOI: 10.1002/hed.21371. PMID: 20187016.

197. Kim TY, Kim WB, Kim ES, Ryu JS, Yeo JS, Kim SC, et al. 2005; Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 90(3):1440–5. DOI: 10.1210/jc.2004-1771. PMID: 15613412.

198. Toubeau M, Touzery C, Arveux P, Chaplain G, Vaillant G, Berriolo A, et al. 2004; Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J Nucl Med. 45(6):988–94.

199. Piccardo A, Arecco F, Puntoni M, Foppiani L, Cabria M, Corvisieri S, et al. 2013; Focus on high-risk DTC patients: high postoperative serum thyroglobulin level is a strong predictor of disease persistence and is associated to progression-free survival and overall survival. Clin Nucl Med. 38(1):18–24. DOI: 10.1097/RLU.0b013e318266d4d8. PMID: 23242039.

200. Polachek A, Hirsch D, Tzvetov G, Grozinsky-Glasberg S, Slutski I, Singer J, et al. 2011; Prognostic value of post-thyroidectomy thyroglobulin levels in patients with differentiated thyroid cancer. J Endocrinol Invest. 34(11):855–60.

201. Heemstra KA, Liu YY, Stokkel M, Kievit J, Corssmit E, Pereira AM, et al. 2007; Serum thyroglobulin concentrations predict disease-free remission and death in differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 66(1):58–64. DOI: 10.1111/j.1365-2265.2006.02685.x. PMID: 17201802.

202. Lin JD, Huang MJ, Hsu BR, Chao TC, Hsueh C, Liu FH, et al. 2002; Significance of postoperative serum thyroglobulin levels in patients with papillary and follicular thyroid carcinomas. J Surg Oncol. 80(1):45–51. DOI: 10.1002/jso.10089. PMID: 11967907.

203. Alzahrani AS, Al Mandil M, Chaudhary MA, Ahmed M, Mohammed GE. 2002; Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery. 131(4):443–9. DOI: 10.1067/msy.2002.122377. PMID: 11935135.

204. Vaisman F, Momesso D, Bulzico DA, Pessoa CH, da Cruz MD, Dias F, et al. 2013; Thyroid lobectomy is associated with excellent clinical outcomes in properly selected differentiated thyroid cancer patients with primary tumors greater than 1 cm. J Thyroid Res. 2013:398194. DOI: 10.1155/2013/398194. PMID: 24455413. PMCID: PMC3884614.

205. Durante C, Montesano T, Attard M, Torlontano M, Monzani F, Costante G, et al. 2012; Long-term surveillance of papillary thyroid cancer patients who do not undergo postoperative radioiodine remnant ablation: is there a role for serum thyroglobulin measurement? J Clin Endocrinol Metab. 97(8):2748–53. DOI: 10.1210/jc.2012-1123. PMID: 22679061.

206. Janovsky CC, Maciel RM, Camacho CP, Padovani RP, Nakabashi CC, Yang JH, et al. 2016; A prospective study showing an excellent response of patients with low-risk differentiated thyroid cancer who did not undergo radioiodine remnant ablation after total thyroidectomy. Eur Thyroid J. 5(1):44–9. DOI: 10.1159/000442048. PMID: 27099838. PMCID: PMC4836168.

207. Matrone A, Faranda A, Latrofa F, Gambale C, Stefani Donati D, Molinaro E, et al. 2020; Thyroglobulin changes are highly dependent on TSH in low-risk DTC patients not treated with radioiodine. J Clin Endocrinol Metab. 105(8):dgaa297. DOI: 10.1210/clinem/dgaa297. PMID: 32453405.

208. Chou R, Dana T, Brent GA, Goldner W, Haymart M, Leung AM, et al. 2022; Serum thyroglobulin measurement following surgery without radioactive iodine for differentiated thyroid cancer: a systematic review. Thyroid. 32(6):613–39. DOI: 10.1089/thy.2021.0666. PMID: 35412871.

209. Li X, Kwon H. 2020; The impact of BRAF mutation on the recurrence of papillary thyroid carcinoma: a meta-analysis. Cancers (Basel). 12(8):2056. DOI: 10.3390/cancers12082056. PMID: 32722429. PMCID: PMC7463825.

210. Moon S, Song YS, Kim YA, Lim JA, Cho SW, Moon JH, et al. 2017; Effects of coexistent BRAF(V600E) and TERT promoter mutations on poor clinical outcomes in papillary thyroid cancer: a meta-analysis. Thyroid. 27(5):651–60. DOI: 10.1089/thy.2016.0350. PMID: 28181854.

211. Vuong HG, Altibi AMA, Duong UNP, Hassell L. 2017; Prognostic implication of BRAF and TERT promoter mutation combination in papillary thyroid carcinoma-a meta-analysis. Clin Endocrinol (Oxf). 87(5):411–7. DOI: 10.1111/cen.13413. PMID: 28666074.

212. Song YS, Lim JA, Choi H, Won JK, Moon JH, Cho SW, et al. 2016; Prognostic effects of TERT promoter mutations are enhanced by coexistence with BRAF or RAS mutations and strengthen the risk prediction by the ATA or TNM staging system in differentiated thyroid cancer patients. Cancer. 122(9):1370–9. DOI: 10.1002/cncr.29934. PMID: 26969876.

213. Liu R, Bishop J, Zhu G, Zhang T, Ladenson PW, Xing M. 2017; Mortality risk stratification by combining BRAF V600E and TERT promoter mutations in papillary thyroid cancer: genetic duet of BRAF and TERT promoter mutations in thyroid cancer mortality. JAMA Oncol. 3(2):202–8. DOI: 10.1001/jamaoncol.2016.3288. PMID: 27581851.

214. Ebina A, Togashi Y, Baba S, Sato Y, Sakata S, Ishikawa M, et al. 2020; TERT promoter mutation and extent of thyroidectomy in patients with 1-4 cm intrathyroidal papillary carcinoma. Cancers (Basel). 12(8):2115. DOI: 10.3390/cancers12082115. PMID: 32751594. PMCID: PMC7464551.

215. Bournaud C, Descotes F, Decaussin-Petrucci M, Berthiller J, de la Fouchardiere C, Giraudet AL, et al. 2019; TERT promoter mutations identify a high-risk group in metastasis-free advanced thyroid carcinoma. Eur J Cancer. 108:41–9. DOI: 10.1016/j.ejca.2018.12.003. PMID: 30648628.

216. Kim SY, Kim T, Kim K, Bae JS, Kim JS, Jung CK. 2020; Highly prevalent BRAF V600E and low-frequency TERT promoter mutations underlie papillary thyroid carcinoma in Koreans. J Pathol Transl Med. 54(4):310–7. DOI: 10.4132/jptm.2020.05.12. PMID: 32527075. PMCID: PMC7385264.

217. Lee J, Ha EJ, Roh J, Kim HK. 2021; Presence of TERT +/- BRAF V600E mutation is not a risk factor for the clinical management of patients with papillary thyroid microcarcinoma. Surgery. 170(3):743–7. DOI: 10.1016/j.surg.2021.03.056. PMID: 33952391.

218. Choi YS, Choi SW, Yi JW. 2021; Prospective analysis of TERT promoter mutations in papillary thyroid carcinoma at a single institution. J Clin Med. 10(10):2179. DOI: 10.3390/jcm10102179. PMID: 34070093. PMCID: PMC8158380.

219. Yang H, Park H, Ryu HJ, Heo J, Kim JS, Oh YL, et al. 2022; Frequency of TERT promoter mutations in real-world analysis of 2,092 thyroid carcinoma patients. Endocrinol Metab (Seoul). 37(4):652–63. DOI: 10.3803/EnM.2022.1477. PMID: 35864728. PMCID: PMC9449103.

220. Kim SY, Jung CK. Frequency of TERT promoter mutations in real-world analysis of 2,092 thyroid carcinoma patients (Endocrinol Metab 2022;37:652-63, Heera Yang et al.). Endocrinol Metab (Seoul). 2022; 37(6):947–8. DOI: 10.3803/EnM.2022.1596. PMID: 36353807. PMCID: PMC9816498.

221. Chakravarty D, Santos E, Ryder M, Knauf JA, Liao XH, West BL, et al. 2011; Small-molecule MAPK inhibitors restore radioiodine incorporation in mouse thyroid cancers with conditional BRAF activation. J Clin Invest. 121(12):4700–11. DOI: 10.1172/JCI46382. PMID: 22105174. PMCID: PMC3225989.

222. Luo Y, Jiang H, Xu W, Wang X, Ma B, Liao T, et al. 2020; Clinical, pathological, and molecular characteristics correlating to the occurrence of radioiodine refractory differentiated thyroid carcinoma: a systematic review and meta-analysis. Front Oncol. 10:549882. DOI: 10.3389/fonc.2020.549882. PMID: 33117686. PMCID: PMC7561400.