Thyroid Tumor Synoptic Report — CAP elements with AJCC 9th Edition (auto stage)
Case / Specimen
Primary tumor / Thyroid
AJCC 9 (thyroid) pT summary (expanded): - pT1: Tumor ≤2 cm in greatest dimension, limited to thyroid. - pT1a: ≤1 cm - pT1b: >1–2 cm - pT2: Tumor >2–4 cm, limited to thyroid. - pT3: Tumor >4 cm limited to thyroid OR minimal extrathyroidal extension (microscopic) — site-specific wording varies; AJCC emphasizes gross ETE for upstaging. - pT4a: Moderately advanced disease — tumor of any size extending beyond thyroid capsule to subcutaneous soft tissues, larynx, trachea, esophagus, recurrent laryngeal nerve. - pT4b: Tumor invades prevertebral fascia, mediastinal vessels, or encases carotid artery.
Notes: - Distinguish microscopic (minimal) ETE from gross macroscopic ETE; gross ETE to major structures carries higher stage. - Anaplastic and poorly differentiated histologies have distinct staging/prognostic considerations; verify AJCC 9 site chapter and histology-specific notes.
Lymph nodes / neck dissection
AJCC 9 (thyroid) pN summary: - pN0: No regional lymph node metastasis. - pN1a: Metastasis to level VI (pretracheal, paratracheal, prelaryngeal/Delphian) or superior mediastinal nodes. - pN1b: Metastasis to unilateral, bilateral, or contralateral lateral cervical (levels I, II, III, IV, or V) or retropharyngeal nodes.
Notes: - Report number of positive nodes, largest nodal deposit, extranodal extension (ENE), and levels involved. Lateral neck metastases (pN1b) often upstage clinically and influence management.
Distant metastasis
AJCC 9 pM summary (thyroid): - pM0: No distant metastasis. - pM1: Distant metastasis present (biopsy-proven when possible).
Any M1 = Stage IV.
Notes: - Common sites: lung, bone, brain; document site, number, size, and method of confirmation (biopsy/imaging). Some histologies (medullary, anaplastic) have different staging emphasis—verify AJCC 9 for histology-specific grouping.
AJCC 9 Stage Group Guidance (expanded)
Simplified AJCC 9 anatomic stage-group principles for thyroid (guidance; confirm with AJCC 9 tables and histology specifics): - Stage I–II: Typically smaller, thyroid‑confined tumors without nodal/distant disease. - Stage III: Tumors with gross extrathyroidal extension to strap muscles or regional nodal disease depending on histology. - Stage IV: Tumors with invasion of major structures (T4a/T4b) or distant metastasis (M1).
Notes: - AJCC staging for differentiated thyroid carcinoma historically incorporated patient age at diagnosis in clinical staging; verify AJCC 9 whether age cutoffs remain relevant and follow histology-specific instructions (medullary and anaplastic cancers staged by anatomic criteria). - Always consult AJCC 9 thyroid chapter for precise grouping by T, N, M and histologic subtype.