Table 1. Open in new tab AJCC TNM...

Additional Features

Stage ≥ 45 y

Stage < 45 y

2009 ATA Risk

2009 RRA Recommended

2014 ATA Risk

2014 RRA Recommended^a

1b-2

I-II

Selective use

Not routine

1–2

Multifocal^b

I-II

Selective use

Not routine

1–3 (size)

FTC minimal vascular invasion

I-II

Selective use

Not routine

3 (size)

III

Yes

Not routine

1–3 (size)

≤ 5 microscopic N1 (< 2 mm)

III

Selective use

Not routine

1–3

III

Selective use

Consider

1–3

> 5 N1 of < 3 cm

III

Selective use

Consider

1b-3

BRAF mutation

I-III

Selective use

Consider

Microscopic extrathyroidal invasion^b

III

Selective use

Consider^c

1–3

IVa

Selective use

Consider

1–3

0–1b

Aggressive histology^b

I-IVa

Selective use

Consider

1–3

0–1b

Uptake outside thyroid bed on RxWBS

I-IVa

Selective use

Consider

1–3

0–1b

Vascular invasion^b

I-IVa

Selective use

Consider

1–3

FTC > 4 foci of vascular invasion

I-III

Selective use

Yes

1–3

1a-b

N1 > 3 cm

III-IVa

Selective use

Yes

IVa

Yes

1a-b

IVa

Yes

Any N

IVb

Yes

Any T

Any N

IVc

Yes

Any T

Any N

Incomplete tumor resection

Yes

Any T

Any N

Tg out of proportion with RxWBS findings

Yes

Table 1.

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AJCC TNM Staging, ATA Risk Classification, and RRA Recommendations According to ATA 2009 and 2015 Previews

T	N	M	Additional Features	Stage ≥ 45 y	Stage < 45 y	2009 ATA Risk	2009 RRA Recommended	2014 ATA Risk	2014 RRA Recommended^a
1a	0	0		I	I	L	No	L	No
1b-2	0	0		I-II	I	L	Selective use	L	Not routine
1–2	0	0	Multifocal^b	I-II	I	L	Selective use	L	Not routine
1–3 (size)	0	0	FTC minimal vascular invasion	I-II	I	L	Selective use	L	Not routine
3 (size)	0	0		III	I	L	Yes	L	Not routine
1–3 (size)	1a	0	≤ 5 microscopic N1 (< 2 mm)	III	I	I	Selective use	L	Not routine
1–3	1a	0		III	I	I	Selective use	I	Consider
1–3	1a	0	> 5 N1 of < 3 cm	III	I	I	Selective use	I	Consider
1b-3	0	0	BRAF mutation	I-III	I	I	Selective use	I	Consider
3	0	0	Microscopic extrathyroidal invasion^b	III	I	I	Selective use	I	Consider^c
1–3	1b	0		IVa	I	I	Selective use	I	Consider
1–3	0–1b	0	Aggressive histology^b	I-IVa	I	I	Selective use	I	Consider
1–3	0–1b	0	Uptake outside thyroid bed on RxWBS	I-IVa	I	I	Selective use	I	Consider
1–3	0–1b	0	Vascular invasion^b	I-IVa	I	I	Selective use	I	Consider
1–3	0	0	FTC > 4 foci of vascular invasion	I-III	I	I	Selective use	H	Yes
1–3	1a-b	0	N1 > 3 cm	III-IVa	I	I	Selective use	H	Yes
4a	0	0		IVa	I	H	Yes	H	Yes
4a	1a-b	0		IVa	I	H	Yes	H	Yes
4b	Any N	0		IVb	I	H	Yes	H	Yes
Any T	Any N	1		IVc	II	H	Yes	H	Yes
Any T	Any N	0	Incomplete tumor resection		I	H	Yes	H	Yes
Any T	Any N	0	Tg out of proportion with RxWBS findings		I	H		H	Yes

T	N	M	Additional Features	Stage ≥ 45 y	Stage < 45 y	2009 ATA Risk	2009 RRA Recommended	2014 ATA Risk	2014 RRA Recommended^a
1a	0	0		I	I	L	No	L	No
1b-2	0	0		I-II	I	L	Selective use	L	Not routine
1–2	0	0	Multifocal^b	I-II	I	L	Selective use	L	Not routine
1–3 (size)	0	0	FTC minimal vascular invasion	I-II	I	L	Selective use	L	Not routine
3 (size)	0	0		III	I	L	Yes	L	Not routine
1–3 (size)	1a	0	≤ 5 microscopic N1 (< 2 mm)	III	I	I	Selective use	L	Not routine
1–3	1a	0		III	I	I	Selective use	I	Consider
1–3	1a	0	> 5 N1 of < 3 cm	III	I	I	Selective use	I	Consider
1b-3	0	0	BRAF mutation	I-III	I	I	Selective use	I	Consider
3	0	0	Microscopic extrathyroidal invasion^b	III	I	I	Selective use	I	Consider^c
1–3	1b	0		IVa	I	I	Selective use	I	Consider
1–3	0–1b	0	Aggressive histology^b	I-IVa	I	I	Selective use	I	Consider
1–3	0–1b	0	Uptake outside thyroid bed on RxWBS	I-IVa	I	I	Selective use	I	Consider
1–3	0–1b	0	Vascular invasion^b	I-IVa	I	I	Selective use	I	Consider
1–3	0	0	FTC > 4 foci of vascular invasion	I-III	I	I	Selective use	H	Yes
1–3	1a-b	0	N1 > 3 cm	III-IVa	I	I	Selective use	H	Yes
4a	0	0		IVa	I	H	Yes	H	Yes
4a	1a-b	0		IVa	I	H	Yes	H	Yes
4b	Any N	0		IVb	I	H	Yes	H	Yes
Any T	Any N	1		IVc	II	H	Yes	H	Yes
Any T	Any N	0	Incomplete tumor resection		I	H	Yes	H	Yes
Any T	Any N	0	Tg out of proportion with RxWBS findings		I	H		H	Yes

Abbreviations: ATA, American Thyroid Association; L, low; I, intermediate; H, high.

2015 ATA guidelines recommendations are taken from an ATA Satellite meeting in Chicago in June 2014 and may differ from the final published version.

Aggressive histology (eg, tall cell, columnar, insular and poorly differentiated), vascular invasion and multifocal foci in combination with size, lymph node status, and age can increase the risk of the patient and may be an argument for RRA for ATA 2009 guidelines.

May be deferred for small tumors.

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