Table 3.
Comparison between CASTLE, differentiated thyroid cancer, and anaplastic thyroid cancer.
| CASTLE (3, 6–8, 12–32) | Differentiated thyroid cancer (33–36) | Anaplastic thyroid cancer (37–40) | |
|---|---|---|---|
| Morbidity | 0.1–0.15% of all thyroid cancer | Over 95% of all thyroid cancer | 2–5% of all thyroid cancer |
| Tumor origin | Thyroid solid cell nests | Thyroid follicular epithelial cells | Thyroid follicular epithelial cells |
| Susceptible age | 50s | 20–50 years | 55–69 years |
| Sex | No gender predominance | Women representing about 1/4 of the patients | Women representing 55–77% of all patients |
| First symptom | Mostly neck mass | Mostly neck mass | Neck pain, dysphagia, hoarseness, stridor, and dyspnea due to the rapidly expanding tumor |
| Lab tests | Mostly normal | Mostly normal | Mostly normal |
| Location | Mostly lower pole | No predominance | No predominance |
| Progression | Mostly indolent | Mostly indolent | Often aggressive |
| PATHOLOGY STUDIES | |||
| FNAC | Sensitivity was only 8.3% | / | / |
| Gross pathology | Lobulated | Nodular | Tumor surface usually reveals a white- to tan-colored firm surface speckled with necrosis. |
| Immuno-histopathology | ✓ Mostly CD5 positive ✓ May be positive for CD117, p63 et al. ✓ Negative for Tg |
✓ Positive for Tg ✓ Mostly positive for TPO, CD57, CK19, galectin3, HBME1 |
✓ Mostly CK and TP53 positive ✓ Negative for Tg, TTF1, and CEA |
| IMAGE TESTS | |||
| Ultrasound | ✓ Lobulated, solid, hypoechoic ✓ Heterogeneous internal echoes ✓ Without cystic components or calcification |
✓ Cystic necrosis and calcification ✓ Avid enhancement |
✓ Cystic necrosis and calcification ✓ Avid enhancement |
| CT | ✓ A well-defined, soft tissue density mass without calcification ✓ Mostly heterogeneously enhanced |
✓ Low or soft tissue density with cystic necrosis and/or calcification ✓ Avid enhancement |
✓ Large, solid, and ill-defined masses ✓ Frequently with necrosis, nodular calcification ✓ Direct invasion into adjacent organs, and/or ✓ Lymph node metastasis |
| MR | ✓ Homogeneous isointensity on T1 slightly hyper intense on T2 | / | / |
| SPECT | Cold nodule | Cold nodule | Cold nodule |
| 18F-FDG PET/CT | Increased uptake in the thyroid lesion/metastatic lymph nodes | ✓ Positive uptake varied from 2.2 to 3.8% ✓ More than half showed a focal uptake pattern |
Increased uptake in the thyroid lesion/metastatic lesions |
| Capsule invasion | About 50–60% | About 6–13% | Over 90% |
| Tumor extension | About 38% | About 5.7–7% | |
| Lymph node metastasis | About one-third to 50% | About 35–50% | |
| TREATMENT | |||
| Surgery | First choice | First choice | First choice |
| Chemotherapy | Should be attempted in patients with advanced or metastatic disease | Not suggested | Chemo radiotherapy was suggested to be performed after surgery |
| Radiotherapy | Postoperative radiotherapy is considered for patients with positive nodal status | Radioiodine ablation | |
| Distant metastasis | 14–29% | 30% | 20 to 50% |
| Prognosis | 5- and 10-year CSS rates were 90 and 82% | 5- and 10-year CSS rates were 98 and 96% | 5-year CSS rates were 5 and 15% |