Table 3.
Initial Evaluation for Staging, Tests, and Procedures
| Laboratory tests |
| - CBC with differential |
| - Comprehensive chemistry panel (electrolytes, calcium, blood urea nitrogen, creatinine, glucose, and liver tests) |
| - Thyroid function tests (TSH, free thyroxine), TG/TG antibody |
| Imaging |
| - 18F FDG PET/CT (preferred, whole body)a |
| - CT of neck, chest, abdomen, and pelvis with contrast or MRI (acceptable if PET unavailable—and as needed for surgical decision-making) |
| Recommended and if clinically indicatedb |
| - MRI of brain with and without contrast |
| Procedures |
| - Laryngoscopy, also esophagoscopy as indicated |
| - BRAF assessment by IHC and NGS testing of tumorc |
a
If PET/CT unavailable, bone scan may be useful to identify bone metastases.
b
Clinically indicated if the patient has symptoms suggestive of brain metastases (i.e., neurologic deficit, headache).
c
BRAF IHC provides a rapid result and if positive NGS testing may not be necessary. If BRAF IHC is negative, NGS should be performed as it is more sensitive.
CBC, complete blood count; NGS, next generation sequencing; TG, thyroglobulin; TSH, thyrotropin.