Skip to main content
. 2022 Dec 12;12(12):3136. doi: 10.3390/diagnostics12123136

Table 1.

Clinical, pathological and molecular characteristics of adult and pediatric thyroid carcinomas.

Characteristics Adults References Pediatric Age Group References
Clinical symptoms Hoarseness, dysphagia, cough.
Nodule common but rarely (<5–10%) malignant		 [14,59] Asymptomatic, incidentally detected.
Nodule uncommon but frequently (22–26%) malignant if present		 [14,59]
Upfront lymph node involvement 20–50% [103] 40–90% [103]
Distant metastasis 2% [103] 20–30% [103]
Radiation exposure Risk of cancer less [104] 5–10 fold increased risk; higher rates reported post-radiotherapy [104,105]
FNAC

  • USG guidance

  • Nodule size

  • Hyperfunctioning nodule

  • The Bethesda system for reporting

  • ROM

Bethesda III

  • Recommended management Bethesda III

  • ROM

Bethesda IV

  • Recommended management

Bethesda IV

  • Molecular testing of nodules with indeterminate cytology

 Not mandatory
<1cm: FNAC usually not recommended
FNAC not recommended
Recommended
6–18%
Repeat FNAC/molecular testing/lobectomy
10–40%
Molecular testing/lobectomy
Recommended		 [6]
[6,103]
[6]
[6,15]
[14,106]
[106]
[14,106]
[106]
[69]		 Mandatory
Size not a criterion for decision making
FNAC not recommended
(should be removed surgically)
Recommended
28%
Lobectomy plus isthmusectomy
58%
Lobectomy plus isthmusectomy
Not recommended		 [6]
[6,103]
[6]
[6,15]
[6,14,15]
[6]
[14]
[6]
[6,69]
Tumor classification system AJCC TNM classification [6] AJCC TNM classification with ATA risk-stratification system * [6]
5-year relative survival 98.3% [3] 99.7% [3]
PTC
multifocality 		20% [107] 65% [6]
Histopathological subtypes of PTC High risk subtypes less common (<20%) [108] Classic PTC 20–50%; high risk subtypes (tall cell, diffuse sclerosing, solid/trabecular) form 15–40% [14,60,61,109]
Molecular profile (PTC)
BRAF V600E		 30–90% [107] 0–63% (sporadic)
0–70% (post-radiation)		 [14,73]
BRAF fusions <3% [63,73] 0–20% (sporadic)
0–11% (post-radiation)		 [14,73]
RET fusions 5–35% [107] 22–65% (sporadic)
33–77% (post-radiation)		 [62,73]
H-/K-/N-RAS mutations 0–35% [107] <10% [1,72]
TERT promoter mutations (C250T, C228T) 5–25% [107] 0–27% [73,83]
NTRK fusions 1–5% [73] 0–20% (sporadic)
1–15% (post-radiation)		 [73,77]
PAX8/PPARG fusion 0–5% [73] 0–9% (sporadic)
4% (post-radiation)		 [73]
DICER1 mutations ∼4% ** [110] 7.6% [83]
ALK fusions 0–3% [73] 0–7% (sporadic)
1–7% (post-radiation)		 [73]
Molecular profile (FTC)
H-/K-/N-RAS mutations		 10–57% [90,91,93,94] 0–50% [14,82,88]
PAX8/PPARG fusion 35–50% [90,92,93,94] 0–20% [67,88,95]
PTEN mutations <1% [63] <2% (sporadic)
25% (carriers of PTEN mutation)		 [72,101]
DICER1 mutations 1% [47] 25–53% *** [47,49]

FNAC, fine needle aspiration cytology; USG, ultrasonography; ROM, risk of malignancy; AJCC, American Joint Committee on Cancer; TNM, tumor node metastasis; ATA, American Thyroid Association; PTC, papillary thyroid carcinoma; FTC, follicular thyroid carcinoma. * For PTC. ** 85.7% germline. *** 50% germline in one study [49].