Fuchs et al reported a grading system for medullary thyroid carcinoma. This can help to identify a patient who may require more aggressive management. The authors are from the University of Sydney in Australia.
Patient selection: medullary carcinoma of the thyroid gland
Parameters:
(1) mitotic count in 2 square millimeters (approximately 10 high power fields) in most mitotically active part
(2) Ki-67 proliferative index in percent (percent of malignant with any nuclear staining)
(3) coagulative necrosis
Mitotic Count
Ki-67 Proliferative Index
Coagulative Necrosis
Grade
< 3
< 3
absent
low
< 3
< 3
present
intermediate
3 to 20
3 to 20
absent
intermediate
3 to 20
3 to 20
present
high
> 20
> 20
NA
high
where:
• The table handles the most common patterns but not all possible combinations.
Grade
Mean Overall Survival
low
193 months
intermediate
146 months
high
45 months
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