Update on current diagnosis and management of anaplastic thyroid carcinoma

Table 1 Used diagnostic tools for anaplastic thyroid carcinoma

n	Modality
1	Plain ultrasound or preferably high resolution ultrasound
2	Core needle biopsy under ultrasound guidance preferably
3	FNA cytology under ultrasound guidance
4	Staging imaging (CT, MRI-MRA, 18F-FDG PET-CT)
5	Bronchoscopy
6	Esophagoscopy
8	Fiberoptic laryngoscopy
9	Molecular testing (BRAF, MEK, NTRK, RET, RAS, p53 genes)
10	MicroRNAs
11	PD-L1 expression
12	Liquid biopsy
13	Histopathology
14	Pathological TNM staging

FNA: Fine-needle aspiration; CT: Computed tomography; MRI-MRA: Magnetic resonance imaging/magnetic resonance angiography; ¹⁸F-FDG PET-CT: [(18)F]fluoro-D-glucose positron emission tomography/computed tomography; PD-L1: Programmed death-ligand 1; TNM: Tumor-node-metastasis.

Table 2 T classification in tumor-node-metastasis system for anaplastic thyroid carcinoma of American Joint Committee on Cancer and Union for International Cancer Control 8^th edition

T	Size	Extension
T1	≤ 2 cm	Limited into thyroid
T1a	≤ 1 cm	Limited into thyroid
T1b	> 1 cm and ≤ 2 cm	Limited into thyroid
T2	> 2 cm and ≤ 4 cm	Limited into thyroid
T3	> 4 cm	Limited into thyroid or extrathyroid macroscopic invasion only of thyroid muscles and subcutaneous tissue
T3a	> 4 cm	Limited into thyroid
T3b	Any size	Extrathyroid macroscopic invasion only of thyroid muscles and subcutaneous tissue
T4	Any size	Macroscopic invasion of major adjacent structures
T4a	Any size	Macroscopic invasion of larynx, trachea, esophagus, recurrent laryngeal nerve
T4b	Any size	Macroscopic invasion of carotid artery, major vessels in mediastinum, prever-tebral fascia

Table 3 Tumor-node-metastasis staging for anaplastic thyroid carcinoma of American Joint Committee on Cancer and Union for International Cancer Control 8^th editiona

Stage	IVA	IVB	IVC
Parameters	T1-T3a, N0, M0	T1-T3a, N1, M0	Any T, any N, M1
		T3b, any N, M0
		T4, any N, M0

T: Tumor size; N0: Negative regional lymph nodes; N1: Positive regional lymph nodes; M0: Without any distant metastases; M1: Presence of distant metastases.

Table 4 Predictive factors for favorable prognosis of anaplastic thyroid carcinoma

n	Factor
1	Female patients
2	Age ≤ 60 yr
3	Married patients
4	Asymptomatic patients
5	Tumor ≤ 5 cm in size
6	Single primary tumor
7	Without local tissue invasion
8	Without lymph node involvement (N0)
9	Without distant metastases (M0)
10	Kind of therapy
11	Multimodality treatment