Introduction: Distant metastasis (DM) at presentation is one of the important prognostic factors in thyroid cancers. Dissemination patterns of different thyroid cancer subtypes are still controversial. This study aimed to systematically elucidate the metastatic patterns and their corresponding survival of each thyroid cancer subtype at time of diagnosis.Methods: We accessed the Surveillance, Epidemiology, and End Results (SEER) database from 2010-2018 to search for primary thyroid cancers with DM at presentation (M1).Results: We included 2,787 M1 thyroid cancers for statistical analyses and the incidence of DM at presentation was 2.4%. Lung was the most common metastatic site for anaplastic thyroid carcinoma (ATC), poorly-differentiated thyroid carcinoma (PDTC), papillary thyroid carcinoma (PTC), and oncocytic (Hurthle) cell carcinoma (HCC) whereas bone is the favorable disseminated site of follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC). The risk of liver metastasis was highest in MTC while metastases to the brain were uncommon among thyroid cancer subtypes. Among M1 thyroid cancers, ATC showed the worst outcome while PTC and FTC exhibited a superior survival. Patients with multi-organ metastases had the worst survival whereas bone metastases were associated with a favorable outcome (p < 0.001). We identi ed signi cant risk factors associated with multi-organ metastases including non-Caucasian race, large tumor diameter, ATC/FTC/MTC histology, and unifocality.Conclusion: There are signi cant differences in DM patterns of thyroid cancer subtypes and their corresponding survival. These clinical data could be useful for clinicians to better evaluate risk strati cation and predict patient outcomes.

Introduction: Distant metastasis (DM) at presentation is one of the important prognostic factors in thyroid cancers. Dissemination patterns of different thyroid cancer subtypes are still controversial. This study aimed to systematically elucidate the metastatic patterns and their corresponding survival of each thyroid cancer subtype at time of diagnosis. Methods: We accessed the Surveillance, Epidemiology, and End Results (SEER) database from 2010-2018 to search for primary thyroid cancers with DM at presentation (M1). Results: We included 2,787 M1 thyroid cancers for statistical analyses and the incidence of DM at presentation was 2.4%. Lung was the most common metastatic site for anaplastic thyroid carcinoma (ATC), poorly-differentiated thyroid carcinoma (PDTC), papillary thyroid carcinoma (PTC), and oncocytic (Hurthle) cell carcinoma (HCC) whereas bone is the favorable disseminated site of follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC). The risk of liver metastasis was highest in MTC while metastases to the brain were uncommon among thyroid cancer subtypes. Among M1 thyroid cancers, ATC showed the worst outcome while PTC and FTC exhibited a superior survival. Patients with multi-organ metastases had the worst survival whereas bone metastases were associated with a favorable outcome (p < 0.001). We identified significant risk factors associated with multi-organ metastases including non-Caucasian race, large tumor diameter, ATC/FTC/MTC histology, and unifocality. Conclusion: There are significant differences in DM patterns of thyroid cancer subtypes and their corresponding survival. These clinical data could be useful for clinicians to better evaluate risk stratification and predict patient outcomes.

Background Tumor‐infiltrating lymphocytes (TILs) are associated with various clinicopathological features. Using cytologic specimens for assessing TILs remains to be established. This retrospective study aimed to establish a practical method to assess TILs in cytologic samples. Methods The authors found 1101 breast fine‐needle aspiration biopsy (FNAB) cytology samples in their hospital, and 214 of them met the inclusion criteria. The TILs score was evaluated using histologic slides, and breast cancers were divided into 2 groups: low‐ (<60%) and high‐TILs (≥60%). Training and validation tests composed of 50 breast cancer samples each were constructed. A cytologic TILs (cTILs) score was introduced to evaluate lymphocytes in FNAB cytology and it was compared with histologically evaluated TILs. The cTILs score was calculated by subtracting the number of neutrophils from the number of lymphocytes surrounding the tumor cells. Results In the training test, a 2‐tier system with low‐ and high‐TILs groups showed a large area under the curve (AUC) (0.943; 95% confidence interval [CI], 0.84‐0.99). A cTILs score cutoff value of >8 had 87.5% sensitivity and 90.5% specificity. In the validation test, the AUC was 0.79 (95% CI, 0.6‐0.93) whereas sensitivity and specificity were 57% and 89.5%, respectively. When small tumors <0.5 cm were excluded, the AUC improved to 0.93 (95% CI, 0.83‐1.0), and sensitivity and specificity were 80% and 88.5%, respectively. Conclusions The cTILs scoring system had acceptable reproducibility and concordance with TILs on histologic samples for tumors ≥0.5 cm. Cytologic evaluation can potentially substitute for histologic evaluation of TILs.

Background: Previous studies have not been consistent in the risk of metastasis in follicular thyroid carcinoma (FTC). Therefore, we conducted a large population study to stratify the risk of distant metastasis in FTC patients using only clinical parameters. Methods:We extracted FTC patients from The Surveillance, Epidemiology, and End Results (SEER) database and divided them into training and validation cohorts. Results:The two cohorts consisted of 4913 and 2391 patients, respectively. We developed a nomogram and risk table based on a logistic regression model using algorithm-selected variables. Receiver Operating Characteristic (ROC) analyses showed high discriminatory power in the training and validation cohorts (Area under the curve [AUC] of 0.85 and 0.84, respectively). Extremely low, low, intermediate, and high-risk groups had 0.3%, 1%, 3.5%, and 16.7% risk of distant metastasis, respectively.Conclusions: Our risk scoring table can separates patients into four risk groups and efficiently detect patients with almost no risk of metastasis.

Tumor-stroma ratio (TSR) of invasive breast carcinoma has gained attention in recent years due to its prognostic signi cance. Previous studies showed TSR is a potential biomarker for indicating the tumor response to neoadjuvant chemotherapy. However, it is not clear how well TSR evaluation in biopsy specimens might re ect the TSR in resection specimens. We conducted a study to investigate whether biopsy evaluation of TSR can be an alternative method. MethodWe collected cases with invasive breast carcinoma of no special type (IBC-NST) from University of Yamanashi hospital between 2011 and 2017 whose biopy and resection specimens both had a pathologically diagnosis of IBC-NST (n=146). We conceptualized a method for evaluating TSR in biopsy specimens within a preliminary cohort (n=50). Within the studied cohort (n=96), biopsy-based TSR (b-TSR) and resection-based TSR (r-TSR) were scored by two pathologists. We then evaluated our method's validity and performance by measuring interobserver variability between the two pathologists, Spearman's correlation between b-TSR and r-TSR, and the receiver operating characteristics (ROC) analysis for de ning stroma-rich and stroma-poor tumors. ResultsIntra-class coe cient between the two pathologists was 0.59. The correlation coe cients between b-TSR and r-TSR in the two pathologists were 0.45 and 0.37. The ROC areas under the curve were 0.7 and 0.67.By considering an r-TSR of < 50% as stroma-poor, the sensitivity and speci city of detecting stroma-poor tumors were 66% and 64.1%, respectively, when b-TSR was <40%. ConclusionAlthough b-TSR provides useful information about r-TSR in breast carcinoma, it should be combined with imaging investigations.