The Delphi Criteria for Advanced Disease in Thyroid Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The Delphi criteria for advanced disease in thyroid cancer:
    • Refer to a consensus-based set of clinical, pathological, and radiological features:
      • Developed by expert panels (often using the Delphi method):
        • To define what constitutes advanced thyroid cancer
    • These criteria help guide decision-making:
      • In terms of treatment strategies, referral to tertiary centers, and inclusion in clinical trials
  • While there is no universal single set of “Delphi criteria” adopted globally for thyroid cancer:
    • Multiple Delphi panels have been convened in recent years to create consensus on what features define advanced or aggressive disease
  • Below is a synthesis of key features commonly included in such panels and used in high-level consensus guidelines:
    • ATA, NCCN, and expert Delphi studies
  • Delphi-Based Criteria for Advanced Thyroid Cancer:
    • Clinical Features:
      • Age > 55 years:
        • For differentiated thyroid cancer (DTC)
      • Rapid tumor growth
      • Hoarseness or vocal cord paralysis
      • Dysphagia or airway compression
      • Distant metastases:
        • Lung, bone, brain
      • Recurrent or persistent disease after initial therapy
    • Pathological Features:
      • High-risk histologies:
        • Poorly differentiated thyroid carcinoma
        • Anaplastic thyroid carcinoma
        • Hürthle cell carcinoma with widely invasive features
        • Tall cell, hobnail, or columnar variants of PTC
        • Extensive vascular invasion
        • Extrathyroidal extension:
          • Especially gross
        • Incomplete resection margins:
          • R2 or R1
    • Radiological Features:
      • Evidence of invasion into adjacent structures::
        • Trachea, esophagus, larynx, recurrent laryngeal nerve, carotid artery
      • Radiographic evidence of unresectability
      • Distant metastases confirmed via CT, MRI, or PET / CT
    • Molecular/Functional Criteria:
      • RAI-refractory disease:
        • Based on functional imaging and response
      • Presence of high-risk mutations:
        • TERT promoter
        • TP53
        • BRAF + TERT
      • High FDG-avidity on PET scan:
        • Often correlates with aggressiveness
    • Biochemical Markers:
      • Rapidly rising thyroglobulin levels post-thyroidectomy and RAI
      • Elevated Tg levels with negative RAI uptake:
        • Suggesting RAI-refractory disease
  • Notable Delphi Studies / Consensus Papers:
    • Tuttle RM et al., Memorial Sloan Kettering Cancer Center: Clinical criteria for RAI-refractory DTC
    • American Thyroid Association (ATA) 2015 Guidelines: Use a similar risk stratification model that incorporates many of these features
    • NCCN Guidelines (latest version): Lists features of unresectable, progressive, or symptomatic disease requiring systemic therapy
    • Molecular Oncology Tumor Boards have also developed decision-making algorithms based on Delphi consensus
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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