• The adverse prognostic significance of tumor extension beyond the thyroid has been recognized for decades:
    • Remarkably, local tumor extent or invasion appears repeatedly in nearly every major historical prognostic system developed for DTC:
      • Despite these systems originating independently at different institutions and during different eras
  • These observations established the principle that ETE is not simply an anatomic descriptor:
    • But a marker of more aggressive thyroid cancer biology

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