Bibliographic record
Abstract
We thank the authors for their comments on the revised College of American Pathologists thyroid cancer protocol.1 The authors raise a valid point regarding the classification of isolated psammoma bodies in lymph nodes without viable tumor cells. This issue had generated considerable debate among the committee members as well. As the authors mention, the focal point of this argument is the generic N classification rule set provided in the 7th edition of the AJCC Cancer Staging Manual of the American Joint Committee on Cancer, specifically, that “lymph nodes with ITC (isolated tumor cells) only (are) generally staged as pN0,” unless “disease specific rules” apply, as in melanoma.2 While our committee generally acknowledges that psammoma bodies in lymph nodes are a very close conceptual approximation of ITCs, we ultimately felt these cases represented a unique scenario that was not specifically addressed by these N classification rules.Indirectly, there is emerging evidence to support the authors' stance, since even patients with small-volume viable tumor metastases have a low locoregional recurrence rate3 and postoperative detectable serum thyroglobulin concentrations4 similar to those of N0 patients. (As a technicality, the study by Lang et al4 quoted by the authors to reflect the prognosis of ITCs actually stratifies nodal disease on the basis of a 2-mm cutoff, which encompasses N1 “micrometastases,” ITCs, and possibly isolated psammoma bodies. This study does not specifically enumerate the number of cases that truly showed clusters of cells less than 0.2 mm, thus fulfilling the definition of ITCs.) While it is reasonable to assume that isolated psammoma bodies in lymph nodes will fit into this indolent category, sufficient direct evidence (ie, a focused assessment of this parameter) is lacking.Admittedly, this is a rare scenario in patients who have undergone a formal central and/or lateral compartmental neck dissection. We agree with the authors that finding psammoma bodies in neck lymph nodes should prompt a more thorough investigation for viable tumor, including additional levels, but we do not agree that NX will necessarily pose a danger of “overemphasis,” particularly because clinicians are becoming increasingly aware of the indolent outcome in patients with small-volume nodal disease regardless of whether it is designated as N0(ITC), N1a, or NX.5 An advantage of an NX designation as it stands now is that in situations where isolated psammoma bodies are noted incidentally or in a limited lymph node dissection or excision, it may prompt a more thorough examination of the neck to ensure low-volume disease.In summary, we understand the authors' stance regarding isolated psammoma bodies in lymph nodes and will revisit this as needed. Since the upcoming 8th edition of the AJCC cancer staging system is currently under way, this will be an opportune time for clarification of this issue.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.101 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.019 | 0.032 |
| Insufficient payload (model declined to judge) | 0.064 | 0.046 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".