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The role of cyclin D1 and vascular endothelial growth factor (VEGF) in radiotherapy response of undifferentiated nasopharyngeal carcinoma Nurhidayat, Ade Apon; Afiati, .; Usman, Hermin Aminah; Hernowo, Bethy Suryawathy
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 4 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (844.579 KB) | DOI: 10.19106/JMedScie/005004201802

Abstract

Nasopharyngeal carcinoma (NPC) has a high incidence and mortality rate in SoutheastAsia included in Indonesia. Radioresistance is a major obstacle for a successful treatmentof NPC. DNA repair in the cell cycle and angiogenesis factors affect the response oftumor cells to radiotherapy. Cyclin D1 that functions in the cell cycle process and vascularendothelial growth factor (VEGF) as an angiogenesis factor are considered to play arole in the occurrence of radioresistance. The objective of this study was to evaluatethe association between cyclin D1 and VEGF expressions with radiotherapy responsein undifferentiated NPC. This study used a retrospective case control analysis design.Secondary data from medical records of patients diagnosed as undifferentiated NPC whoreceived a complete radiotherapy at the Department of Radiation Oncology, Dr. HasanSadikin General Hospital, Bandung. There were 44 samples divided into radiosensitive(22 samples) and radioresistant (22 samples) groups. Immunohistochemical examinationof cyclin D1 and VEGF expressions was performed on paraffin blocks of patients’nasopharyngeal biopsy. Data analysis used Chi-Square test with p ≤0.05. Cyclin D1 wasexpressed strongly in 86.4% of the radioresistant group and 59.1% in the radiosensitivegroup (p<0.05), VEGF was strongly expressed in 77.3% of the radioresistant group and54.5% in the radiosensitive group (p>0.05). In conclusion, there is significant associationbetween cyclin D1 expression with radiotherapy response in undifferentiated NPC.However, there is no association between VEGF expression with radiotherapy response.
KORELASI ANTARA EKSPRESI AROMATASE, FOLLICLE STIMULATING HORMONE (FSH), DAN INSULIN-LIKE GROWTH FACTOR (IGF)-I DENGAN MATURITAS OOSIT PADA PELAYANAN TEKNOLOGI REPRODUKSI BERBANTU (TRB) Assangga Guyansyah; Achmad Biben; Johanes C. Mose; Bethy Suryawathy Hernowo
Indonesian Journal of Applied Sciences Vol 2, No 1 (2012)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (336.032 KB) | DOI: 10.24198/ijas.v2i1.2729

Abstract

Karakteristik biokimia cairan folikel disekitar oosit memainkan peran penting dalam menentukan kualitas oosit yang padaakhirnya dapat meningkatkan keberhasilan program TRB. Secara umum mekanisme maturitas oosit yang dipengaruhi oleh unsur kimia cairan folikel melibatkan IGF-I yang bekerja dengan melipatgandakan efek FSHR, lalu menginduksi peningkatan kadar cAMP intraseluler yang merupakan mediasi utama stimulasi FSH pada ekspresi aromatase. Penelitian ini merupakan studi analitik korelasional dengan pendekatan crossectional pada pasien yang mengikuti program TRB di Klinik Aster Rumah Sakit Dr. Hasan Sadikin Bandung dalam kurun waktu Januari 2011 sampai dengan Februari 2012. Analisis hasil dilakukan menggunakan uji Shapiro Wilk, uji Wilcoxon, uji Mann-Whitney, uji ANAVA, rank Spearman, dan uji chi-kuadrat. Kemaknaan hasil uji akan ditentukan berdasarkan nilai p < 0,05. Pada penelitian ini didapatkan perbandingan jumlah oosit matur dan imatur pada ekspresi FSH kuat menunjukkan ada perbedaan yang bermakna (p=0,03). Analisis hubungan antara ekspresi IGF-I dengan maturitas oosit menunjukkan hasil yang tidak bermakna secara statistik (p=0,192). Didapatkan pula median proporsi prevalensimaturitas sebesar 0,71. Maturitas oosit dengan median rasio prevalensi > 0,71 pada ekspresi FSH kuat besarnya 1,71 kali bila dibandingkan dengan ekspresi FSH negatif. Pada ekspresi aromatase sedang dengan median rasio prevalensi maturitas > 0,71 sebesar 1,55 kali bila dibandingkan dengan ekspresi aromatase yang negatif.
Triple Negative Breast Cancer Characteristics Based on Basal-like and Non-Basal-like Subtypes Fifi Akwarini; Trinugroho Heri Fadjari; Bethy Suryawathy Hernowo
International Journal of Integrated Health Sciences Vol 7, No 1 (2019)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v7n1.1570

Abstract

Objective: To observe triple negative breast cancer (TNBC) characteristics in three hospitals located in Bandung based on basal-like (BL) and non-basal-like (NBL) subtypes.Methods: This was a cross-sectional study which used descriptive categorical data from medical records and paraffin blocks of TNBC patients treated in Dr. Hasan Sadikin General Hospital, Bandung; Borromeus Hospital; and Santosa Hospital Bandung Central in the period of January 1, 2012–December 31, 2016. The subjects of the study were 57 TNBC patients. The data collected in the study based on medical records were age, tumor size, histopathological images, severity, and immunohistochemical data. The paraffin blocks of the patients based on the completed medicals records were investigated through examinations of immunohistochemichal cytokeratin (CK) 5/6 expressions and epidermal growth factor receptor (EGFR).Results: Prevalence of TNBC were 82.5% of basal-like subjects and 17.5% of non-basal-like subjects. Among the TNBC subjects, median age of each subtype was 50 years of basal-like subtype and 45 years of non-basal-like subtype. Both subtypes were mostly found in the subjects who aged >40 years. Higher histopathological grade was discovered in both subtypes. The therapy mostly carried out to the subjects was adjuvant chemotherapy. Majority of basal-like subtype subjects were still alive and had longer survival rate and lower incidences of deaths when compared to the non-basal-like subtype.Conclusion: In TNBC, the basal-like subjects showed greater median age, lower severity stage, and longer survival rate than the non-basal-like subjects. There was no histopathology grade between both subtypes. Keywords: Basal-like and non-basal-like subtypes, breast cancer, characteristics, triple negative 
The Role of Fibroblast Growth Factor Receptor 3 (FGFR3) and Androgen Receptor (AR) in a Non-invasive Urothelial Carcinoma Recurrences Oki Meilani Dewi; Sri Suryanti; Bethy Suryawathy Hernowo
Global Medical & Health Communication (GMHC) Vol 7, No 2 (2019)
Publisher : Universitas Islam Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (230.702 KB) | DOI: 10.29313/gmhc.v7i2.3956

Abstract

Urothelial carcinoma is a bladder carcinoma that took place in the urinary tract. Non-invasive urothelial carcinoma patients have high recurrence rates (50–70%). The recurrences took so many years that may lead to the high-cost treatment and low survival rate. Fibroblast growth factor receptor 3 (FGFR3) and androgen receptor (AR) known to play a role in non-invasive urothelial carcinoma and potentially act as a prognostic marker to predict recurrences. This study aimed to discover the role of FGFR3 and AR in recurrences of non-invasive urothelial carcinoma. This research used a case-control study design. Samples took from patients diagnosed with non-invasive urothelial carcinoma registered at Dr. Hasan Sadikin General Hospital Bandung 1 January 2010–30 December 2015 period. Sixty samples consisted of 30 recurrent groups, and 30 non-recurrent groups individually fixated and embedded to paraffin block for FGFR3 and AR immunohistochemistry analysis. Analysis chi-square performed with a level of confidence 95% and statistical power 95%. p values<0.05 were considered to be statistically significant. Statistical analysis showed that FGFR3 immunoexpression was found significantly low on the recurrence group (p=0.002, OR=5.50). While AR immunoexpression was found insignificant (p=1.000, OR=1.00). FGFR3 immunoexpression from samples in the recurrent group with multiple tumors found to be significantly low (p=0.031, OR=6.067). This study showed that recurrences took place when FGFR3 lowly expressed within non-invasive urothelial carcinoma samples with multiple tumors. This finding may raise a candidate to early-predict the recurrence, thus will suggest early therapy.PERANAN FIBROBLAST GROWTH FACTOR RECEPTOR 3 (FGFR3) DAN RESEPTOR ANDROGEN (RA) TERHADAP KEJADIAN REKURENSI PADA KARSINOMA UROTELIAL BULI NON-INVASIFKarsinoma urotelial merupakan karsinoma buli yang sering terjadi pada saluran kemih. Karsinoma urotelial dibagi menjadi karsinoma urotelial non-invasif dan invasif. Pasien karsinoma urotelial non-invasif mempunyai kejadian rekurensi tinggi (50–70%) dan membutuhkan waktu lama untuk memantau kejadian rekurensi sehingga membutuhkan biaya tinggi dengan angka ketahanan hidup rendah. Fibroblast growth factor receptor 3 (FGFR3) dan reseptor androgen (RA) berperan dalam terjadinya karsinoma urotelial non-invasif dan berpotensi sebagai penanda prognostik yang memprediksi rekurensi secara akurat. Tujuan penelitian ini mengetahui peranan FGFR3 dan RA terhadap kejadian rekurensi pada karsinoma urotelial non-invasif. Penelitian menggunakan rancangan case-control study. Sampel berupa blok parafin yang diagnosis sebagai karsinoma urotelial non-invasif di RSUP Dr. Hasan Sadikin Bandung periode 1 Januari 2010–30 Desember 2015. Sebanyak 60 sampel dievaluasi terdiri atas 30 sampel kelompok rekurensi dan 30 kelompok tidak rekurensi. Pemeriksaan imunohistokimia menggunakan antibodi FGFR3 dan RA. Analisis menggunakan uji chi-square dengan taraf kepercayaan 95% dan kuasa uji (power test) 95%. Nilai p<0,05 dianggap signifikan secara statistik. Pada analisis statistik, imunoekspresi FGFR3 rendah signifikan pada kelompok rekurensi (p=0,002; OR=5,50) dan imunoekspresi RA tidak signifikan (p=1,000; OR=1,00). Imunoekspresi FGFR3 rendah dengan tumor multipel signifikan pada kelompok rekurensi (p=0,031;  OR=6,067). Hasil penelitian menunjukkan bahwa rekurensi terjadi ketika FGFR3 terekspresi rendah pada sampel karsinoma non-invasif dengan tumor multipel. Hal ini dapat menjadi penanda memprediksi kejadian rekurensi sehingga dapat dilakukan terapi yang lebih cepat.
The Role of Cyclin D1 and VEGF in Radiotherapy Response of Advance Stage Undifferentiated Nasopharyngeal Carcinoma Nurhidayat, Ade Apon; Afiati, Afiati; Usman, Hermin Aminah; Hernowo, Bethy Suryawathy
Folia Medica Indonesiana Vol. 56 No. 4 (2020): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1619.919 KB) | DOI: 10.20473/fmi.v56i4.24554

Abstract

Nasopharyngeal carcinoma has a high incidence and mortality rate in Southeast Asia and Indonesia. Radioresistance is a major obstacle to successful treatment of nasopharyngeal carcinoma. DNA repair in the cell cycle and angiogenesis factors affects the response of tumor cells to radiotherapy. Cyclin D1 that functions in the cell cycle process and VEGF as an angiogenesis factor are considered to play a role in the occurrence of radioresistance. The objective of this study is to find the association between immunoexpression of Cyclin D1 and VEGF with radiotherapy response in undifferentiated nasopharyngeal carcinoma. This study used a retrospective case control analysis design, secondary data from medical records of patients diagnosed as undifferentiated nasopharyngeal carcinoma who received complete radiotherapy at the Radiation Oncology Department  Dr Hasan Sadikin Bandung were taken. There were 44 samples divided into radiosensitive (22 samples) and radioresistant (22 samples) groups. Immunohistochemical examination of Cyclin D1 and VEGF was performed on paraffin blocks of patients' biopsy. Data analysis using Chi-Square test (p ≤0.05) , OR 95% CI. Cyclin D1 expressed strongly in 86.4% of the radioresistant group and 59.1% in the radiosensitive group (p<0.05) and the OR 4,385 (0.993-19.356), VEGF was strongly expressed in 77.3% of the radioresistant group and 54.5% in the radiosensitive group (p>0.05). As conclusion, there were significant association between Cyclin D1 with radiotherapy respons in undifferentiated nasopharyngeal carcinoma. The stronger immunoexpression of Cyclin D1, the higher likelihood of radioresistancy. VEGF immunoexpression showed no significant association with radiotherapy response.
In vivo histomorphological evaluation of geopolymer-carbonated apatite nanocomposites implanted on rabbit tibia at early bone healing Sutanto, Dahlia; Satari, Mieke Hemiawati; Hernowo, Bethy Suryawathy; Priosoeryanto, Bambang Pontjo; Septawendar, Rifki; Asri, Lia Amelia Tresna Wulan; Purwasasmita, Bambang Sunendar
Padjadjaran Journal of Dentistry Vol 33, No 1 (2021): March 2021
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/pjd.vol33no1.28899

Abstract

Introduction: Dental implants have become a more desirable treatment for replacing missing teeth. The mechanical properties and biocompatibility of titanium and zirconia are excellent, but they are less bioactive. The chemical composition of the carbonate apatite is similar to enamel and dentin. Geopolymers are inorganic polymers, and they are similar to ceramics. They have excellent mechanical properties, bioactivity, biocompatibility. The purpose of this study was to assess histomorphological evaluation of geopolymer-carbonated apatite nanocomposites implanted on rabbit tibia at early bone healing in vivo. Methods: Geopolymer-CHA nanocomposites with a diameter of 3 mm and length of 6 mm was placed in the tibia of eight male New Zealand White rabbit whose body weight is 3 to 3.5 kg and six-month ages. Experimental subjects were randomly assigned to 2 groups for assessing the bone healing capability around samples to 14 and 28 days histomorphologically. Wilcoxon test was performed, and p<0.05 was considered significant, using Minitab software version 13. Results: Granulation tissue, woven, and lamellar bone was analysed. A reactive bone formation was revealed in the 14th day. Osteoblasts, osteoids, and osteocytes showed more mature and woven bone became denser on the 28th day. Conclusion: Geopolymer-CHA nanocomposites could be considered a candidate for dental implant material from this histomorphological evaluation.
Osteocalcin expression of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) added with hydroxyapatite (HA) in rabbit’s post extraction tooth sockets Damayanti, Meta Maulida; Hernowo, Bethy Suryawathy; Susanah, Susi
Padjadjaran Journal of Dentistry Vol 32, No 3 (2020): November 2020
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/pjd.vol32no3.24848

Abstract

Introduction: Platelets play an important role in wound healing because it is a reservoir for growth factors and cytokines which is important in bone regeneration and soft tissue healing. The purpose of this study was to compare the use of scaffolds in platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) which added with hydroxyapatite (HA) in the socket healing process after tooth extraction in the value of regenerating an alveolar bone tissue. Methods: The research was conducted at biomedical laboratory Bandung Islamic University. Eighteen rabbits (Oryctolagus cuniculus) with extracted anterior and inferior teeth were divided into 2 treatment groups and 3 observation times. The tooth socket is filled with PRF (Group 1) and PRP + HA (Group 2). The observation was conducted on Day 3, Day 7 and Day 14. Immunoexpression Osteocalcin was performed to assess the healing process of alveolar bone. Data was analyzed with the SPSS software program. Analysis of normality data by Shapiro-Wilk test, homogeneity of variance with Levene's test and comparison between treatment groups with the Chi-square test. Results: Group 1 shown the average score was higher than in Group 2 with a strong category of 72.2% for Group 1 and 56.6% for Group 2. Based on statistically,  there was no difference in osteocalcin immunoexpression between Group 1 and Group 2 with the p-value>0.05. Conclusion: Regeneration of rabbit’s alveolar bone tissue by application of PRF and PRP plus HA as scaffolds have results was similar. The use of PRF in post-extraction wound recovery is a better choice because it has an easy procedure and lower cost.
Correlation of CD10 immunoexpression and eosinophil count in stromal tissue as predictors of prognosis of squamous cell carcinoma of the oral cavity Patuti, Deece; Yusuf, Harmas Yazid; Hernowo, Bethy Suryawathy
Padjadjaran Journal of Dentistry Vol 22, No 2 (2010): July 2010
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/pjd.vol22no2.26873

Abstract

Introduction: CD10 can also facilitate the ability of tumour metastasis by its ability to invade blood vessel walls.Correlation of CD10 immunoexpression and eosinophil count in stromal tissue as predictors of prognosis of squamous cell carcinoma of the oral cavity. Methods: This study was preceded by collecting data on squamous cell carcinoma of the oral cavity in the medical record and paraffin blocks in the Anatomy Pathology section of 15 samples with enlarged regional lymph nodes and 15 samples without enlargement of regional lymph nodes. Then two preparations were made, the first preparation was stained with Hematoxylin Eosin (HE) to establish the diagnosis and determine the histopathological gradation, then count the number of eosinophils, and the other development was smeared with CD10. Outward immunohistochemistry uses the Labelled streptavidin biotin immunoperoxidase complex (LSAB) method using the Starr Trek Universal HRP Detection system. (Biocare Medical, USA). The primary antibody used was CD10 (Novocastra Laboratories Ltd, Newcastle upon Tyne, UK) with a dilution of 1:25 - 1: 50. Results: There was no statistically significant correlation between CD10 and enlargement of the lymph node regionally tested statistically using the Spearman rank test rs = -0.236, meaning that the increase in CD10 immunoexpression is inversely proportional to the enlargement of regional lymph node, but the correlation is not statistically significant The results of the analysis using the Spearman rank test found significance of p = 0.043 (significant) with a correlation strength of 37.2% Conclusion: There was no correlation between CD10 and enlargement of the lymph node regionally and correlation strength eosinophil distribution in squamous cell carcinoma of the oral cavity without regional lymph node enlargement.
Program Edukasi Tulus, Edukasi Tuberkulosis Pada Pasien Lupus di Rumah Sakit Hasan Sadikin Tear, Alveron Andreas; Alfi, Mohammad Abyan; Azzahra, Fadhilla Zakya; Lestari, Frida Dwi; Astuti, Intan Widya; Maharani, Khalista Ismaya; Faliq, Muhammad Faza; A, Muhammad Naufal; Putri, Rahmania Devina; Shadrina, Siti Azyyati Nur; Fadillah, Viki; Hernowo, Bethy Suryawathy; Hamijoyo, Laniyati; Sahiratmadja, Edhyana
Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM) Vol 8, No 8 (2025): Volume 8 No 8 (2025)
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkpm.v8i8.19987

Abstract

ABSTRAK Pasien lupus eritematosus sistemik (LES) memiliki risiko lebih tinggi terhadap infeksi tuberkulosis (TB) akibat penggunaan obat lupus dan penyakitnya. Di Indonesia, prevalensi TB aktif pada pasien LES mencapai 10,2%, jauh lebih tinggi dibandingkan populasi umum. Kurangnya pengetahuan pasien mengenai TB dapat menyebabkan keterlambatan diagnosis dan pengobatan yang optimal. Tujuan: Melakukan program edukasi Tuberkulosis pada pasien lupus yang diberi nama TULUS dalam meningkatkan pemahaman pasien LES tentang risiko dan pencegahan TB dan mengevaluasi efektivitas program edukasi tersebut. Kami melaksanakan kegiatan edukasi berbasis penyuluhan secara langsung dengan media pendukung berupa poster dan flyer. Pengetahuan pasien diukur dengan pre-test dan post-test. Kegiatan ini dilakukan di Poli Reumatologi, Rumah Sakit Dr. Hasan Sadikin Bandung. Hasil test dianalisis menggunakan uji Wilcoxon Signed Ranks untuk mengukur pengetahuan pasien. Sebanyak 21 pasien LES berpartisipasi dalam kegiatan edukasi TULUS. Terdapat peningkatan yang signifikan pada median skor pengetahuan dari 7 pada pre-test menjadi 9 pada post-test (p=0,001). Program edukasi TULUS terbukti efektif dalam meningkatkan pengetahuan pasien LES mengenai TB. Kegiatan lanjutan perlu dilakukan untuk menilai retensi pengetahuan tentang TB pada pasien LES. Kata Kunci: Lupus Eritematosus Sistemik, Tuberkulosis, Edukasi Kesehatan, Pencegahan TB.  ABSTRACT Systemic lupus erythematosus (SLE) patients have a higher risk of tuberculosis (TB) infection, due to the use of lupus drugs and the disease activity. In Indonesia, the prevalence of active TB in SLE patients has reached 10.2%, much higher than the general population. Lack of patient knowledge about TB can cause delays in diagnosis and optimal treatment. To evaluate the effectiveness of the Tuberculosis Education in Lupus Patients called TULUS education program in increasing the knowledge of SLE patients about TB risks and prevention. We carried out direct education methods with supporting media in the form of posters and flyers. Patient knowledge was measured before and after the education. The activity was conducted at the Rheumatology Clinic, Dr. Hasan Sadikin General Hospital, Bandung. The pre-test and post-test results were analyzed using the Wilcoxon Signed Ranks test to measure patient knowledge. A total of 21 SLE patients participated in the TULUS education. There was a significant increase in the median knowledge score from 7 on the pre-test to 9 on the post-test (p=0.001). The TULUS education program has proven effective in increasing SLE patients' knowledge about TB. Further activities are needed to assess retention of knowledge about TB in SLE patients. Keywords: Systemic Lupus Erythematosus, Tuberculosis, Health Promotion
Clinicopathological Characteristic of Radioactive Iodine-Refractory Differentiated Thyroid Carcinoma at Dr. Hasan Sadikin Hospital 2016-2021 Ayni, Tutik Nur; Agustina, Hasrayati; Hernowo, Bethy Suryawathy; Koesoemah, Raden Erwin Affandi Soeriadi; Azhar, Yohana
Majalah Patologi Indonesia Vol. 33 No. 1 (2024): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Anatomik Indonesia (PDSPA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55816/mpi.v33i1.606

Abstract

Background Initial therapy for differentiated thyroid carcinoma (DTC) is thyroidectomy with or without cervical lymph node dissection. Furthermore, radioactive iodine (RAI) is given to patients by considering risk stratification and other patient factors. Although most cases of DTC have a good prognosis after standard therapeutic approaches, the risks of local recurrence and distant metastases can be as high as 20% and 10%. Among these patients, two-thirds showed RAI-refractory. This is concerning because 10-year survival rate is less than 10%. This study aimed to analyze the clinicopathological characteristics of RAI-refractory DTC.   Methods This is a case-control study. Data was collected from the Department of Nuclear Medicine and Molecular Theranostics and Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung period 1 January 2016-31 December 2021.   Results Clinicopathological factors associated with RAI-refractory DTC are age, sex, aggressive histologic subtype, LVI (lymphovascular invasion), m-ETE (microscopic extrathyroid extension), TNM (tumor, nodal, metastasis) stage, and ENE (extranodal extension), with p-value <0.05. Meanwhile, there was no significant difference in the histologic type between RAI-refractory and non-RAI-refractory groups.   Conclusion In the pathology report, it is necessary to include prognostically relevant tumor histopathological characteristics. In addition to histologic type, histologic subtype, and tumor size, other features such as presence and extent of capsular invasion, LVI, microscopic and macroscopic ETE, ENE, and number and size of metastatic lymph nodes, have been shown to provide additional prognostic information and are required in standard pathology reports for DTC.