No CrossRef data available.
Article contents
A study of variation in therapeutic approach to low-risk differentiated thyroid cancer in the UK
Published online by Cambridge University Press: 17 May 2023
Abstract
Background
The British Thyroid Association and American Thyroid Association guideline definitions for low-risk differentiated thyroid cancers are susceptible to differing interpretations, resulting in different clinical management in the UK.
Objective
To explore the national effect of these guidelines on the management of low-risk differentiated thyroid cancers.
Methods
Anonymised questionnaires were sent to multidisciplinary teams performing thyroidectomies in the UK. Risk factors that multidisciplinary teams considered important when managing low-risk differentiated thyroid cancers were established.
Results
Most surgeons (71 out of 75; 94.7 per cent) confirmed they were core multidisciplinary team members. More than 80 per cent of respondents performed at least 30 hemi- and/or total thyroidectomies per annum. A majority of multidisciplinary teams (50 out of 75; 66.7 per cent) followed British Thyroid Association guidelines. Risk factors considered important when managing low-risk differentiated thyroid cancers included: type of tumour histology findings (87.8 per cent), tumour size of greater than 4 cm (86.5 per cent), tumour stage T3b (85.1 per cent) and central neck node involvement (85.1 per cent). Extent of thyroid surgery (e.g. hemi- or total thyroidectomy) was highly variable for low-risk differentiated thyroid cancers.
Conclusion
Management of low-risk differentiated thyroid cancers is highly variable, leading to a heterogeneous patient experience.
- Type
- Main Article
- Information
- Copyright
- Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED
Footnotes
Pavithran Maniam takes responsibility for the integrity of the content of this paper
References
Wiltshire, J, Drake, T, Uttley, L, Balasubramanian, S. Systematic review of trends in the incidence rates of thyroid cancer. Thyroid 2016;26:1541–5210.1089/thy.2016.0100CrossRefGoogle ScholarPubMed
McIntyre, C, Jacques, T, Palazzo, F, Farnell, K, Tolley, N. Quality of life in differentiated thyroid cancer. Int J Surg 2018;50:133–610.1016/j.ijsu.2017.12.014CrossRefGoogle ScholarPubMed
Tarasova, V, Tuttle, R. Current management of low risk differentiated thyroid cancer and papillary microcarcinoma. Clin Oncol 2017;29:290–710.1016/j.clon.2016.12.009CrossRefGoogle ScholarPubMed
Roti, E, degli Uberti, E, Bondanelli, M, Braverman, L. Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 2008;159:659–7310.1530/EJE-07-0896CrossRefGoogle ScholarPubMed
Sipos, J, Mazzaferri, E. Thyroid cancer epidemiology and prognostic variables. Clin Oncol 2010;22:395–40410.1016/j.clon.2010.05.004CrossRefGoogle ScholarPubMed
Nixon, I, Simo, R, Kim, D. Refining definitions within low-risk differentiated thyroid cancers. Clin Otolaryngol 2018;43:1195–20010.1111/coa.13145CrossRefGoogle ScholarPubMed
Hay, ID, Bergstralh, EJ, Goellner, JR, Ebersold, JR, Grant, CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993;114:1050–7Google Scholar
Haugen, B, Alexander, E, Bible, K, Doherty, G, Mandel, S, Nikiforov, Y et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1–13310.1089/thy.2015.0020CrossRefGoogle ScholarPubMed
Shah, J, Montero, P. New AJCC/UICC staging system for head and neck, and thyroid cancer. Revista Médica Clínica Las Condes 2018;29:397–40410.1016/j.rmclc.2018.07.002CrossRefGoogle Scholar
Cady, B, Sedgwick, C, Meissner, W, Bookwalter, J, Romagosa, V, Werber, J. Changing clinical, pathologic, therapeutic, and survival patterns in differentiated thyroid carcinoma. Ann Surg 1976;184:541–5310.1097/00000658-197611000-00003CrossRefGoogle ScholarPubMed
McConahey, W, Hay, I, Woolner, L, van Heerden, J, Taylor, W. Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy, and outcome. Mayo Clin Proc 1986;61:978–9610.1016/S0025-6196(12)62641-XCrossRefGoogle Scholar
Perros, P, Boelaert, K, Colley, S, Evans, C, Evans, R, Gerrard Ba, G et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014;81:1–122CrossRefGoogle ScholarPubMed
British Association of Endocrine and Thyroid Surgeons (BAETS). In: https://www.baets.org.uk [23 May 2023]Google Scholar
Gray, W, Aspinall, S, Tolley, N, Day, J, Lansdown, M. The volume and outcome relationship for thyroidectomy in England. Langenbecks Arch Surg 2021;406:1999–2010CrossRefGoogle ScholarPubMed
Lorenz, K, Raffaeli, M, Barczyński, M, Lorente-Poch, L, Sancho, J. Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement. Langenbecks Arch Surg 2020;405:401–2510.1007/s00423-020-01907-xCrossRefGoogle ScholarPubMed
Adam, M, Thomas, S, Youngwirth, L, Hyslop, T, Reed, S, Scheri, R et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 2017;265:402–710.1097/SLA.0000000000001688CrossRefGoogle Scholar
Aspinall, S, Oweis, D, Chadwick, D. Effect of surgeons’ annual operative volume on the risk of permanent hypoparathyroidism, recurrent laryngeal nerve palsy and haematoma following thyroidectomy: analysis of United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS). Langenbecks Arch Surg 2019;404:421–3010.1007/s00423-019-01798-7CrossRefGoogle ScholarPubMed
Sakorafas, G, Koureas, A, Mpampali, I, Balalis, D, Nasikas, D, Ganztzoulas, S. Patterns of lymph node metastasis in differentiated thyroid cancer; clinical implications with particular emphasis on the emerging role of compartment-oriented lymph node dissection. Oncol Res Treat 2019;42:143–710.1159/000488905CrossRefGoogle ScholarPubMed
Nickel, B, Brito, J, Barratt, A, Jordan, S, Moynihan, R, McCaffery, K. Clinicians' views on management and terminology for papillary thyroid microcarcinoma: a qualitative study. Thyroid 2017;27:661–71CrossRefGoogle ScholarPubMed
Haymart, M, Banerjee, M, Yang, D, Stewart, A, Sisson, J, Koenig, R et al. Variation in the management of thyroid cancer. J Clin Endocrinol Metab 2013;98:2001–8CrossRefGoogle ScholarPubMed
Park, S, Jeon, MJ, Oh, H-S, Lee, Y-M, Sung, T-Y, Han, M et al. Changes in serum thyroglobulin levels after lobectomy in patients with low-risk papillary thyroid cancer. Thyroid 2018;28:997–100310.1089/thy.2018.0046CrossRefGoogle ScholarPubMed
Hauch, A, Al-Qurayshi, Z, Randolph, G, Kandil, E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol 2014;21:3844–5210.1245/s10434-014-3846-8CrossRefGoogle ScholarPubMed
Leboulleux, S, Bournaud, C, Chougnet, CN, Zerdoud, S, Al Ghuzlan, A, Catargi, B et al. Thyroidectomy without radioiodine in patients with low-risk thyroid cancer. N Engl J Med 2022;386:923–3210.1056/NEJMoa2111953CrossRefGoogle ScholarPubMed
Cancer Research UK: a trial looking at surgery to remove the whole thyroid or part of the thyroid (HoT trial). In: https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-surgery-to-remove-the-whole-thyroid-or-part-of-the-thyroid-hot-trial [11 June 2022]Google Scholar
The British Association of Endocrine & Thyroid Surgeons National Audit Report. In: https://e-dendrite.com/Publishing/Reports/BAETS/Sixth_Audit_Report.pdf [23 May 2023]Google Scholar
Maniam et al. supplementary material 1
File
18.1 KB
Maniam et al. supplementary material 2
File
17.4 KB