Referral Practice for Radioactive Iodine Ablation (RAI) after ATA guidelines 2015: results from a Tertiary Cancer Care Centre

被引:1
作者
Dhar, Harsh [1 ]
Thiagarajan, Shivakumar [2 ]
Yousuf, Aamir [3 ]
Nayyar, Supreet Singh [4 ]
Chaukar, Devendra [2 ]
机构
[1] Narayana Superspecial Hosp, Kolkata, West Bengal, India
[2] Homi Bhabha Natl Inst, Dept Head & Neck Surg Oncol, Tata Mem Ctr, Mumbai 400012, Maharashtra, India
[3] Govt Med Coll, Dept ENT, Srinagar, India
[4] Base Hosp, Dept ENT, New Delhi, India
关键词
Differentiated thyroid cancer; Risk factors; Radioactive iodine ablation; ATA; 2015; guidelines; Remnant ablation; THYROID ASSOCIATION GUIDELINES; REMNANT ABLATION; MANAGEMENT GUIDELINES; ADULT PATIENTS; NODULES; SURVEILLANCE; EXTENSION; SURVIVAL; IMPACT;
D O I
10.1007/s00405-020-05946-4
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Introduction The ATA guidelines for differentiated thyroid cancer (DTC) are one of the most widely referred to. Their 2015 edition proposed a new risk stratification system and modified the indications for radioactive iodine (RAI) ablation especially for the low risk category. We attempted to analyze whether the new guidelines altered referral practices for RAI ablation at our institute. Methodology Patients who underwent total or completion thyroidectomy for DTC during 2016-2017 were included. Relevant demographical and pathological data was tabulated. Patients were classified as per the new stratification system and referral practice for RAI ablation documented. Results 238 patients were included. Of these 20.6% were low risk, 44.1% were intermediate and 35.3% were high risk as per modified guidelines. All patients within the intermediate and high-risk group and 77.8% of the low risk group were referred for RAI ablation. Analysis of risk factors revealed that within the low risk group there were three patients with < 5 metastatic nodes, all within 3 cm in size-a category that the ATA failed to stratify appropriately. Among those labeled as Intermediate risk due to microscopic extra thyroidal extension (ETE), 85% had no other risk factors and were upstaged solely due to microscopic ETE, which is interestingly no longer included in the TNM staging. Conclusion Majority of low risk patients continue to receive RAI ablation due to persistent belief emanating from literature that remnant ablation improves outcomes and aids in follow up. The issue of RAI ablation for low risk group and prognostic implications of microscopic ETE and limited nodal disease need to be revisited.
引用
收藏
页码:2521 / 2526
页数:6
相关论文
共 17 条
  • [1] Amin M.B., 2017, AJCC Cancer Staging Manual, V8th
  • [2] Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer
    Cooper, David S.
    Doherty, Gerard M.
    Haugen, Bryan R.
    Kloos, Richard T.
    Lee, Stephanie L.
    Mandel, Susan J.
    Mazzaferri, Ernest L.
    McIver, Bryan
    Pacini, Furio
    Schlumberger, Martin
    Sherman, Steven I.
    Steward, David L.
    Tuttle, R. Michael
    [J]. THYROID, 2009, 19 (11) : 1167 - 1214
  • [3] Long-Term Surveillance of Papillary Thyroid Cancer Patients Who Do Not Undergo Postoperative Radioiodine Remnant Ablation: Is There a Role for Serum Thyroglobulin Measurement?
    Durante, Cosimo
    Montesano, Teresa
    Attard, Marco
    Torlontano, Massimo
    Monzani, Fabio
    Costante, Giuseppe
    Meringolo, Domenico
    Ferdeghini, Marco
    Tumino, Salvatore
    Lamartina, Livia
    Paciaroni, Alessandra
    Massa, Michela
    Giacomelli, Laura
    Ronga, Giuseppe
    Filetti, Sebastiano
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2012, 97 (08) : 2748 - 2753
  • [4] NCCN Guidelines® Insights Thyroid Carcinoma, Version 2.2018 Featured Updates to the NCCN Guidelines
    Haddad, Robert I.
    Nasr, Christian
    Bischoff, Lindsay
    Busaidy, Naifa Lamki
    Byrd, David
    Callender, Glenda
    Dickson, Paxton
    Duh, Quan-Yang
    Ehya, Hormoz
    Goldner, Whitney
    Haymart, Megan
    Hoh, Carl
    Hunt, Jason P.
    Iagaru, Andrei
    Kandeel, Fouad
    Kopp, Peter
    Lamonica, Dominick M.
    McIver, Bryan
    Raeburn, Christopher D.
    Ridge, John A.
    Ringel, Matthew D.
    Scheri, Randall P.
    Shah, Jatin P.
    Sippel, Rebecca
    Smallridge, Robert C.
    Sturgeon, Cord
    Wang, Thomas N.
    Wirth, Lori J.
    Wong, Richard J.
    Johnson-Chilla, Alyse
    Hoffmann, Karin G.
    Gurski, Lisa A.
    [J]. JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, 2018, 16 (12): : 1429 - 1440
  • [5] 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
    Haugen, Bryan R.
    Alexander, Erik K.
    Bible, Keith C.
    Doherty, Gerard M.
    Mandel, Susan J.
    Nikiforov, Yuri E.
    Pacini, Furio
    Randolph, Gregory W.
    Sawka, Anna M.
    Schlumberger, Martin
    Schuff, Kathryn G.
    Sherman, Steven I.
    Sosa, Julie Ann
    Steward, David L.
    Tuttle, R. Michael
    Wartofsky, Leonard
    [J]. THYROID, 2016, 26 (01) : 1 - 133
  • [6] Less is More: Comparing the 2015 and 2009 American Thyroid Association Guidelines for Thyroid Nodules and Cancer
    Kim, Brian W.
    Yousman, Wina
    Wong, Wei Xiang
    Cheng, Cheng
    McAninch, Elizabeth A.
    [J]. THYROID, 2016, 26 (06) : 759 - 764
  • [7] Minimal extrathyroidal extension affects the prognosis of differentiated thyroid cancer: Is there a need for change in the AJCC classification system?
    Liu, Zeming
    Huang, Yihui
    Chen, Sichao
    Hu, Di
    Wang, Min
    Zhou, Ling
    Zhou, Wei
    Chen, Danyang
    Feng, Haifeng
    Wei, Wei
    Zhang, Chao
    Zeng, Wen
    Guo, Liang
    [J]. PLOS ONE, 2019, 14 (06):
  • [8] The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer
    Nixon, Iain J.
    Ganly, Ian
    Patel, Snehal
    Palmer, Frank L.
    Whitcher, Monica M.
    Tuttle, Robert M.
    Shaha, Ashok R.
    Shah, Jatin P.
    [J]. SURGERY, 2011, 150 (06) : 1242 - 1248
  • [9] Analysis of Age and Disease Status as Predictors of Thyroid Cancer-Specific Mortality Using the Surveillance, Epidemiology, and End Results Database
    Orosco, Ryan K.
    Hussain, Timon
    Brumund, Kevin T.
    Oh, Deborah K.
    Chang, David C.
    Bouvet, Michael
    [J]. THYROID, 2015, 25 (01) : 125 - 132
  • [10] Perros P, 2014, CLIN ENDOCRINOL, V81, P1, DOI 10.1111/cen.12515