Controversies in primary treatment of low-risk papillary thyroid cancer

An Exponential Growth in Incidence of Thyroid Cancer: Trends and Impact of CT Imaging

“…This pattern of increased diagnosis of a silent reservoir of disease with an indolent natural history is similar to the epidemiologic changes in prostate cancer that occurred with prostaticspecific antigen and digital rectal examination-based screening. 2 Davies and Welch 1 and McLeod et al 3 proposed that advances in sonography and fine-needle aspiration were leading to an increased diagnosis of subclinical (ie, small, impalpable) thyroid cancers that would otherwise remain asymptomatic during a patient's lifetime and not increase mortality rates. Epidemiologists have labeled this situation "overdiagnosis."…”

Thyroid cancer: An epidemic of disease or an epidemic of diagnosis?

“…12 Different ways to address the problem of overdiagnosis and overtreatment of low-risk TC can be envisaged. 11,12 They include: (i) avoidance of TC screening activities; (ii) reclassification of low-risk TC using terms other than cancer. This reclassification approach was useful in cervical cancer screening 9 (i.e., cervical intraepithelial neoplasia grade 1-3) and has been proposed for in situ ductal carcinoma of the breast and (iii) establishment of randomized clinical trials or observational cohorts of watchful-waiting approaches.…”

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

“…The extent of thyroidectomy (hemithyroidectomy versus total thyroidectomy) for differentiated thyroid carcinoma is subject to debate, as high-level evidence favoring a more aggressive surgical approach in terms of recurrence risk reduction and absolute survival is lacking [1,50,51]. A well-performed total thyroidectomy is associated with a relatively low incidence of complications, ensures good local control of cancer by removing even microscopic tumor foci (that are frequent and often bilateral), facilitates subsequent radiometabolic treatment and allows using serum thyroglobulin monitoring for follow-up.…”

“…A well-performed total thyroidectomy is associated with a relatively low incidence of complications, ensures good local control of cancer by removing even microscopic tumor foci (that are frequent and often bilateral), facilitates subsequent radiometabolic treatment and allows using serum thyroglobulin monitoring for follow-up. On the other hand, hemithyroidectomy may be proposed because of the relatively low risk of recurrence in exchange for half the postoperative complications of total thyroidectomy [50]. For lymphadenectomy, please refer to the appropriate section.…”

“…For this reason, when lymph node metastases are found pre-or intraoperatively, therapeutic lymphadenectomy extended to the levels involved is indicated [1]: level VI neck dissection if lymph nodes of the central compartment are involved; lateral cervical lymphadenectomy if lateral cervical lymph node levels are involved (ipsi-and/or bilaterally). The role and extent of prophylactic lymphadenectomy in differentiated thyroid carcinoma, in the absence of pre-and intraoperative evidence of lymph node involvement (cN0) is still debated [1,50]. It is known that prophylactic central neck dissection may be associated with an increased risk of postoperative complications (hypoparathyroidism and recurrent nerve injury), with no high-level scientific evidence confirming its benefits.…”