In reference to <i>The increasing incidence of small thyroid cancers: Where are the cases coming from</i>?

Wang, Chen‐Chi; Tsai, Tung-Lung; Hsing, Chih-Yu; Wu, Shang‐Heng

doi:10.1002/lary.22418

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…Similar trends are reported worldwide, including the United Kingdom, the United States, and South Korea [2][3][4]. This observed increased incidence primarily comprises differentiated TC (DTC), without a concomitant increase in mortality, suggesting potential overdiagnosis of indolent pathology [4][5][6][7]. In Ireland, the 5-year TC survival rate has improved from 71% (1994-1998) to 91.8% (2010-2014), while the 5-year DTC-specific survival is 98% [1].…”

Section: Introductionsupporting

confidence: 57%

Differentiated Thyroid Cancer: How Do Current Practice Guidelines Affect Management?

Owens

McVeigh²,

Fahey

et al. 2018

Eur Thyroid J

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Background: International best-practice guidelines recommend completion thyroidectomy and radioiodine remnant ablation (RRA) for patients with differentiated thyroid cancer (DTC) > 4 cm or with specific risk factors. Patients with DTC < 1 cm without risk factors are recommended for lobectomy alone. Indications for aggressive surgery and RRA are less clearly defined for tumours measuring 1–4 cm. A personalised approach to decision-making is recommended. Objectives: This study assesses therapeutic approaches to DTC as compared to the current British Thyroid Association (BTA) clinical practice guidelines. We ascertained the effect of equivocal guidance in the 1–4 cm tumour cohort on contemporary practice patterns. Methods: Data were obtained from a prospectively maintained thyroid cancer database of patients treated for DTC in a tertiary referral centre at the University Hospital Galway. Consecutive patients attending a dedicated thyroid cancer clinic between August 2014 and August 2017 were included. Clinicopathological characteristics and management strategies were assessed. Results: Ninety-four percent (n = 168/178) of patients were surgically managed in adherence with guidelines. A minority (n = 10) received surgery not aligned with guidelines. Ninety-seven percent (n = 172/178) of RRA treatment decisions were in accordance with guidelines. The BTA guidelines recommended a personalised decision-making approach for 18.0% (n = 32) and 44.9% (n = 80) of surgery and RRA treatment decisions, respectively. The more aggressive, treatment-driven approach was typically favoured by the multidisciplinary team, with 97% (n = 31/32) undergoing completion thyroidectomy and 100% (n = 80) proceeding to RRA. Conclusions: Management of DTC at our institution closely adheres to contemporary clinical practice guidelines. The finding of more aggressive management in those requiring a personalised decision-making approach highlights the requirement for improved risk stratification in this cohort to rationalise management strategies.

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Section: Introductionsupporting

confidence: 57%

Differentiated Thyroid Cancer: How Do Current Practice Guidelines Affect Management?

Owens

McVeigh²,

Fahey

et al. 2018

Eur Thyroid J

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“…The increasing incidence of WDTC is probably due to over diagnosis [ 1 , 7 – 12 ]. Almost 50% of WDTC is initially discovered on imaging studies [ 13 , 20 ] and a correlation has been shown between frequency of ultrasonography and WDTC incidence [ 21 ]. Further, an association between obesity and the incidence of WDTC has been reported [ 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Method of Detection of Well-Differentiated Thyroid Cancers in Obese and Non-Obese Patients

et al. 2016

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BackgroundThe incidence of well-differentiated thyroid cancer (WDTC) is increasing rapidly. Many authors feel that this increase is due to over-diagnosis and that one of the contributing factors is the increasing use of various imaging studies. The rate of obesity has also been increasing in the United States. It has been suggested that patients with an increased body mass index (BMI kg/m2) have a higher incidence of WDTC than patients with normal BMI. One might hypothesize that thyroid nodules are more difficult to palpate in obese patients and that as more cancers are detected by imaging the apparent rate of increase in WDTC in obese patients would appear to be greater than in non-obese patients. This study was undertaken to evaluate this hypothesis by determining if there is any difference in the way thyroid cancers are initially detected in obese and non-obese patients.MethodsThe medical records of all 519 patients with a postoperative diagnosis of WDTC who underwent thyroidectomy at NYU Langone Medical Center from January 1, 2007 through August 31, 2010 by the three members of NYU Endocrine Surgery Associates were reviewed. Patients were divided into Non-obese (BMI<30 kg/m2) and Obese (BMI≥30 kg/m2) groups. Patients were also divided by the initial method of detection of their tumor into Palpation, Imaging, and Incidental groups.ResultsThe final study group contained 270 patients, 181(67%) of whom were in the Non-obese Group and 89(33%) were in the Obese Group. In the Non-obese group, 81(45%) of tumors were found by palpation, 72(40%) were found by imaging, and 28(16%) were found incidentally. In the Obese group, 40(45%) were found by palpation, 38(43%) were found by imaging, and 11(12%) were found incidentally. These differences were not statistically significant (p-value 0.769).ConclusionWe show that BMI does not play a role in the method of initial detection in patients with WDTC. This suggests that the prevalence of WDTC detected by imaging is not an artifact caused by an increasingly obese population and that any association of WDTC and obesity is not related to the way in which these tumors are detected.

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In reference to The increasing incidence of small thyroid cancers: Where are the cases coming from?

Cited by 2 publications

References 6 publications

Differentiated Thyroid Cancer: How Do Current Practice Guidelines Affect Management?

Differentiated Thyroid Cancer: How Do Current Practice Guidelines Affect Management?

Method of Detection of Well-Differentiated Thyroid Cancers in Obese and Non-Obese Patients

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