Radioiodine remnant ablation in papillary thyroid microcarcinoma

Yang, Ting; Zheng, Shiyang; Jiao, Ju; Zou, Qiong; Zhang, Yong

doi:10.1097/mnm.0000000000001018

Cited by 15 publications

(13 citation statements)

References 33 publications

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“…Radioactive I 131 therapy is also an important part of comprehensive treatment of thyroid cancer. 28,29 All patients with lymph node metastasis, whether in the central or cervical region, were treated with I 131 administered at doses of 80-130 mCi, according to risk stratification assessment, with additional rounds of treatment if needed, based on the results of follow-up observation. The method of treatment of thyroid cancer is influenced not only by surgeons, but also by nuclear medicine, imaging, and other clinicians, and even by health insurance companies.…”

Section: Discussionmentioning

confidence: 99%

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

Lin

et al. 2021

Cancer Medicine

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Section: Discussionmentioning

confidence: 99%

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

Lin

et al. 2021

Cancer Medicine

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“… 29 In our institution, most patients were submitted to total thyroidectomy, based on patient preference and clinical criteria such as previous neck irradiation, hypothyroidism, familial predisposition, bilateral nodularity, or as a strategy to simplify the follow-up. Most authors, 30 31 but not all, 32 33 agree that postthyroidectomy RAI ablation is not beneficial in reducing cancer recurrence in PTMC patients. Otherwise, RAI ablation can make the follow-up easier by improving the sensitivity of Tg and anti-Tg antibodies.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients

Carvalho

Köhler

Gomes

et al. 2021

Int Arch Otorhinolaryngol

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Introduction The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial. Objective To identify the clinical and pathological factors predictive of tumor recurrence. Methods We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the American Thyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence. Results After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (p = 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (p = 0.032; HR: 1.76; 95%CI: 1.05 to 2.96), and the presence of lymph-node metastasis (p < 0.001; HR: 3.69; 95%CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients. Conclusions The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age < 55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.

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“…None of the other variables that upgrade risk categorisation, such as high-risk histopathology histology features, extrathyroidal extension, node involvement, or intravascular invasion, appeared statistically different. A meta-analysis of 22 studies including more than 28,000 patients showed similar rates of RAI administration after total thyroidectomy for PTC, but some included papers published before the latest ATA guidelines (which remains more conservative on this treatment modality) [ 17 ]. Despite this, there were no observed differences in the two periods, suggesting either a prompt uptake of the recommendations or, and this appears to be more likely, an overall reluctancy to abandon RAI in low-risk PTC patients.…”

Section: Discussionmentioning

confidence: 99%

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

Fenton

Wade

Pirrili

et al. 2021

JCM

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Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.

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Radioiodine remnant ablation in papillary thyroid microcarcinoma

Cited by 15 publications

References 33 publications

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

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