Selective use of radioactive iodine in the postoperative management of patients with papillary and follicular thyroid carcinoma

Hay, Ian

doi:10.1002/jso.20696

Cited by 91 publications

(59 citation statements)

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“…Since 1997, many studies have reported the outcomes of PTC and FTC patients who were subjected to radioactive iodine ablation after bilateral lobe resection. It was recognized later on that most of these patients are truly at ''low risk'' of developing life-threatening recurrences (32). This may explain our finding that the inappropriate selection criteria during the late 1990s could have failed to identify the true high-risk FV-PTC or FTC patients, which largely masked the significant effectiveness of total thyroidectomy and radioactive iodine ablation.…”

Section: Discussionmentioning

confidence: 92%

Follicular Variant of Papillary Thyroid Carcinoma is a Unique Clinical Entity: A Population-Based Study of 10,740 Cases

Schneider

Leverson

et al. 2013

Thyroid

126

120

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Background: Follicular variant of papillary thyroid carcinoma (FV-PTC) has been increasingly diagnosed in recent years. However, little is known about its clinical behavior. The purpose of this study was to determine the disease characteristics of FV-PTC, and to compare it with classical papillary thyroid carcinoma (C-PTC) and follicular thyroid carcinoma (FTC). Methods: All cases of C-PTC, FV-PTC, and FTC larger than 1 cm in the Surveillance, Epidemiology and End Results (SEER) Cancer Database from 1988 to 2007 were identified. Tumor behavior and patient survival were compared among these three groups. Different risk factors for disease-specific mortality in each group were evaluated by multivariate analysis. Results: More than 36,000 surgical cases were identified, including 21,796 C-PTCs, 10,740 FV-PTCs, and 3958 FTCs. Extrathyroidal extension and lymph-node metastases were more common in FV-PTC than in FTC, but significantly less common than in C-PTC ( p < 0.0001). Distant metastasis rates were present in 2% of patients with FV-PTC, in 1% with C-PTC, and in 4% with FTC ( p < 0.0001). The 10-year disease-specific survival for patients with FV-PTC was 98%, similar to C-PTC (97%) but better than FTC (94%, p < 0.0001). Being over the age of 45 years remained a strong risk factor for disease-specific mortality in both FV-PTC and C-PTC, while the presence of extrathyroidal extension and distant metastases were stronger predictors of disease-specific mortality in FV-PTC than in C-PTC. Conclusions: FV-PTC is a common variant of PTC. Its clinical behavior is unique and represents an intermediate entity with clinical features that are between C-PTC and FTC. Interestingly, despite the variations in clinical behavior, the long-term outcome of these patients remains excellent and similar to C-PTC.

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Section: Discussionmentioning

confidence: 92%

Follicular Variant of Papillary Thyroid Carcinoma is a Unique Clinical Entity: A Population-Based Study of 10,740 Cases

Schneider

Leverson

et al. 2013

Thyroid

126

120

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“…In patients with a normal thyroglobulin level, conducting imaging, and laboratory tests and taking a careful history can help to make the differential diagnosis. CT, magnetic resonance imaging (MRI), and US are widely used imaging modalities (1)(2)(3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

“…Both postoperative radioiodine ablation and whole body scanning (WBS) are widely accepted therapeutic regimens for treating differentiated thyroid carcinoma (1)(2)(3). The presence of uptake sites following diagnostic or therapeutic I-131 administration may suggest the need for further therapy with I-131.…”

Section: Introductionmentioning

confidence: 99%

False-positive Radioiodine Uptake in a Functional Ovarian Cyst in a Patient Treated with Total Thyroidectomy for Papillary Cancer

Jang

Kim

et al. 2013

Intern. Med.

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False positive radioiodine uptake following thyroidectomy for differentiated thyroid cancer has been reported in some cases. A 42-year-old woman was referred for ablative radioiodine treatment six weeks after undergoing total thyroidectomy for papillary thyroid carcinoma. Posttherapeutic I-131 scintigraphy showed an intense hot spot in the left pelvis. Pelvic computed tomography (CT) revealed a benign left ovarian mass such as a functional cyst. After menstruation, ultrasonographic imaging demonstrated a shrunken ovarian mass. Therefore, we diagnosed the patient with a functional cyst that was influenced by hormonal fluctuation. It is believed that this is the first case of false-positive radioiodine uptake in a functional ovarian cyst.

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“…There is a major focus on shifting away from routine use of radioactive iodine in low risk thyroid cancer patients, as the survival in this group exceeds 98 %. 5 Unfortunately, patients often ask for scans and ablation to make sure their tumor has not spread to other parts of the body and often insist on overtreatment. Clearly, such overtreatment has no sound biological basis and may have unpleasant sequelae.…”

Section: Schuesslermentioning

confidence: 99%

Low-risk Thyroid Cancer, Surgical Training, and Radioactive Iodine

Shaha

2012

Ann Surg Oncol

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Schuessler1 and her colleagues from the University of Michigan have undertaken an interesting and complex study of surgeon training and use of radioactive iodine for low risk thyroid cancer patients. This study is based on several hypotheses, a questionnaire to the surgeons and correlating their training to radioactive iodine use. Clearly, management of thyroid cancer starting from extent of thyroidectomy, radioactive iodine use and extent of suppressive therapy continue to be a controversial subject and depends on experience and judgment of the treating physician. Even though there are no firm standards of practice, the general tendency in the United States appears to be total thyroidectomy followed by radioactive iodine ablation. Some of these decisions are made definitely by surgeons who have performed the surgical procedure; however, there is an enormous impact of endocrinologists, and the patient themselves having read extensively on Google. Clearly, trying to correlate these issues of treatment, referring specifically to the surgeon training, parent specialty, and attending the professional meeting may be difficult. In any case, the authors have made a genuine effort to correlate these issues and concluded that training with a thyroid surgeon and attending one or more professional society meeting a year was associated with lower rate of hospital based RAI use. Clearly, these conclusions may be difficult to digest because decision making regarding RAI is generally not one individual decision. The manuscript mentions Stage I thyroid cancer patients while a majority of the manuscript discusses the low risk thyroid cancer patients. Clearly, Stage I thyroid cancer patients, especially below the age of 45 with lymph node metastasis, definitely will require radioactive iodine and is quite rational approach, while in the truly low risk thyroid cancer patient, where the tumor appears to be intrathyroidal, the role of radioactive iodine is always questioned and similar opinion is reflected in the ATA guidelines. The basic conclusion that can be made out of this manuscript is the surgeon training, and the experience of the surgeon is more important in treatment policies.Having read this manuscript several times, certain important points need to be highlighted. The collection of the data and its relation to NCDB is quite complex. It should be mentioned that the average surgeon age was 51 years and the surgeon's average years in practice was 19. This reflects the seniority of the surgeons and their training several years before the ATA guidelines and our recent multidisciplinary management of thyroid cancer.The practice distribution of thyroidectomy is also quite interesting that the general surgeons comprised of 39 % while the otolaryngologists comprised of 44 % a reflection of current shifting practice pattern in the United States. There are very few individuals who are members of the American Association of Endocrine Surgeons with high level training background of the endocrine surgery. The authors have mentioned ab...

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Selective use of radioactive iodine in the postoperative management of patients with papillary and follicular thyroid carcinoma

Cited by 91 publications

References 50 publications

Follicular Variant of Papillary Thyroid Carcinoma is a Unique Clinical Entity: A Population-Based Study of 10,740 Cases

Follicular Variant of Papillary Thyroid Carcinoma is a Unique Clinical Entity: A Population-Based Study of 10,740 Cases

False-positive Radioiodine Uptake in a Functional Ovarian Cyst in a Patient Treated with Total Thyroidectomy for Papillary Cancer

Low-risk Thyroid Cancer, Surgical Training, and Radioactive Iodine

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