Dynamic Risk Stratification in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine

Momesso, Denise; Vaisman, Fernanda; Yang, Samantha Peiling; Bulzico, Daniel; Corbo, Rossana; Vaisman, Mário; Tuttle, R. Michael

doi:10.1210/jc.2015-4290

Cited by 197 publications

(193 citation statements)

References 28 publications

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“…Total thyroidectomy and RAI ablation Haugen et al (2016) Total thyroidectomy alone Momesso et al (2016) Lobectomy alone Momesso et al (2016) These rates were significantly lower than this one, noticed in DRS high-risk category (66.6%). Interestingly, no significant differences in recurrence rate after a period of complete remission between low-and high-risk groups were observed, regardless of the stratification system used.…”

Section: Dynamic Risk Stratification In Dtc Patients Treated With Totmentioning

confidence: 64%

“…Criteria on how to classify treatment responses in these patients, proposed in Momesso et al (2016), are given in Table 2.…”

Section: Dynamic Risk Stratification In Dtc Patients Treated With Totmentioning

confidence: 99%

“…The first one included 507 DTC patients, among whom, 187 underwent lobectomy (L) and 320 underwent total thyroidectomy (TT) (Momesso et al 2016). First, after the operation, patients were categorized according to ATA between 0.2 and 5.0 ng/mL, and positive stable or declining antiTg antibodies.…”

Section: Dynamic Risk Stratification In Dtc Patients Treated With Totmentioning

confidence: 99%

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Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

Krajewska¹,

Chmielik²,

Jarząb³

2017

Endocrine-Related Cancer

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The adequate risk stratification in thyroid carcinoma is crucial to avoid on one hand the overtreatment of low-risk and on the other hand the undertreatment of high-risk patients. The question how to properly assess the risk of relapse has been discussed during recent years and resulted in a substantial change in our approach to risk stratification in differentiated thyroid cancer, proposed by the newest ATA guidelines. First initial risk stratification, based on histopathological data is carried out just after primary surgery. It should be emphasized, that a high quality of histopathological report is crucial for proper risk stratification. Next, during the follow-up, patients are restratified considering their response to treatment applied and classified to one of the following categories: excellent response, biochemical incomplete response, structural incomplete or indeterminate response. This new approach is called dynamic risk stratification as, in contrary to the previous rigid evaluation performed at diagnosis, reflects a real-time prognosis and thereby substantially influences and personalizes disease management. In this review, we raise some unresolved questions, among them the lack of prospective studies, fulfilling evidence-based criteria, necessary to validate this model of risk stratification. We also provided some data concerning the use of dynamic risk stratification in medullary thyroid cancer, not yet reflected in ATA guidelines. In conclusion, dynamic risk stratification allows for better prediction of the risk of recurrence in thyroid carcinoma, what has been demonstrated in numerous retrospective analyses. However, the validation of this approach in prospective studies seems to be our task for near future.

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Section: Dynamic Risk Stratification In Dtc Patients Treated With Totmentioning

confidence: 64%

“…Criteria on how to classify treatment responses in these patients, proposed in Momesso et al (2016), are given in Table 2.…”

Section: Dynamic Risk Stratification In Dtc Patients Treated With Totmentioning

confidence: 99%

Section: Dynamic Risk Stratification In Dtc Patients Treated With Totmentioning

confidence: 99%

See 1 more Smart Citation

Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

Krajewska¹,

Chmielik²,

Jarząb³

2017

Endocrine-Related Cancer

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“…As a result, the low risk category was expanded to include patients with small-volume lymph node metastases (clinical N0 or < 5 pathologic N1 micrometastases, < 0.2 cm in the largest dimension), the intermediate RR group now considers only a subset of patients with lymph node metastases (clinical N1 or > 5 pathologic N1 with all involved lymph nodes < 3 cm in the largest dimension), and a second group, with intermediate to high risk of recurrence, now includes those cases with large-volume lymph node involvement (any metastatic lymph node > 3 cm in the largest dimension, > 3 lymph node metastasis with extranodal extension) and FTC with extensive vascular invasion (> 4 foci of vascular invasion or extracapsular vascular invasion). The 2015 guidelines defined this new version of the RR as the "modified risk stratification system from ATA 2009 guidelines" (MRSS ATA 2009) and were validated by our and other groups around the world in ablated and non-ablated patients (11)(12)(13)(14).…”

Section: Pathology Review and Risk Of Recurrencementioning

confidence: 99%

Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

Pitoia¹,

Jerkovich²,

Urciuoli³

et al. 2018

Archives of Endocrinology and Metabolism

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Objective: To compare the historic risk of recurrence (RR) and response to therapy to risk stratification estimated with historical pathology reports (HPRs) and contemporary re-review of the pathological slides in patients with differentiated thyroid cancer (DTC). Subjects and methods: Out of 210 DTC patients with low and intermediate RR who underwent total thyroidectomy and remnant ablation in our hospital, 63 available historic pathologic samples (HPS) were reviewed. The RR and the response to therapy were evaluated considering historical histological features (histological type, tumor size, capsular invasion, number of lymph node metastases) and then, reassessed after observing additional histological features (vascular invasion, extrathyroidal extension, size of lymph node metastases, presence of extranodal extension, and/or status of the resection margins).

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“…In the presence of normal thyroid tissue (even small remnants), the result of a single serum Tg assay is of limited use. In these cases, Tg assays provide reliable information on the presence of persistent/ recurrent disease only later, when serial measurements are available, and can be analyzed to identify increases in Tg production over time (44,45,46,47). Substantial rises are an indication for additional imaging work-up (US and/or second-line studies) ( The rate of structural disease recurrence during follow-up (median 10 years) was 8% (4/49) in the subgroup whose initial US findings were negative (as opposed to 12% (5/41) in the group with indeterminate scan results) (49).…”

Section: Post-treatment Staging and Surveillancementioning

confidence: 99%

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

Lamartina¹,

Deandreis

Durante³

et al. 2016

European Journal of Endocrinology

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The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is, though, moving toward more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow-up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short-and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome.

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Dynamic Risk Stratification in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine

Cited by 197 publications

References 28 publications

Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

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