Extent of Surgery for Low-Risk Differentiated Thyroid Cancer

McDow, Alexandria D.; Pitt, Susan C.

doi:10.1016/j.suc.2019.04.003

Cited by 35 publications

(31 citation statements)

References 47 publications

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“…Unlike those with many other malignancies, patients with localized PTC have excellent long-term survival-99.9% at 10 years (2). Patients at low risk for recurrence also have an excellent prognosis regardless of the extent of thyroidectomy (3,4). The American Thyroid Association (ATA) updated guidelines for managing these patients in 2015 (1,5).…”

Section: Introductionmentioning

confidence: 99%

Patients' Reaction to Diagnosis with Thyroid Cancer or an Indeterminate Thyroid Nodule

Pitt

Saucke

Wendt

et al. 2021

Thyroid

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Introduction: Little is known about the experiences and concerns of patients recently diagnosed with thyroid cancer or an indeterminate thyroid nodule. This study sought to explore patients' reactions to diagnosis with papillary thyroid cancer (PTC) or indeterminate cytology on fine needle aspiration. Methods: We conducted semistructured interviews with 85 patients with recently diagnosed PTC or an indeterminate thyroid nodule before undergoing thyroidectomy. We included adults with nodules ‡1 cm and Bethesda III, IV, V, and VI cytology. The analysis utilized grounded theory methodology to create a conceptual model of patient reactions. Results: After diagnosis, participants experienced shock, anxiety, fear, and a strong need to ''get it out'' because ''it's cancer!'' This response was frequently followed by a sense of urgency to ''get it done,'' which made waiting for surgery difficult. These reactions occurred regardless of whether participants had confirmed PTC or indeterminate cytology. Participants described the wait between diagnosis and surgery as difficult, because the cancer or nodule was ''still sitting there'' and ''could be spreading.'' Participants often viewed surgery and getting the cancer out as a ''fix'' that would resolve their fears and worries, returning them to normalcy. The need to ''get it out'' also led some participants to minimize the risk of complications or adverse outcomes. Education about the slow-growing nature of PTC reassured some, but not all patients. Conclusions: After diagnosis with PTC or an indeterminate thyroid nodule, many patients have strong emotional reactions and an impulse to ''get it out'' elicited by the word ''cancer.'' This reaction can persist even after receiving education about the excellent prognosis. Understanding patients' response to diagnosis is critical, because their emotional reactions likely pose a barrier to implementing guidelines recommending less extensive management for PTC.

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Section: Introductionmentioning

confidence: 99%

Patients' Reaction to Diagnosis with Thyroid Cancer or an Indeterminate Thyroid Nodule

Pitt

Saucke

Wendt

et al. 2021

Thyroid

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“…This phenomenon cannot be fully explained by improvements in the sensitivity of testing methods, nor increased awareness among doctors and patients of screening. 9 Scholars from other countries have actively researched the risk factors associated with thyroid cancer, and found that autoimmune disorders, ionizing radiation, iodine intake, estrogen, environmental endocrine disruptors, negative psychosocial factors, and heredity may contribute to increases in thyroid cancer incidence. 10,11 From 1984 to 2010, the incidence of differentiated thyroid carcinoma in the United States increased, with tumors of diameter ≤ 0.5 rising by 5.09%, while those of 0.5-0.99 cm in diameter increased by 8.45%, average diameter tumors (1.0-1.99 cm) by 3.42%, and large tumors ≥ 2.0 cm by 2.96%.…”

Section: Discussionmentioning

confidence: 99%

2108 cases of thyroid cancer cervical lymph node dissection or not

Han

Zhang

et al. 2019

Preprint

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Clinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them,There were 1001 cases underwent open operation with total thyroidectomy + central lymph node dissection, meanwhile 1107 cases were treated with neck lateral lymph node dissection at the same time.The overall metastasis rate of all patients was 57.23%. Even the lymph node metastasis of PTMC was as high as 48.97%. When the mass rose above 2cm, the proportion of metastasis increased to 77.22%. With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54% to 73.33%, which showed positive correlation.When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.When the tumor diameter exceeds 1cm, the risk of cervical lymph node metastasis is high, we recommended the lateral lymph node dissection.

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“…Any cancer that initially occurs is not late-stage advanced papillary thyroid carcinoma (PTC). 7,8 The incidence of lymph node metastasis in patients with central region PTC is 20-66%, 9,10 which indicates that although PTC progresses slowly, its ability and tendency to metastasize to lymph nodes are obvious, and even for distant organs. It is unscientific to classify malignant tumors based on tumor size, as the invasiveness and distant metastatic ability of tumors are a consequence of the evolution of the tumor genome.…”

Section: Introductionmentioning

confidence: 99%

<p>With High-Risk Factors, Total Thyroidectomy is Preferred for Thyroid Cancer</p>

Lin

et al. 2020

CMAR

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Introduction: Based on thyroid cancer data from patients treated in Liaocheng People's Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective. Patients and Methods: Clinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection. Results: The metastasis rate for all patients was 59.42%. Further, among patients with bilateral or multiple tumors or capsule invasion, the proportions who developed metastatic disease were 63.54% and 71.19% and 67.46%, respectively. Meanwhile, the incidence of contralateral accidental malignancy was 7.25% after postoperative paraffin pathology. Discussion: Rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that, among patients with risk factors, initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.

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Extent of Surgery for Low-Risk Differentiated Thyroid Cancer

Cited by 35 publications

References 47 publications

Patients' Reaction to Diagnosis with Thyroid Cancer or an Indeterminate Thyroid Nodule

Patients' Reaction to Diagnosis with Thyroid Cancer or an Indeterminate Thyroid Nodule

2108 cases of thyroid cancer cervical lymph node dissection or not

<p>With High-Risk Factors, Total Thyroidectomy is Preferred for Thyroid Cancer</p>

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