Impact of the new guidelines of the American Thyroid Association on the treatment of the differentiated thyroid tumor in an Italian center with medium-high volume thyroid surgery

Bove, Aldo; Panaccio, Paolo; Palone, Gino; Esposito, Ludovica; Mariño, Lucia Porteiro; Bongarzoni, Giuseppe

doi:10.1186/s12893-018-0462-8

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…The other two subjects with an initial cytology finding of the Bethesda 3 group refused to repeat FNAB and the consequent surgical treatment and opted for periodic US monitoring. In our study group, we notice a slightly higher frequency of inadequate samples from the Bethesda 1 group, whereas the distribution in other groups follows the literature data ( 36 , 37 ).…”

Section: Discussionsupporting

confidence: 82%

Nitric oxide, thyroglobulin, and calcitonin: unraveling the nature of thyroid nodules

Samardzic,

Macvanin,

Zafirovic

et al. 2023

Front. Endocrinol.

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BackgroundThyroid nodules (TN) are localized morphological changes in the thyroid gland and can be benign or malignant.ObjectiveThe present study investigates the relationships between biochemical markers in serum (s) and their homologs in washout (w) after fine-needle aspiration biopsy (FNAB) of the TN of interest and their correlation with cytology specimen findings.MethodsWe investigated the relationships between serum biochemical markers nitric oxide (NO), thyroglobulin (TG), and calcitonin (CT), their homologs in washout after FNAB of the TN of interest, and cytology findings of biopsy samples classified according to the Bethesda system for thyroid cytopathology in this study, which included 86 subjects.ResultsWashout TG (TGw) level positively correlates with the cytology finding of the biopsy. A higher level of TGw correlates with higher categories of the Bethesda classification and indicates a higher malignant potential. The levels of serum NO (NOs), serum TG (TGs), serum CT (CTs), and washout CT (CTw) do not correlate with the cytology finding of the biopsy, and the higher levels of washout NO (NOw) correspond to the more suspicious ultrasound findings.ConclusionThe findings of our study suggest that TGw and NOw could be used as potential predictors of malignancy in TN.

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Section: Discussionsupporting

confidence: 82%

Nitric oxide, thyroglobulin, and calcitonin: unraveling the nature of thyroid nodules

Samardzic,

Macvanin,

Zafirovic

et al. 2023

Front. Endocrinol.

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“…Only three out of 197 patients subjected to thyroid surgery underwent TL. The main reason favoring TT were tumor multifocality and tumor size [37]. A similar opinion was presented by another Italian group.…”

Section: How Did 2015 Ata Gl Affect Daily Clinical Practice ?supporting

confidence: 65%

Lobo-isthmectomy in the management of differentiated thyroid cancer

et al. 2023

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We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones.The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015.Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma.This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.

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“…Outside of central habits, it is possible that in our iodine-deficient region (Ardennes massif), contralateral nodules have often been found. How to improve the large-scale diffusion of guidelines remains a significant issue [ 16 ]. Even more with new perspectives, such as the development of active surveillance for small PTC or minimally invasive treatment, which will probably once again change recommendations for thyroid cancer [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Evolution in the management of thyroid surgery over a period of 15 years in a Belgian center

Saïe,

Marchand,

Zhang-Yin

et al. 2024

BMC Surg

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Background Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze the change made in operative thyroid management and the impact on thyroid cancer diagnosis. Background Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease overdiagnosis of low risk thyroid cancer. Our goal was to study the evolution, over a long period, of pre- and postoperative management and the influence on histological cancer diagnosis and, more particularly, microcancer. Methods In this retrospective cohort study, we included 891 consecutive patients who underwent thyroid surgery between 2007 and 2020. Results Respectively 305, 290 and 266 patients underwent surgery over the 3 periods of 2007–2010, 2011–2015 and 2016–2020. In all three periods, women represented approximately 70% of the population, and the mean age was 54 years old (range: 67). Most surgeries (90%) involved total thyroidectomies. Over the study period, the proportion of preoperative fine needle aspiration (FNA) increased from 13 to 55%, p < 0,01. Cancer was found in a total of 116 patients: 35 (11%) patients between 2007 and 2010, 50 (17%) between 2011 and 2015 and 32 (12%) between 2016 and 2020 (p = 0.08). For all 3 periods, papillary thyroid cancer (PTC) was the most prevalent, at approximately 80%. The proportion of thyroid cancer > T1a increased significantly from 37% (2011–2015 period) to 81% (2016–2020 period), p = 0.001. Patients treated with radioiodine remained relatively stable (approximately 60%) but were more frequently treated with a low dose of radioiodine (p < 0.01) and recombinant human TSH (p < 0.01). Operative thyroid weight decreased over time in all but the low-risk T1a PTC cases. Conclusions Over a period of 15 years and according to the evolution of recommendations, the care of patients who underwent thyroid surgery changed with the increased use of preoperative FNA. This change came with a decrease in low-risk T1a PTC.

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Impact of the new guidelines of the American Thyroid Association on the treatment of the differentiated thyroid tumor in an Italian center with medium-high volume thyroid surgery

Cited by 5 publications

References 20 publications

Nitric oxide, thyroglobulin, and calcitonin: unraveling the nature of thyroid nodules

Nitric oxide, thyroglobulin, and calcitonin: unraveling the nature of thyroid nodules

Lobo-isthmectomy in the management of differentiated thyroid cancer

Evolution in the management of thyroid surgery over a period of 15 years in a Belgian center

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