Screening for Thyroid Cancer

Lin, Jennifer S; Bowles, Erin J. Aiello; Williams, Selvi B; Morrison, Caitlin C

doi:10.1001/jama.2017.0562

Cited by 523 publications

(64 citation statements)

References 412 publications

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“…Our findings are significant, because the incidence of thyroid cancer has increased substantially worldwide [11][12][13], a trend that is attributed to the overdiagnosis of small PTC. As a result, the current treatment guideline of DTC has become more conservative [14,15], and lobectomy has been performed more frequently in the treatment of low-risk DTC [4,16]. However, even if a DTC is completely resected, it may recur later, resulting in a poorer prognosis and requiring additional operations that can adversely impact patient health-related quality of life [17].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer

Kim

Park

Choe

et al. 2020

Cancers

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Lymph node metastasis (LNM) in differentiated thyroid cancer (DTC) is usually detected with preoperative ultrasonography; however, this has limited sensitivity for small metastases, and there is currently no predictive biomarker that can help to inform the extent of surgery required. We evaluated whether preoperative serum thyroglobulin levels can predict tumor burden and extent. We retrospectively reviewed the clinical records of 4029 DTC cases diagnosed and treated at a Samsung Medical Center between 1994 and 2016. We reviewed primary tumor size, number and location of LNM, and presence of distant metastases to reveal relationships between tumor burden and extent and preoperative serum thyroglobulin levels. We found a linear association between increasing preoperative thyroglobulin levels, the size of the primary tumor, and the number of LNM (r = 0.34, p < 0.001, r = 0.20, p < 0.001, respectively). Tumor extent also increased with each decile of increasing preoperative thyroglobulin level (r = 0.18, p < 0.001). Preoperative thyroglobulin levels of 13.15 ng/mL, 30.05 ng/mL, and 62.9 ng/mL were associated with the presence of ipsilateral lateral LNM, contralateral lateral LNM, and distant metastasis, respectively. Our results suggest that preoperative measurement of serum thyroglobulin may help to predict LNM and help to tailor surgery.

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Section: Discussionmentioning

confidence: 99%

Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer

Kim

Park

Choe

et al. 2020

Cancers

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“…The US Preventive Services Task Force recommends against screening for thyroid cancer in adults without symptoms. However, in the case of thyroid cancer, indirect detection through imaging frequently occurs 2627…”

Section: Clinical Significance and Association With Overdiagnosis Of mentioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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“…A recent study by Tonorezos et al[94] found that annual physical exam was sufficient to screen for thyroid cancer, and the authors concluded that the harms of screening (expense, invasive procedures, and anxiety) could be safely reduced if practitioners caring for cancer survivors at risk for thyroid cancer focus on the physical exam of the neck instead of costly imaging. In asymptomatic adult patients (notably not cancer survivors), ultrasonography of the neck and subsequent fine needle aspiration biopsy can certainly diagnose thyroid cancer, but it is unclear if screening can decrease mortality rates or improve patient health outcomes, whereas treatment of indolent thyroid malignancies that are identified by screening may increase the risk of patient harm [127]. However, many pediatric experts advocate for ultrasound screening in childhood cancer survivors because of the high rate of second primary thyroid cancers and the fact that earlier detection can lead to less aggressive treatment and better outcomes [128].…”

Section: Screening and Managementmentioning

confidence: 99%

Thyroid Sequelae of Pediatric Cancer Therapy

Waguespack

2018

Horm Res Paediatr

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The hypothalamic-pituitary-thyroid axis is a common site of unintended, acquired disease either during or after the treatment of cancer. Children treated with external radiation therapy are at the highest risk for developing a thyroid-related late effect, but thyroid dysfunction and second primary thyroid neoplasms can also occur after treatment with radiopharmaceutical agents such as ¹³¹I-metaiodobenzylguanidine. Increasingly recognized is the development of early thyroid dysfunction as an off-target consequence of the more novel cancer therapeutics such as the tyrosine kinase inhibitors and immune checkpoint inhibitors. Thyroid sequelae resulting from irradiation may manifest only after years to decades of follow-up, and their resultant clinical symptoms may be indolent and non-specific. Therefore, lifelong monitoring of the childhood cancer survivor at risk for thyroid disease is paramount. In this comprehensive review, the myriad thyroid adverse effects resulting from pediatric cancer treatment are discussed and an overview of screening and treatment of these thyroid sequelae provided.

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Screening for Thyroid Cancer

Cited by 523 publications

References 412 publications

Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer

Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Thyroid Sequelae of Pediatric Cancer Therapy

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