SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Follow-up: How and how long?

Leboulleux, Sophie; Lamartina, Livia; Sokol, E. Lecornet; Ménégaux, Fabrice; Leenhardt, Laurence; Russ, Gilles

doi:10.1016/j.ando.2022.10.010

Cited by 6 publications

(4 citation statements)

References 88 publications

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“…Bethesda II FNAC in EU-TIRADS 5 nodules was more common but still not frequent occurring in only 5.7% of the cohort. This is the basis for the recommendation of a second FNAC in Bethesda II – EU-TIRADS 5 nodules ( 6 , 8 ). However, the limitation of the EU-TIRADS 5 category is its wide range of malignancy rate.…”

Section: Discussionmentioning

confidence: 94%

“…Thyroid nodules are common, being palpable in 5% of adults and present in more than 60% of adults on high-frequency ultrasound (US) of the neck ( 1 , 2 ). Five to 10% of these nodules are malignant, and patients are then treated with surgery, active surveillance, or local treatment, depending on the size of the nodule ( 3 , 4 , 5 , 6 ). Given the high rate of thyroid nodules, most of which are benign, to reduce fine needle aspiration cytology (FNAC) and unnecessary surgery, ultrasound scores are used to determine which nodules should undergo FNAC and the Bethesda classification is used to assess management based on the risk of malignancy ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

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Unnecessary thyroid surgery rate for suspicious nodule in the absence of molecular testing

Mavromati,

Saiji,

Demarchi

et al. 2023

European Thyroid Journal

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Background: Molecular tests for suspicious thyroid nodules decrease rates of unnecessary surgeries but are not widely used due to reimbursement issues. The aim of this study was to assess the rate of unnecessary surgery performed in real life setting for Bethesda III, IV and V nodules in the absence of molecular testing. Method: This is a single-center retrospective study of consecutive patients undergoing fine needle aspiration cytology (FNAC) with rapid on-site evaluation between January 2017 and December 2021. Unnecessary surgery was defined as surgery performed because of Bethesda III, IV or V results in the absence of local compressive symptoms with final benign pathology and as second surgery for completion thyroidectomy. Results: Among 862 patients (640 female, mean age 54.2 years), 1010 nodules (median size 24.4 mm) underwent 1189 FNAC. Nodules were EU-TIRADS 2, 3, 4 and 5 in 3%, 34%, 42% and 22% of cases, respectively. FNAC was Bethesda I, II, III, IV, V and VI in 8%, 48%, 17%, 17%, 3% and 6%, respectively. Surgery was performed in 36% of Bethesda III nodules (benign on pathology: 81%), in 74% of Bethesda IV nodules (benign on pathology: 76%) and in 97% of Bethesda V nodules (benign on pathology: 21%). Surgery was considered unnecessary in 56%, 68% and 21% of patients with Bethesda III, IV and V nodules, respectively. Conclusion: In this real data cohort surgery was unnecessary in more than half of patients with Bethesda III and IV nodules and in 21% of patients with Bethesda V nodules.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Unnecessary thyroid surgery rate for suspicious nodule in the absence of molecular testing

Mavromati,

Saiji,

Demarchi

et al. 2023

European Thyroid Journal

View full text Add to dashboard Cite

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“…Therefore, most guidelines recommend AS for older patients and generally advise against it for patients under the age of 18 to 20 [ 50 , 53 , 60 ]. While most guidelines do not provide specific age recommendations, the French Society of Endocrinology, French Association of Endocrine Surgery, and French Society of Nuclear Medicine (SFE/AFCE/SFMN) guidelines (2022) suggest that patients aged 45 and older are more suitable for AS [ 51 ]. The SBEM (2022) and Korean Thyroid Association (KTA) (2023) guidelines state that AS is ideal for patients aged 60 and above and can be considered appropriate for those between 18 and 59 [ 53 , 55 ].…”

Section: Indications or Candidates For Asmentioning

confidence: 99%

“…Currently, there is no definitive evidence regarding when AS can be safely discontinued. Consequently, it is advised to continue AS throughout life [ 50 , 51 ].…”

Section: Follow-up Protocol For Asmentioning

confidence: 99%

Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines

Kim,

Moon,

Lee

et al. 2024

Endocrinol Metab

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The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.

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Key data from the 2023 European Thyroid Association annual meeting: De-escalation strategy in diagnosis and the treatment of differentiated thyroid carcinoma: Update after the 2023 ETA congress

Haissaguerre,

Lamartina,

Caron

2024

Annales d'Endocrinologie

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SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Follow-up: How and how long?

Cited by 6 publications

References 88 publications

Unnecessary thyroid surgery rate for suspicious nodule in the absence of molecular testing

Unnecessary thyroid surgery rate for suspicious nodule in the absence of molecular testing

Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines

Key data from the 2023 European Thyroid Association annual meeting: De-escalation strategy in diagnosis and the treatment of differentiated thyroid carcinoma: Update after the 2023 ETA congress

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