Tailored surgery according to molecular analysis in differentiated thyroid carcinomas

Abstract

Papillary thyroid carcinoma (PTC) is an often indolent disease implying a long survival and in most of the cases an excellent prognosis, but there is still a limited percentage of cases where, in spite of their pre-operative conventional staging, these tumors could better be treated through a more selective surgical approach. Small PTC in fact are generally considered as "low risk" tumors but using simply a TNM classification might lead to a limited surgery such as unilateral hemithyroidectomy, in particular according to the most recent guidelines of the American Thyroid Association. On the other hand though, an absence of the mutation could allow simplifying the follow-up of these patients, for example avoiding unnecessary radioactivated iodine therapy after surgery or even limiting to a unilateral thyroidectomy the operative procedure for these cases. Molecular testing has a peculiar interest for surgeons in two different ways: (I) with respect to diagnosis, in order to reduce the number of indeterminate citologies; (II) with respect to prognosis after both cytology and histology, in order to improve risk stratification and help the surgeon in developing a tailored surgical therapy. The aim of this review is the second issue: how to implement the concept of a tailored surgery according to molecular analysis in differentiated thyroid carcinomas (DTC).

Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience

“…14 This has led to a more tailored approach to dealing with patients’ indeterminate nodules and could give patients and surgeons a more accurate picture regarding malignancy risk in discussions or advisement of surgery. 15…”

“…Despite these limitations, the use of molecular markers is expected to improve the accuracy of cancer diagnosis in indeterminate thyroid nodules and allow for more individualized surgical and postsurgical treatment of patients with thyroid cancer 14 . This has led to a more tailored approach to dealing with patients’ indeterminate nodules and could give patients and surgeons a more accurate picture regarding malignancy risk in discussions or advisement of surgery 15 …”

Effects of Psychological Intervention on Pain and Mental State of Patients Underwent Total Thyroidectomy

“…Inclusion criteria: those who were diagnosed with double lobe multifocal carcinoma of thyroid and met relevant clinical diagnostic criteria; All patients have signed the consent form for surgical treatment and nursing; no relevant contraindications [3][4]. Exclusion criteria: diagnosis with mental disorders and unwillingness to cooperate with psychological intervention.…”

“…In recent years, the incidence of thyroid cancer is on the rise globally year by year [1][2], among which the proportion of thyroid micro papillary cancer is gradual rise, while the treatment scheme is still not unified. Surgical resection is the most important means of treatment of thyroid papillary carcinoma [3]. The Futaba multifocal carcinoma in thyroid subtotal resection and one of the central lymph cleaning is the main operation.…”

Pseudomonas aeruginosa injection decreases drainage in lateral neck dissection for metastatic thyroid cancer

“…The duration of hospitalization stay generally depends on when the tube is removed. Since chyle leakage and hemorrhage occur at a relatively low rate (5-8% vs. 0.1-2.1%), the hospitalization stay is determined by the volume of the drainage (4)(5)(6).…”