The Prospective Implementation of the 2015 ATA Guidelines and Modified ATA Recurrence Risk Stratification System for Treatment of Differentiated Thyroid Cancer in a Canadian Tertiary Care Referral Setting

Wu, Jiahui; Hu, Xin; Ghaznavi, Sana; Kinnear, Susan Elizabeth; Symonds, Christopher; Grundy, Peter; Parkins, Vicky; Sharma, Priyanka; Lamb, Debbie; Khalil, Moosa; Hyrcza, Martin; Chandarana, Shamir; Pasieka, Janice L.; Harvey, Adrian; Warshawski, Joseph; Hart, Robert D.; Deutschmann, Michael W.; Randall, Derrick R.; Paschke, Ralf

doi:10.1089/thy.2022.0055

Cited by 10 publications

(6 citation statements)

References 30 publications

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“…It considers risk of DTC recurrence as a continuum but also classifies DTC into low-, intermediate- and high risk for recurrence ( 7 , 45 ). Several studies have shown the robustness of this system for predicting recurrence and it is currently the most widely used system in clinical practice and research communication ( 10 , 11 , 46 , 47 ). The AJCC TNM system is one of the mortality-predicting staging systems and is based on age and several histopathological features including tumor size, extrathyroidal invasion, lymph node and distant metastasis ( 8 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

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How do BRAFV600E and TERT promoter mutations interact with the ATA and TNM staging systems in thyroid cancer?

Mukhtar,

Alhamoudi,

Alswailem

et al. 2023

Front. Endocrinol.

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ContextThe American Thyroid Association risk stratification (ATA) and the American Joint Committee on Cancer Tumor Node Metastases (TNM) predict recurrence and mortality of differentiated thyroid cancer (DTC). BRAFV600E and TERT promoter mutations have been shown to correlate with the histopathological features and outcome of DTC. Our objectives were to study the correlation of these molecular markers with these clinicopathological-staging systems.Patients and methodsWe studied 296 unselected patients, 214 females and 82 males with a median age of 36 years (IQR 23.3-49.0). BRAFV600E and TERT promoter mutations were tested by PCR-based Sanger sequencing. Data were extracted from medical records and analysed using Chi-Square and Fisher Exact tests and Kaplan Meier analysis.ResultsOf 296 patients tested, 137 (46.3%) had BRAFV600E-positive tumors and 72 (24.3%) were positive for TERT promoter mutations. The BRAFV600E mutation did not correlate with the ATA and TNM staging, being non-significantly different in various stages of these systems and did not predict the development of persistent disease (PD) (P 0.12). Unlike BRAFV600E, TERT promoter mutations were more frequent in the ATA high-risk than in intermediate- or low-risk tumors (P 0.006) and in TNM stages III and IV than lower stages (P <0.0001). TERT promoter mutations also predicted the outcome, being present in 37.2% of patients with PD compared to only 15.4% in those without evidence of disease (P <0.0001). The same pattern was also seen when BRAFV600E and TERT promoter mutations were combined.ConclusionTERT promoter mutations alone or in combination with BRAFV600E mutation, but not BRAFV600E mutation alone, correlated well with the ATA and TNM staging and predicted development of PD, especially in higher stages of these systems.

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Section: Discussionmentioning

confidence: 99%

“…The ATA system predicts risk of DTC recurrence, while the TNM system predicts risk of DTC-related mortality ( 6 , 7 , 9 ). Both systems have been well validated and are routinely used in clinical practice and research communications ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

How do BRAFV600E and TERT promoter mutations interact with the ATA and TNM staging systems in thyroid cancer?

Mukhtar,

Alhamoudi,

Alswailem

et al. 2023

Front. Endocrinol.

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“…In April 2017, the University of Calgary Division of Endocrinology implemented the 2015 ATA guidelines ( 11 ). Within 3 months of histologic diagnosis, thyroid cancer patients were prospectively assessed according to the 2015 ATA guidelines for their initial RR, TNM (tumor (T), nodes (N), and metastases (M)) cancer stage, and RR-dependant indication for RAI treatment and then followed for the long-term with RTT assessments.…”

Section: Methodsmentioning

confidence: 99%

“…Based on our January 2018 implementation of ETA guideline-based POU assessment with implementation radiology group (IRG), we prospectively evaluated the quality of POU in our health-care region for thyroid cancer patients after the implementation of lobectomy criteria for the treatment of thyroid cancer and implementation of standardized unanimous assessment of ATA RR. We also stratified initial recommendation for or against postoperative RAI for all new thyroid cancer patients ( 11 ) and assessed the differences in the quality of POU before and after the implementation of ETA guidelines. Furthermore, we investigated the utility of undetectable (<0.2 ng/mL) or low detectable (0.21–0.99 ng/mL) serum Tg measurements at 1-year FU in predicting the absence of persistent disease or relapse at 3-year FU, which aims to further improve RTT assessment based on the implementation of ATA guideline-based treatment de-escalation ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…We also stratified initial recommendation for or against postoperative RAI for all new thyroid cancer patients ( 11 ) and assessed the differences in the quality of POU before and after the implementation of ETA guidelines. Furthermore, we investigated the utility of undetectable (<0.2 ng/mL) or low detectable (0.21–0.99 ng/mL) serum Tg measurements at 1-year FU in predicting the absence of persistent disease or relapse at 3-year FU, which aims to further improve RTT assessment based on the implementation of ATA guideline-based treatment de-escalation ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Improvement in neck ultrasound report quality following the implementation of European Thyroid Association guidelines for postoperative cervical ultrasound for thyroid cancer follow-up, a prospective population study

Seal

et al. 2023

European Thyroid Journal

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Objective: To prospectively evaluate the quality of postoperative neck ultrasound (POU) for thyroid cancer patients after implementing European Thyroid Association (ETA) guideline-based POU assessment. Methods: Our analysis involved 672 differentiated thyroid cancer patients. POU report quality was compared between implementation radiology group (IRG), which implemented ETA guideline-based assessment in 2018, and all non-implementation radiology groups (NIRG). Differences in POU quality were evaluated before and after the implementation of guideline-based assessment. Additionally, we evaluated the ability of serum thyroglobulin (Tg) level <0.2 ng/mL or between 0.21 to 0.99 ng/mL and normal POU lesion status at 1-year follow-up to predict the absence of persistent disease or relapse at 3-year follow-up. Results: IRG had significantly higher mean utility scores for POU reports of abnormal thyroid bed nodules compared to NIRG (p < 0.001). IRG's POU reports for suspicious nodules and lymph nodes were considered sufficient in 94% and 85% of cases, respectively, compared to 45% and 68% for NIRG. For patients with normal US lesion status and Tg < 0.2 ng/mL or Tg 0.21 to 0.99 ng/mL at 1-year follow-up, the negative predictive values were both 96%. Conclusions: Implementation of 2013 ETA POU reporting guidelines allowed for the provision of high-quality POU reports, which may lead to increased accuracy in assessing the response to treatment and in estimating the risk of recurrence of thyroid cancer and likely reduce unnecessary repeat POU or FNA.

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Machine learning for risk stratification of thyroid cancer patients: a 15-year cohort study

Borzooei,

Briganti,

Golparian

et al. 2023

Eur Arch Otorhinolaryngol

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The Prospective Implementation of the 2015 ATA Guidelines and Modified ATA Recurrence Risk Stratification System for Treatment of Differentiated Thyroid Cancer in a Canadian Tertiary Care Referral Setting

Cited by 10 publications

References 30 publications

How do BRAFV600E and TERT promoter mutations interact with the ATA and TNM staging systems in thyroid cancer?

How do BRAFV600E and TERT promoter mutations interact with the ATA and TNM staging systems in thyroid cancer?

Improvement in neck ultrasound report quality following the implementation of European Thyroid Association guidelines for postoperative cervical ultrasound for thyroid cancer follow-up, a prospective population study

Machine learning for risk stratification of thyroid cancer patients: a 15-year cohort study

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