Minimalistic Initial Therapy Options For Low Risk Papillary Thyroid Cancer
|
|
- Wilfred Stevens
- 5 years ago
- Views:
Transcription
1 Minimalistic Initial Therapy Options For Low Risk Papillary Thyroid Cancer An emphasis on proper patient selection R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine Weill Medical College of Cornell University
2 Minimalistic Treatment Options Active Surveillance (0bservation) Thyroid Lobectomy Not for every low risk thyroid cancer Not for every patient Not for every clinician
3 Observational Management Approach to Papillary Microcarcinoma 2,153 Low Risk Papillary Microcarcinoma Patients Dr Akira Miyauchi Kuma Clinic Japan Active Surveillance 1,179 (55%) Immediate Surgery 974 (45%) Median Follow-up 4 yrs (range 1-10 yrs) Continued Observation 1,085 (92%) Surgery, Stable Disease 61 (5.2%) Increase Size Primary Tumor 27 (2.3%) Novel LN Metastasis 6 (0.5%) Salvage therapy is very effective Oda et al, Thyroid 2016; 26(1): Ito et al. World J Surg. 2010;34(1): Sugitani et al. World J Surg. 2010;34(6): Ito et al. Thyroid
4 Active Surveillance of Low Risk Papillary Thyroid Cancer 291 MSKCC patients < 1.5 cm PTC/Suspicious PTC Median 2 yr follow up, Median age 51 yrs (20-86) Diameter increase of 3mm Volume increase of 50% Cumulative incidence 2.5% Cumulative incidence 12.1% 11.5% 24.8% Time (months) Time (months) Time n Time n Tuttle et al, JAMA Otolaryngology Head & Neck Surgery, 2017
5 192 PMC Patients Followed for 1 year (Median 2.5 yrs) Decrease volume Stable Volume Increase 3mm & Increase volume Increase volume without 3 mm increase Novel LN metastasis (33/192) (132/192) (4/192) (27/192) (1/192) 17% 69% 2% 14% 0.5% Asan Medical Center, Seoul, Korea JCEM June 2017
6 Active Surveillance of Low Risk PTC Outcomes are similar Japan, USA and Korea 10-15% increase volume over several years Young patients more likely to increase volume 1-2% have LN mets identified Salvage therapy very effective
7 Implementing Active Surveillance in the US Requires concurrent evaluation of three inter-related domains Tumor/US Inappropriate Ideal Medical Team Patient Appropriate A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. JP Brito, Y Ito, A Miyauchi, RM Tuttle. Thyroid 2015
8 Proper Patient Selection Tumor/US Intrathyroidal PTC Bethesda VI Bethesda V with highly suspicious US (Highly suspicious US without FNA) Cytology interpretation and US examination at MSKCC Primary tumor up to 1.5 cm Acceptable Features Background thyroid abnormalities (Hashimoto s, MNG) BRAF V600E mutation (genetic testing not required) Without Documented increase in size LN metastases Extrathyroidal extension Subcapsular location adjacent to trachea/rln JP Brito, Y Ito, A Miyauchi, RM Tuttle. Thyroid 2015
9 Relationship of Nodule to Thyroid Capsule Ideal: normal thyroid tissue surrounding the PMC
10 Relationship of Nodule to Thyroid Capsule Inappropriate 67 yr old female, right anterior superior pole, 8x7x9mm, definite anterior extrathyroidal extension, confirmed by histology (7mm TCV PTC, minor ETE)
11 Course of the Recurrent Laryngeal Nerves Relative to the Intact Thyroid Gland Surgery of the Thyroid And Parathyroid Glands, Randolph G, editor
12 Biopsy Proven PTC In Worrisome Location Posterior Right Lobe Nodule (6x8x6mm)
13 Biopsy Proven PTC In Worrisome Location Left Mid Pole Nodule (13x10x11mm) Ara Chalian, U Penn: 3-4 mm section of RLN involved
14 Implementing Active Surveillance in the US Requires concurrent evaluation of three inter-related domains Tumor/US Multidisciplinary Management Team Shared Treatment Philosophy Quality Ultrasonography Prospective Data Collection Tracking System Medical Team Patient Motivated Compliant Supportive Family/Clinicians Differences in Patient Decision Making JP Brito, Y Ito, A Miyauchi, RM Tuttle. Thyroid 2015
15 How do patients perceive initial treatment options? SURGERY ACTIVE SURVEILLANCE Slide from Elizabeth Grubbs, MD Anderson BOTH D Agostino et al. Psychooncology, 27:61-68, 2018.
16 How do patients perceive initial treatment options? SURGERY ACTIVE SURVEILLANCE Sense of urgency Perception as potentially life threatening disease Fear of disease progression & uncertainty with active surveillance Surgery as a means of control and potential cure Slide from Elizabeth Grubbs, MD Anderson BOTH D Agostino et al. Psychooncology, 27:61-68, 2018.
17 How do patients perceive initial treatment options? SURGERY ACTIVE SURVEILLANCE Sense of urgency Perception as potentially life threatening disease Fear of disease progression & uncertainty with active surveillance Surgery as a means of control and potential cure View as a common, indolent, low risk disease Concerns about adjusting to life without a thyroid/ reliance on hormone replacement Openness to reconsidering surgery over the long run Slide from Elizabeth Grubbs, MD Anderson BOTH D Agostino et al. Psychooncology, 27:61-68, 2018.
18 How do patients perceive initial treatment options? SURGERY ACTIVE SURVEILLANCE Sense of urgency Perception as potentially life threatening disease Fear of disease progression & uncertainty with active surveillance Surgery as a means of control and potential cure Deep level of trust & confidence in physician & cancer center Use of physician & internet as 1 sources treatment related info View as a common, indolent, low risk disease Concerns about adjusting to life without a thyroid/ reliance on hormone replacement Openness to reconsidering surgery over the long run Slide from Elizabeth Grubbs, MD Anderson BOTH
19 Weighing the Risks and Benefits of Treatment Medical Decision Making Maximalists or Minimalists Believers Or Doubters Technology Orientation Or Naturalistic Orientation
20 Weighing the Risks and Benefits of Treatment Medical Decision Making Maximalists Cancer Blood pressure Cholesterol Glucose BMI Availability Bias Minimalists Cancer Blood pressure Cholesterol Glucose BMI be ahead of the curve why wait more is better Believers Technology Orientation less is more unintended consequences outweigh potential benefits Doubters Naturalistic Orientation Development of the Medical Maximizer-Minimizer Scale. Scherer et al, Health Psychology, 2016
21 Implementing Active Surveillance in the US Applicable to primary tumor, LN mets, and distant metastases Tumor/US Ideal Tumor Volume Follow-up Strategy Patient Appropriate Rate of Change (Doubling Time) Intervention Indications Medical Team Inappropriate Tumor Location Proper Selection Active Surveillance Management Decisions
22 Observational Management Strategy Serial US evaluations of the thyroid and neck Q 6 months for 2 years Then less frequently TSH suppression is not recommended Goal TSH miu/l Thyroid function tests Yearly Indications for surgical intervention Increase in tumor volume (doubling time) Identification of metastatic disease Development of extrathyroidal extension Other worrisome ultrasonographic changes Patient preference JP Brito, Y Ito, A Miyauchi, RM Tuttle. Thyroid 2015
23 Selecting Patients for Lobectomy Intra-operative Findings Post-operative Path Report Tumor/US Medical Team Ideal Inappropriate Patient Appropriate R. Michael Tuttle, Ling Zhang and Ashok Shaha, Expert Review of Endo & Metab, 2018.
24 Selecting Patients for Lobectomy Intra-operative Findings Post-operative Path Report Tumor/US Medical Team Immediate Completion 6-20% Delayed Completion 5-10% Ideal Inappropriate Patient Effective Salvage Therapy Appropriate Nixon Surgery 2012, Vaisman Clinical Endo (Oxf) 2011, Vaisman J Thyroid Res 2013, Kluijfhout Surgery 2017, Calcatera Endo Practice 2017
25 A Clinical Framework for Decision Making with Regard to Extent of Initial Surgery Pre-operative/Intra-operative Decision Making Tumor/Imaging characteristics Ideal Solitary nodule Intrathyroidal 1 cm Clinical N0 neck Patient characteristics Minimalist mentality Motivated patient Willingness to accept possibility of small volume disease in contralateral lobe Desire to preserve thyroid function Desire to minimize surgical complications Open to intra-operative decision making Medical Team Experienced MDT Experienced US Shared treatment philosophy Uses RAI very selectively for ablation/adjuvant therapy and follow up Frozen section available R. Michael Tuttle, Ling Zhang and Ashok Shaha, Expert Review of Endo & Metab, 2018.
26 A Clinical Framework for Decision Making with Regard to Extent of Initial Surgery Pre-operative/Intra-operative Decision Making Tumor/Imaging characteristics Appropriate 1-4 cm Benign appearing changes on US (Hashimoto s, benign nodules) Benign appearing LN s Clinical N0 Patient characteristics Minimalist/Maximalist Desire to keep normal thyroid (or avoidance of surgical complications) outweighs concern for disease in the contralateral lobe or the desire for RAI Medical Team Surgeon and endocrinologist agree on post-op management plan Unlikely to include need for RAI Comfortable that follow-up US is adequate for low risk patient R. Michael Tuttle, Ling Zhang and Ashok Shaha, Expert Review of Endo & Metab, 2018.
27 A Clinical Framework for Decision Making with Regard to Extent of Initial Surgery Pre-operative/Intra-operative Decision Making Tumor/Imaging characteristics Inappropriate >4 cm Extrathyroidal extension Metastatic cervical LN s Distant metastases Multifocal, macroscopic PTC High risk molecular profile Patient characteristics Maximalist mentality Patient desires total thyroidectomy and/or RAI Indications for RAI ablation/adjuvant therapy/staging Medical Team Treatment team desires RAI for scanning/therapy or optimized serum Tg for staging and follow-up R. Michael Tuttle, Ling Zhang and Ashok Shaha, Expert Review of Endo & Metab, 2018.
28 Post-operative Decision Making Features Ideal Intrathyroidal classical PTC FV-PTC without vascular invasion NIFT-P Minimally invasive FTC (capsular invasion only) Pathology N0/Nx Non-stimulated Tg < 5 ng/ml Appropriate Minor extrathyroidal extension Clinical N0 but pn1 LN mets Multifocality Lymphovascular invasion Minor vascular invasion 1-2 cm potentially aggressive tumors (tall cell, hobnail, columnar cell) Non-stimulated Tg 5-30 ng/ml Inappropriate Extensive vascular invasion (FTC or HCC) Gross extrathyroidal extension Clinical N1 histologically confirmed LN mets Non-stimulated Tg > 30 ng/ml R. Michael Tuttle, Ling Zhang and Ashok Shaha, Expert Review of Endo & Metab, 2018.
29 Proper Patient Selection for Lobectomy Ongoing dynamic risk stratification Tumor/US Patient Ideal Appropriate Intra-Op Findings Ideal Appropriate Medical Team Inappropriate Post-Op Findings Inappropriate Pre-Op Evaluation Pre-Op Classification Additional Information Post-Op Classification R. Michael Tuttle, Ling Zhang and Ashok Shaha, Expert Review of Endo & Metab, 2018.
30 A Practical Approach to Follow-up After Lobectomy Excellent disease specific survival Highly sensitive disease detection techniques are not necessary Tumor/Imaging characteristics TSH goal miu/ml With or without levothyroxine Clinic visits Post-op (to review path, check TSH, Tg) Then 6-12 month follow-up Yearly for 2-3 years with exam TSH, Free T4, Tg, TgAb with each clinic visit Imaging Neck US 6-12 months, 3 yrs, and 5 yrs Then very rarely Late completion thyroidectomy Physical exam findings Neck US findings Need for RAI Sustained, serial rise in Tg over time
31 Minimalistic Treatment Options Active Surveillance (0bservation) Thyroid Lobectomy Not for every low risk thyroid cancer Not for every patient Not for every clinician
Dynamic Risk Stratification:
Dynamic Risk Stratification: Using Risk Estimates to Guide Initial Management R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine
More informationRisk Adapted Follow-Up
Risk Adapted Follow-Up Individualizing Follow- Up Strategies R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine Weill Medical College
More informationThyroid Cancer: When to Treat? MEGAN R. HAYMART, MD
Thyroid Cancer: When to Treat? MEGAN R. HAYMART, MD ASSOCIATE PROFESSOR OF MEDICINE UNIVERSITY OF MICHIGAN MICHIGAN AACE 2018 ANNUAL MEETING Thyroid Cancer: When Not to Treat? FOCUS WILL BE ON LOW-RISK
More informationWTC 2013 Panel Discussion: Minimal disease
WTC 2013 Panel Discussion: Minimal disease Susan J. Mandel MD MPH Panelists Ken Ain Yasuhiro Ito Stephanie Lee Erich Sturgis Mark Urken Faculty/Presenter Disclosure Relationships with commercial interests
More informationGerard M. Doherty, MD
Surgical Management of Differentiated Thyroid Cancer: Update on 2015 ATA Guidelines Gerard M. Doherty, MD Chair of Surgery Utley Professor of Surgery and Medicine Boston University Surgeon-in-Chief Boston
More informationUltrasound for Pre-operative Evaluation of Well Differentiated Thyroid Cancer
Ultrasound for Pre-operative Evaluation of Well Differentiated Thyroid Cancer Its Not Just About the Nodes AACE Advances in Medical and Surgical Management of Thyroid Cancer - 2017 Robert A. Levine, MD,
More information2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines
2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines Angela M. Leung, MD, MSc, ECNU November 5, 2016 Outline Workup of nontoxic thyroid nodule(s) Ultrasound FNAB Management of FNAB results
More informationHow Will (Should) the Latest Guidelines Affect the Endocrinologist s Management of Thyroid Cancer? AACE 2017
How Will (Should) the Latest Guidelines Affect the Endocrinologist s Management of Thyroid Cancer? AACE 2017 Bryan R. Haugen, MD University of Colorado, School of Medicine Outline Some statistics New guidelines
More informationPre-operative Ultrasound of Lymph Nodes in Thyroid Cancer
Pre-operative Ultrasound of Lymph Nodes in Thyroid Cancer AACE - Advances in Medical and Surgical Management of Thyroid Cancer - 2018 Robert A. Levine, MD, FACE, ECNU Thyroid Center of New Hampshire Geisel
More informationNew York, the nation s thyroid gland. Christopher Morley ( ), "Shore Leave"
New York, the nation s thyroid gland Christopher Morley (1890-1957), "Shore Leave" Thyroid Literature Medline Thyroid disease 136,053 Thyroid tumors 33,554 New Paper on Thyroid Disease Every 3 Hours New
More informationDilemmas in Cytopathology and Histopathology
Dilemmas in Cytopathology and Histopathology Yuri E. Nikiforov, MD, PhD Division of Molecular & Genomic Pathology University of Pittsburgh Medical Center, USA Objectives Discuss new WHO classification
More informationThyroid Surgery: Lobectomy, total thyroidectomy, LN biopsies or only watchful waiting?
Thyroid Surgery: Lobectomy, total thyroidectomy, LN biopsies or only watchful waiting? Jacob Moalem, MD, FACS Associate Professor Endocrine Surgery and Endocrinology URMC Agenda 1. When is lobectomy alone
More informationManagement of Recurrent Thyroid Cancer
Management of Recurrent Thyroid Cancer Eric Genden, MD, MHA Isidore Professor and Chairman Department of Otolaryngology- Head and Neck Surgery Senior Associate Dean for Clinical Affairs The Icahn School
More informationPersistent & Recurrent Differentiated Thyroid Cancer
Persistent & Recurrent Differentiated Thyroid Cancer Electron Kebebew University of California, San Francisco Department of Surgery Objectives Risk factors for persistent & recurrent disease Causes of
More informationStrategies for detection of recurrent disease in longterm follow-up of differentiated thyroid cancer
Strategies for detection of recurrent disease in longterm follow-up of differentiated thyroid cancer A rational approach to longterm follow-up based on dynamic risk assessment. World Congress on Thyroid
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationHow good are we at finding nodules? Thyroid Nodules Thyroid Cancer Epidemiology Initial management Long-term follow up Disease-free status
New Perspectives in Thyroid Cancer Jennifer Sipos, MD Assistant Professor of Medicine Division of Endocrinology The Ohio State University Outline Thyroid Nodules Thyroid Cancer Epidemiology Initial management
More informationDifferentiated Thyroid Carcinoma
Differentiated Thyroid Carcinoma The GOOD cancer? Jennifer Sipos, MD Associate Professor of Medicine Director, Benign Thyroid Program Division of Endocrinology, Diabetes and Metabolism The Ohio State University
More informationAACE Thyroid Cancer Tumor board 25 years of the Endocrine and Surgery collaboration
AACE Thyroid Cancer Tumor board 25 years of the Endocrine and Surgery collaboration Dr. Peter Singer, Endocrinology Dr. Peter Sadow, Pathology Moderator Dr. Greg Randolph, Otolaryngology Relevant Financial
More information(Not so) New Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer Minnesota/Midwest Chapter of AACE
(Not so) New Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer Minnesota/Midwest Chapter of AACE Bryan R. Haugen, MD University of Colorado, School of Medicine Outline Some
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationCurrent Issues in Thyroid Cancer Surgery in 2017
Current Issues in Thyroid Cancer Surgery in 2017 Dr. David Goldstein MD Msc FRCSC FACS Associate Professor, Department Otolaryngology Head & Neck Surgery, U of T Department of Surgical Oncology, Princess
More informationKey Topics in Thyroid Cancer Worldwide epidemic What Should the Endocrinologist and Surgeon do?
Key Topics in Thyroid Cancer Worldwide epidemic What Should the Endocrinologist and Surgeon do? Martin Schlumberger Gustave Presenter Roussy Name and Université Paris Saclay, Villejuif, France 1 Disclosure
More informationYCN Thyroid NSSG. *** VALID ON DATE OF PRINTING ONLY - all guidelines available at *** page 1 of 8 version number: 1.
YCN Thyroid NSSG Guidelines on Indications for Thyroid Surgery, Prophylactic Level 6 and Radioiodine plus follow-up of low risk differentiated thyroid cancer page 1 of 8 i Document Control Title Author(s)
More informationThyroid nodules. Most thyroid nodules are benign
Thyroid nodules Postgraduate Course in General Surgery Jessica E. Gosnell MD Assistant Professor March 22, 2011 Most thyroid nodules are benign thyroid nodules occur in 77% of the world s population palpable
More informationThyroid Pathology: It starts and ends with the gross. Causes of Thyrophobia. Agenda. Diagnostic ambiguity. Treatment/prognosis disconnect
Thyroid Pathology: It starts and ends with the gross Jennifer L. Hunt, MD, MEd Aubrey J. Hough Jr, MD, Endowed Professor of Pathology Chair of Pathology and Laboratory Medicine University of Arkansas for
More informationThyroid nodules - medical and surgical management. Endocrinology and Endocrine Surgery Manchester Royal Infirmary
Thyroid nodules - medical and surgical management JRE Davis NR Parrott Endocrinology and Endocrine Surgery Manchester Royal Infirmary Thyroid nodules - prevalence Thyroid nodules common, increase with
More informationNIFTP: Histopathology of a Cytological Monkey Wrench. B. Wehrli
NIFTP: Histopathology of a Cytological Monkey Wrench B. Wehrli Non-Invasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma Before 2016 Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like
More informationWhat s an NIFTP? Keeping Up To Date in Thyroid 2018
What s an NIFTP? Keeping Up To Date in Thyroid 2018 Kathleen Hands, MD, FACE, ECNU Director, Thyroid Center of South Texas Assistant Clinical Professor UTHSCSA DrHands@Thyroid-Center.com 210-844-6163 text
More informationMegan R. Haymart, MD 83 rd Annual Meeting of the ATA October 16, 2013
Megan R. Haymart, MD 83 rd Annual Meeting of the ATA October 16, 2013 Disclosure: Nothing to Disclose Learning Objectives Thyroid cancer - diagnosis - prognosis - treatment - follow-up Thyroid function
More information- RET/PTC rearrangement: 20% papillary thyroid cancer - RET: medullary thyroid cancer
Thyroid Cancer UpToDate: Introduction: Risk Factors: Biology: Symptoms: Diagnosis: 1. Lenvina is the first line therapy with powerful durable response and superior PFS in pts with RAI-refractory disease.
More informationAGGRESSIVE VARIANTS OF PAPILLARY THYROID CARCINOMA DIAGNOSIS AND PROGNOSIS
AGGRESSIVE VARIANTS OF PAPILLARY THYROID CARCINOMA DIAGNOSIS AND PROGNOSIS PAPILLARY THYROID CARCINOMA Clinical Any age Microscopic to large Female: Male= 2-4:1 Radiation history Lymph nodes Prognosis
More information40 TH EUROPEAN CONGRESS 0F CYTOLOGY LIVERPOOL, UK October 2-5, 2016
Outcomes from the diagnostic approach of thyroid lesions using US-FNA and LBC in clinical practice Emmanouel Mastorakis MD PhD Cytopathologist Director in Cytopathology Laboratory Regional General Hospital
More informationIni7al Staging of Follicular Cell-derived Thyroid Cancers: the ATA 2015 IRS and AJCC 8th Ed. Cancer Staging Systems
12/25/17 9th Annual AACE Advances in Thyroid Cancer Course Tempe, Arizona January 12-13, 2018. Ini7al Staging of Follicular Cell-derived Thyroid Cancers: the ATA 2015 IRS and AJCC 8th Ed. Cancer Staging
More informationDr Catherine Woolnough, Hospital Scientist, Chemical Pathology, Royal Prince Alfred Hospital. NSW Health Pathology University of Sydney
Dr Catherine Woolnough, Hospital Scientist, Chemical Pathology, Royal Prince Alfred Hospital NSW Health Pathology University of Sydney Thyroid Cancer TC incidence rates in NSW Several subtypes - Papillary
More informationThyroid nodules 3/22/2011. Most thyroid nodules are benign. Thyroid nodules: differential diagnosis
Most thyroid nodules are benign Thyroid nodules Postgraduate Course in General Surgery thyroid nodules occur in 77% of the world s population palpable thyroid nodules occur in about 5% of women and 1%
More information4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey.
Management of Differentiated Thyroid Cancer: Head Neck Surgeon Perspective Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey Thyroid gland Small endocrine gland:
More information5/18/2013. Most thyroid nodules are benign. Thyroid nodules: new techniques in evaluation
Most thyroid nodules are benign Thyroid nodules: new techniques in evaluation Incidence Etiology Risk factors Diagnosis Gene classification system Treatment Postgraduate Course in General Surgery Jessica
More informationDisclosures Nodal Management in Differentiated Thyroid Carcinoma
Disclosures Nodal Management in Differentiated Thyroid Carcinoma Nothing to disclose Jonathan George, MD, MPH Assistant Professor UCSF Head and Neck Oncologic & Endocrine Surgery Objectives Overview Describe
More informationAn Alphabet Soup of Thyroid Neoplasms
Overall Objectives An Alphabet Soup of Thyroid Neoplasms Lester D. R. Thompson www.lester-thompson.com What is the current management of papillary carcinoma? What are the trends and what can we do differently?
More informationInitial surgery for differentiated thyroid cancer: What is the appropriate extent and attendant risks and benefits?
Initial surgery for differentiated thyroid cancer: What is the appropriate extent and attendant risks and benefits? Julie Ann Sosa, MD MA FACS Professor of Surgery and Medicine Chief, Section of Endocrine
More informationManaging Thyroid Microcarcinomas
Review Article http://dx.doi.org/10.3349/ymj.2012.53.1.1 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 53(1):1-14, 2012 Managing Thyroid Microcarcinomas Ernest L. Mazzaferri Division of Endocrinology,
More informationPEDIATRIC Ariel Katz MD
PEDIATRIC Ariel Katz MD Dept. Otolaryngology Head &Neck Surgery Wolfson Medical Center Holon, Israel OBJECTIVES Overview/Background Epidemiology/Etiology Intro to Guidelines Workup Treatment Follow-Up
More informationManagement of Thyroid Nodules
Management of Thyroid Nodules 38 y/o female with solid 1.5 cm right Thyroid nodule. TSH=0.68 Vincent J. Reid, MD., FACS Thyroid Cancer Incidence & Mortality 1974 to 2004 Overall Women Men Mortality 1 Cancer
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationClinical and Molecular Approach to Using Thyroid Needle Biopsy for Nodular Disease
Clinical and Molecular Approach to Using Thyroid Needle Biopsy for Nodular Disease Robert L. Ferris, MD, PhD Department of Otolaryngology/Head and Neck Surgery and Yuri E. Nikiforov, MD, PhD Division of
More informationPreoperative Evaluation
Preoperative Evaluation Lateral compartment lymph nodes are easier to detect and are amenable to FNA Central compartment lymph nodes are much more difficult to detect and FNA (Tg washout testing is compromised)
More informationSurgical Treatment for Papillary Thyroid Carcinoma in Japan: Differences from Other Countries
REVIEW ARTICLE J Korean Thyroid Assoc Vol. 4, No. 2, November 2011 Surgical Treatment for Papillary Thyroid Carcinoma in Japan: Differences from Other Countries Yasuhiro Ito, MD and Akira Miyauchi, MD
More informationDifferentiated Thyroid Cancer: Initial Management
Page 1 ATA HOME GIVE ONLINE ABOUT THE ATA JOIN THE ATA MEMBER SIGN-IN INFORMATION FOR PATIENTS FIND A THYROID SPECIALIST Home Management Guidelines for Patients with Thyroid Nodules and Differentiated
More informationPathology of the Thyroid
Pathology of the Thyroid Thyroid Carcinoma Arising from Follicular Cells 2015-01-19 Prof. Dr. med. Katharina Glatz Pathologie Carcinomas Arising from Follicular Cells Differentiated Carcinoma Papillary
More informationI-131 ABLATION AND ADJUVANT THERAPY OF THYROID CANCER
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS Advances in Medical and Surgical Management of Thyroid Cancer January 23-24, 2015 I-131 ABLATION AND ADJUVANT THERAPY OF THYROID CANCER 2015 Leonard Wartofsky,
More informationCAP Cancer Protocol and ecc Summary of Changes for August 2014 Thyroid Agile Release
CAP Cancer Protocol and ecc Summary of Changes for August 2014 Thyroid Agile Release 2 REVISION HISTORY Date Author / Editor Comments 5/19/2014 Jaleh Mirza Created the document 8/12/2014 Samantha Spencer/Jaleh
More informationThyroid Gland. Protocol applies to all malignant tumors of the thyroid gland, except lymphomas.
Thyroid Gland Protocol applies to all malignant tumors of the thyroid gland, except lymphomas. Procedures Cytology (No Accompanying Checklist) Partial Thyroidectomy Total Thyroidectomy With/Without Lymph
More information2015 ATA Thyroid Nodule and DTC Guidelines: Perspectives from the Chair What were you thinking????
2015 ATA Thyroid Nodule and DTC Guidelines: Perspectives from the Chair What were you thinking???? Bryan R. Haugen, MD University of Colorado, School of Medicine Outline Some statistics New guidelines
More informationThyroid Nodule. Disclosure. Learning Objectives P A P A P A 3/18/2014. Nothing to disclose.
Thyroid Nodule Evaluating the patient with a thyroid nodule and some management options. Miguel V. Valdez PA C Disclosure Nothing to disclose. Learning Objectives Examination of thyroid gland Options for
More information3/29/2012. Thyroid cancer- what s new. Thyroid Cancer. Thyroid cancer is now the most rapidly increasing cancer in women
Thyroid cancer- what s new Thyroid Cancer Changing epidemiology Molecular markers Lymph node dissection Technical advances rhtsh Genetic testing and prophylactic surgery Vandetanib What s new? Jessica
More informationTHYROID CANCER IN CHILDREN. Humberto Lugo-Vicente MD FACS FAAP Professor Pediatric Surgery UPR School of Medicine
THYROID CANCER IN CHILDREN Humberto Lugo-Vicente MD FACS FAAP Professor Pediatric Surgery UPR School of Medicine Thyroid nodules Rare Female predominance 4-fold as likely to be malignant Hx Radiation exposure?
More informationProphylactic Central Compartment Neck Dissection(CCND) for Papillary Thyroid Cancer: Con
Prophylactic Central Compartment Neck Dissection(CCND) for Papillary Thyroid Cancer: Con Christopher R. McHenry, M.D. Vice Chairman Department of Surgery MetroHealth Medical Center Professor of Surgery
More informationELIZABETH CEDARS DR. KOREY HOOD Available September 29
ELIZABETH CEDARS DR. KOREY HOOD Available September 29 Title and Investigators Optimizing Surgical Management of Thyroid Cancer: Using Surgeon-performed Ultrasound to Predict Extrathyroidal Extension of
More informationFACULTY OF MEDICINE Active surveillance as the initial treatment of papillary thyroid microcarcinoma: a 10-years multicentric prospective study
FACULTY OF MEDICINE Active surveillance as the initial treatment of papillary thyroid microcarcinoma: a 10-years multicentric prospective study FINAL DEGREE PROJECT Author: Tutor: Josefina Biarnés Costa
More informationA variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study
ORIGINAL ARTICLE A variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study Joon-Hyop Lee, MD, Yoo Seung Chung, MD, PhD,* Young Don Lee, MD, PhD
More informationPapillary Thyroid Microcarcinoma Presenting as Horner s Syndrome: A Novel Clinical Presentation
Case Report American Journal of Cancer Case Reports http://ivyunion.org/index.php/ajccr/ Page 1 of 6 Papillary Thyroid Microcarcinoma Presenting as Horner s Syndrome: A Novel Clinical Presentation Ammara
More informationReview Article Management of thyroid carcinoma Alauddin M, Joarder AH
Management of thyroid carcinoma Alauddin M, Joarder AH The ORION Medical Journal 2004 May;18:163-166 Overview The two most common forms of thyroid cancer, papillaryand follicular thyroid cancer, together
More informationClinical outcomes after delayed thyroid surgery in patients with. papillary thyroid microcarcinoma
Page 1 of 23 Accepted Preprint first posted on 21 April 2017 as Manuscript EJE-17-0160 Clinical outcomes after delayed thyroid surgery in patients with papillary thyroid microcarcinoma Min Ji Jeon 1, Won
More informationPediatric Thyroid Cancer Lung Metastases. Liora Lazar MD
Pediatric Thyroid Cancer Lung Metastases Liora Lazar MD Differentiated thyroid cancer (DTC) The 3rd most common solid tumor in childhood and adolescence Accounting for 1.5%-3% of all childhood cancers
More informationPOORLY DIFFERENTIATED, HIGH GRADE AND ANAPLASTIC CARCINOMAS: WHAT IS EVERYONE TALKING ABOUT?
POORLY DIFFERENTIATED, HIGH GRADE AND ANAPLASTIC CARCINOMAS: WHAT IS EVERYONE TALKING ABOUT? AGGRESSIVE THYROID CANCERS PAPILLARY CARCINOMA CERTAIN SUBTYPES POORLY DIFFERENTIATED CARCINOMA HIGH GRADE DIFFERENTIATED
More informationShifting Paradigms and Debates in the Management of Well-differentiated Thyroid Cancer
DEBATE WJOES Shifting Paradigms and Debates in the Management of Well-differentiated Thyroid Cancer Shifting Paradigms and Debates in the Management of Well-differentiated Thyroid Cancer Ashok R Shaha
More informationThyroid INTRODUCTION ANATOMY SUMMARY OF CHANGES
AJC 7/14/06 1:19 PM Page 67 Thyroid C73.9 Thyroid gland SUMMARY OF CHANGES Tumor staging (T) has been revised and the categories redefined. T4 is now divided into T4a and T4b. Nodal staging (N) has been
More informationThe Frozen Section: Diagnostic Challenges and Pitfalls
The Frozen Section: Diagnostic Challenges and Pitfalls William C. Faquin, M.D., Ph.D. Director, Head and Neck Pathology Massachusetts General Hospital & Massachusetts Eye and Ear Infirmary Harvard Medical
More informationIntroduction. Materials and methods Y-N XU 1,2, J-D WANG 1,2
1 di 5 11/04/2016 17:54 G Chir Vol. 31 - n. 5 - pp. 205-209 Maggio 2010 Y-N XU 1,2, J-D WANG 1,2 Introduction The World Health Organization (WHO) defined papillary thyroid microcarcinomas (PTMC) as tumors
More informationWell Differen*ated Thyroid Microcarcinoma. Robert A. Levine, MD, FACE, ECNU Thyroid Center of New Hampshire Geisel School of Medicine at Dartmouth
Well Differen*ated Thyroid Microcarcinoma Robert A. Levine, MD, FACE, ECNU Thyroid Center of New Hampshire Geisel School of Medicine at Dartmouth Objec*ves (1) Review epidemiology of thyroid microcarcinoma.
More informationCarcinoma tiroideo differenziato: gestione della persistenza biochimica di malattia
Carcinoma tiroideo differenziato: gestione della persistenza biochimica di malattia Massimo Torlontano U.O. Endocrinologia IRCCS Casa Sollievo della Sofferenza Thyroid cancer Incidence 1975-2009 (USA)
More informationOncological outcomes for patients with well differentiated thyroid cancer Nixon, I.J.
UvA-DARE (Digital Academic Repository) Oncological outcomes for patients with well differentiated thyroid cancer Nixon, I.J. Link to publication Citation for published version (APA): Nixon, I. J. (2013).
More information1. Protocol Summary Summary of Trial Design. IoN
1. Protocol Summary 1.1. Summary of Trial Design Title: Short Title/acronym: IoN Is ablative radioiodine Necessary for low risk differentiated thyroid cancer patients IoN EUDRACT no: 2011-000144-21 Sponsor
More information10/24/2008. Surgery for Well-differentiated Thyroid Carcinoma- The Primary
Surgery for Well-differentiated Thyroid Carcinoma- The Primary Head and Neck Endocrine Surgery Department of Otolaryngology-Head and Neck Surgery, UCSF October 24-25, 2008 Robert A. Sofferman, MD Professor
More informationChanging trends in the management of well-differentiated thyroid carcinoma in Korea
2016, 63 (6), 515-521 Original Changing trends in the management of well-differentiated thyroid carcinoma in Korea Yong Sang Lee, Hang-Seok Chang and Cheong Soo Park Thyroid Cancer Center, Department of
More informationTHE FOLLICULAR VARIANT OF PAPILLARY THYROID CARCINOMA AND NIFTP
THE FOLLICULAR VARIANT OF PAPILLARY THYROID CARCINOMA AND NIFTP FOLLICULAR VARIANT OF PAPILLARY CARCINOMA HISTORICAL PERSPECTIVE FOLLICULAR VARIANT OF PAPILLARY CARCINOMA 1960 described by Dr. Stuart Lindsay
More informationManagement of Thyroid Nodules. February 2 nd, 2018 Sarah Hopkins
Management of Thyroid Nodules February 2 nd, 2018 Sarah Hopkins No disclosures Goals: Review Initial Evaluation of Thyroid Nodules Review Indications for Biopsy Approach to Multinodular Goiter Review Management
More informationTowards a selective use of postoperative radioiodine in thyroid cancer patients
Towards a selective use of postoperative radioiodine in thyroid cancer patients Martin Schlumberger Gustave Presenter Roussy Name and Université Paris Saclay, Villejuif, France 1 Disclosure Relevant financial
More informationMarkers in Thyroid Nodule Evaluation. Yuri E. Nikiforov, MD, PhD Division of Molecular & Genomic Pathology University of Pittsburgh Medical Center
Markers in Thyroid Nodule Evaluation Yuri E. Nikiforov, MD, PhD Division of Molecular & Genomic Pathology University of Pittsburgh Medical Center Disclosures Quest Diagnostics (consultant) UPMC/CBLPath
More informationPRACTICE GUIDELINES: Thyroid Nodules and Cancer 2017 ESEO Alexandria
PRACTICE GUIDELINES: Thyroid Nodules and Cancer 2017 ESEO Alexandria James V. Hennessey MD Associate Professor of Medicine Harvard Medical School Case 1 28 year old woman sees OB for routine visit ROS:
More informationThe use of Radioactive Iodine (RAI) for Differentiated Thyroid Cancer
The use of Radioactive Iodine (RAI) for Differentiated Thyroid Cancer Wendy Sacks, M.D. Cedars Sinai Medical Center California Chapter Annual Meeting, AACE Nov 5, 2016 Increasing Incidence of Thyroid Cancer
More informationLong-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules
Long-term Follow-up for Patients with Papillary Thyroid Carcinoma Treated as Benign Nodules YASUHIRO ITO, TAKUYA HIGASHIYAMA, YUUKI TAKAMURA, AKIHIRO MIYA, KAORU KOBAYASHI, FUMIO MATSUZUKA, KANJI KUMA
More informationSurgical Management of Thyroid Disease. Tom Shi Connally, MD, FACS
Surgical Management of Thyroid Disease Tom Shi Connally, MD, FACS Disclosures Speaker Bureau: Veracyte Castle Diagnostics Objectives Understand the role of ultrasound and FNA in managing thyroid cancer
More informationReview Article Thyroidectomy and Lymph Node Dissection in Papillary Thyroid Carcinoma
SAGE-Hindawi Access to Research Thyroid Research Volume 2011, Article ID 634170, 6 pages doi:10.4061/2011/634170 Review Article Thyroidectomy and Lymph Node Dissection in Papillary Thyroid Carcinoma Yasuhiro
More informationEndocrine Surgery When to Refer and What We Do
Endocrine Surgery When to Refer and What We Do None Disclosures W. Heath Giles, M.D., F.A.C.S. Surgery Residency Program Director Assistant Professor of Surgery What is Endocrine Surgery? Who performs
More informationFollicular Derived Thyroid Tumors
Follicular Derived Thyroid Tumors Jennifer L. Hunt, MD, MEd Aubrey J. Hough Jr, MD, Endowed Professor of Pathology Chair of Pathology and Laboratory Medicine University of Arkansas for Medical Sciences
More informationThyroid Ultrasound for the Endocrine Surgeon: A Valuable Clinical Tool that Enhances Diagnostic and Therapeutic Outcomes
Thyroid Ultrasound for the Endocrine Surgeon: A Valuable Clinical Tool that Enhances Diagnostic and Therapeutic Outcomes Allan Siperstein MD The Cleveland Clinic Audience Quiz Taken ultrasound course Perform
More informationThyroid US. Background: Thyroid/Neck US. Use of Office Ultrasound in the Thyroid Surgery Practice
2010 UCSF Head and Neck Endocrine Surgery Course Use of Office Ultrasound in the Thyroid Surgery Practice Lisa A. Orloff, MD FACS Dept of Otolaryngology-Head and Neck Surgery University of California,
More informationDifferentiated Thyroid Cancer: Reclassification of the Risk of Recurrence Based on the Response to Initial Treatment
ORIGINAL ARTICLE Differentiated Thyroid Cancer: Reclassification of the Risk of Recurrence Based on the Response to Initial Treatment Martínez MP, Lozano Bullrich MP, Rey M, Ridruejo MC, Bomarito MJ, Claus
More informationLong Term Follow-Up for Differentiated Thyroid Cancer: The Mayo Experience
Long Term Follow-Up for Differentiated Thyroid Cancer: The Mayo Experience Geoffrey B. Thompson, MD Professor of Surgery College of Medicine, Mayo Clinic Differentiated Thyroid Cancer Objectives Overview
More informationOh, I get it, the TSH goes up and down
Evaluation and Management of the Thyroid Nodule Oh, I get it, the TSH goes up and down UCSF Head and Neck Conference October 24, 2008 Peter A. Singer, M.D. Professor and Chief Clinical Endocrinology University
More information04/09/2018. Follicular Thyroid Tumors Updates in Classification & Practical Tips. Dissecting Indeterminants. In pursuit of the low grade malignancy
Follicular Thyroid Tumors Updates in Classification & Practical Tips Jennifer L. Hunt, MD, MEd Aubrey J. Hough Jr, MD, Endowed Professor of Pathology Chair of Pathology and Laboratory Medicine University
More informationVolume 2 Issue ISSN
Volume 2 Issue 3 2012 ISSN 2250-0359 Correlation of fine needle aspiration and final histopathology in thyroid disease: a series of 702 patients managed in an endocrine surgical unit *Chandrasekaran Maharajan
More informationClinical Trials of Active Surveillance of Papillary Microcarcinoma of the Thyroid
World J Surg (2016) 40:516 522 DOI 10.1007/s00268-015-3392-y ORIGINAL SCIENTIFIC REPORT Clinical Trials of Active Surveillance of Papillary Microcarcinoma of the Thyroid Akira Miyauchi 1,2 Published online:
More informationFuqiang Li, Yijun Wu, Liang Chen, Liang Hu, Xiaosun Liu. Original Article
Original Article Page 1 of 11 Evaluation of clinical risk factors for predicting insidious right central and posterior right recurrent laryngeal nerve lymph node metastasis in papillary thyroid microcarcinoma
More informationEvaluation and Management of Thyroid Nodules. Overview of Thyroid Nodules and Their Management. Thyroid Nodule detection: U/S versus Exam
Overview of Thyroid Nodules and Their Management Matthew D. Ringel, M.D. Professor of Medicine Divisions of Endocrinology and Oncology, The Ohio State University Co-Director, Thyroid Cancer Unit Arthur
More informationMandana Moosavi 1 and Stuart Kreisman Background
Case Reports in Endocrinology Volume 2016, Article ID 6471081, 4 pages http://dx.doi.org/10.1155/2016/6471081 Case Report A Case Report of Dramatically Increased Thyroglobulin after Lymph Node Biopsy in
More informationEvaluation of thyroid isthmusectomy as a potential treatment for papillary thyroid carcinoma limited to the isthmus: A clinical study of 73 patients
ORIGINAL ARTICLE Evaluation of thyroid isthmusectomy as a potential treatment for papillary thyroid carcinoma limited to the isthmus: A clinical study of 73 patients Jianbiao Wang, MM, 1 Haili Sun, BM,
More informationManagement guideline for patients with differentiated thyroid cancer. Teeraporn Ratanaanekchai ENT, KKU 17 October 2007
Management guideline for patients with differentiated thyroid Teeraporn Ratanaanekchai ENT, KKU 17 October 2007 Incidence (Srinagarind Hospital, 2005, both sex) Site (all) cases % 1. Liver 1178 27 2. Lung
More information