Abstract
PurposeThe interdisciplinary “Martinique-Principles” of four international professional societies concerned with the patient management of differentiated thyroid cancer (DTC) patients were agreed upon. Differences in perioperative diagnostics can lead to differences in clinical decision founding regarding the treatment of thyroid carcinoma. Our aim was to analyze the perioperative diagnostics of patients referred for postoperative I-131 therapy of DTC.MethodsWe retrospectively examined the data of 142 patients who were referred to our center for the first course of postsurgical I-131 therapy. We extracted data on perioperative diagnostics.ResultsFine-needle biopsy (FNB) was performed in 27/142 patients. In 17 patients, FNB yielded findings suspicious of malignancy, in 3 patients a follicular lesion was reported. An intraoperative frozen section analysis was performed in 79/142 patients. 5/63 patients showed already a cytologically proven malignancy. In 10/79 patients, the frozen section had a nonmalignant result, although DTC was found on final assessment. In 2/79 patients, frozen section analysis was indecisive, although the final report confirmed DTC. In the remaining 67 patients, frozen section yielded DTC.ConclusionsThere is room for improvement in perioperative diagnostics surrounding thyroid surgery, currently many procedures are performed without adequate information on potential presence of thyroid cancer. More frequent use of FNB might be able to decrease the number of unnecessary thyroid surgeries, increased use of frozen section might decrease the number of second operations and might contribute to less discordance between experts in the field of DTC treatment.
Highlights
The recommended diagnostic cascade resulting in a diagnosis of differentiated thyroid cancer (DTC) involves neck ultrasound and fine-needle biopsy of any suspicious nodule
In a first attempt to answer this complex question, the aim of the present study was to analyze the perioperative diagnostics of patients referred for postoperative I-131 therapy of DTC in a tertiary referral center in a iodine-deficient country
We retrospectively examined the data of all 146 patients who were referred to our tertiary referral center for the first course of postsurgical I-131 therapy of DTC between July 1, 2017 and June 30, 2019
Summary
The recommended diagnostic cascade resulting in a diagnosis of differentiated thyroid cancer (DTC) involves neck ultrasound and fine-needle biopsy of any suspicious nodule. This is, depending on the results, followed by Department of Nuclear Medicine, University Hospital Marburg, 35043 Marburg, Germany. If thyroid cancer is known prior to surgery, the surgical approach will be oriented more strongly toward expandation total thyroidectomy versus lobectomy, extent of lymph node dissection, and possibly even increasing the likelihood that frozen section may be used intraoperatively, whereas the prevention of complications will be of paramount importance for surgery of supposedly benign disease. In a majority of patients referred for thyroid surgery no fine-needle biopsy, Endocrine (2021) 72:721–726 even of sonographically or scintigraphically suspicious nodules, is performed [2, 3]
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