Abstract
Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.
Highlights
Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients with complex scenarios [1]
In this group of patients, we investigated if completion thyroidectomy was or was not recommended by the MDT
papillary thyroid carcinoma (PTC) between 2 and 4 cm in diameter without macroscopic extrathyroidal extension initially treated with hemithyroidectomy. In this group of patients, we investigated if completion thyroidectomy was or was not recommended by the MDT (ATA Recommendation 35.C)
Summary
Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients with complex scenarios [1]. MDTs are of paramount importance in the management of cancer patients. It has been well-documented that MDTs improve the outcomes for such patients [2], likely due to engagement of different specialties in a consensus and evidence-based exercise. Meeting Observational Tool (MOT) [3,4], which score the MDT based on involvement of clinicians and availability of information, but not the successfulness of the clinical decision. Whilst the application of these tools has been shown to improve performance within MDTs [4,5], it does not assess the adherence to current best-practice guidelines, nor consistency and reproducibility of MDT outcomes
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