scholarly journals Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

2017 ◽  
Vol 24 (11) ◽  
pp. R387-R402 ◽  
Author(s):  
Jolanta Krajewska ◽  
Ewa Chmielik ◽  
Barbara Jarząb
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Risk Stratification ◽  
Prospective Studies ◽  
Response To Treatment ◽  
Dynamic Risk ◽  
Primary Surgery ◽  
Risk Patients ◽  
Near Future

The adequate risk stratification in thyroid carcinoma is crucial to avoid on one hand the overtreatment of low-risk and on the other hand the undertreatment of high-risk patients. The question how to properly assess the risk of relapse has been discussed during recent years and resulted in a substantial change in our approach to risk stratification in differentiated thyroid cancer, proposed by the newest ATA guidelines. First initial risk stratification, based on histopathological data is carried out just after primary surgery. It should be emphasized, that a high quality of histopathological report is crucial for proper risk stratification. Next, during the follow-up, patients are restratified considering their response to treatment applied and classified to one of the following categories: excellent response, biochemical incomplete response, structural incomplete or indeterminate response. This new approach is called dynamic risk stratification as, in contrary to the previous rigid evaluation performed at diagnosis, reflects a real-time prognosis and thereby substantially influences and personalizes disease management. In this review, we raise some unresolved questions, among them the lack of prospective studies, fulfilling evidence-based criteria, necessary to validate this model of risk stratification. We also provided some data concerning the use of dynamic risk stratification in medullary thyroid cancer, not yet reflected in ATA guidelines. In conclusion, dynamic risk stratification allows for better prediction of the risk of recurrence in thyroid carcinoma, what has been demonstrated in numerous retrospective analyses. However, the validation of this approach in prospective studies seems to be our task for near future.

scholarly journals Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients

2011 ◽  
Vol 165 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Fabio Maino ◽  
Claudia Cipri ◽  
Valentina Belardini ◽  
Alexandra Theodoropoulou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Risk Category ◽  
Radioiodine Ablation ◽  
Risk Patients

IntroductionAfter initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.ObjectiveTo evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8–12 months after initial treatment).MethodsWe reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8–12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.ResultsUsing DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively,P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.ConclusionsDelaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.

Dynamic Risk Stratification in the Follow-Up of Children and Adolescents with Differentiated Thyroid Cancer

Thyroid ◽  
2018 ◽  
Vol 28 (10) ◽  
pp. 1285-1292 ◽  
Author(s):  
André Borsatto Zanella ◽  
Rafael Selbach Scheffel ◽  
Carla Fernanda Nava ◽  
Lenara Golbert ◽  
Erika Laurini de Souza Meyer ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Children And Adolescents ◽  
Differentiated Thyroid Cancer ◽  
Dynamic Risk

scholarly journals Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

2020 ◽  
Vol 182 (5) ◽  
pp. D1-D16 ◽  
Author(s):  
Livia Lamartina ◽  
Daria Handkiewicz-Junak
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Differentiated Thyroid Carcinoma ◽  
Low Risk ◽  
Response To Treatment ◽  
Early Discontinuation ◽  
Risk Patients ◽  
Low Prevalence ◽  
Time Point

Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

Dynamic risk stratification in the follow-up of children and adolescents with differentiated thyroid cancer

2018 ◽  
Author(s):  
Rafael Selbach Scheffel ◽  
Andre Borsatto Zanella ◽  
Carla Fernanda Nava ◽  
Lenara Golbert ◽  
Souza Meyer Erika Laurini de ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Children And Adolescents ◽  
Differentiated Thyroid Cancer ◽  
Dynamic Risk

scholarly journals Natural Course of the American Thyroid Association Response to Therapy Statuses (Dynamic Risk Stratification) in Differentiated Thyroid Cancer

2020 ◽  
pp. 1-10
Author(s):  
Noha Mukhtar ◽  
Hadeel Aljamei ◽  
Abeer Aljomaiah ◽  
Yosra Moria ◽  
Ali S. Alzahrani
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Differentiated Thyroid Cancer ◽  
Response To Therapy ◽  
Natural Course ◽  
Initial Management ◽  
Excellent Response ◽  
Dynamic Risk ◽  
The Status

The concept of response to therapy in differentiated thyroid cancer (DTC) was introduced as a dynamic risk stratification used to assess the status of the disease at the time of the evaluation during the follow-up and the risk of recurrence in the future. Our aim in this study was to evaluate the natural course over time of different response to therapy statuses. <b><i>Methods:</i></b> We studied 501 nonselected DTC patients (102 males and 399 females) with a median age of 37 years (interquartile range [IQR] 29–48). All patients underwent near-total or total thyroidectomy followed by I-131 ablation (initial management). <b><i>Results:</i></b> Of the 501 patients, 387 patients (77.2%) did not have any additional therapuetic interventions after the initial management. In this group, the response to therapy status at the time of the first evaluation after I-131 (median 17 months, IQR 14–22) was an excellent response in 258 (66.7%), an indeterminate response in 101 (26.1%), biochemically incomplete in 17 (4.4%), and structurally incomplete in 11 patients (2.8%). The status changed spontaneously without any intervention in many of them. At the last follow-up visit (median duration 101 months, IQR 71–126), 357 patients (92.2%) achieved an excellent response, 4 (1%) an indeterminate response, 8 (2.1%) a biochemically incomplete status, 16 (4.1%) a structurally incomplete status, and 2 (0.5%) died secondary to DTC with a structurally incomplete status. The response to therapy in the other 114 patients who underwent additional interventions changed from before intervention to the last evaluation as follows: excellent response, 0 to 60 patients (52.6%), indeterminate response, 20 (17.5%) to 1 patient (0.9%), biochemically incomplete 25 (21.9%) to 10 patients (9%), and structurally incomplete 69 (60.5%) to 43 patients (37.7%). Overall, at the last evaluation, 417 (83.2%) were in an excellent response, 5 (1%) in an indeterminate response, 18 (3.6%) in a biochemically incomplete status, 50 (10.2%) in a structurally incomplete status, and 11 (2.2%) died secondary to DTC with a structurally incomplete status. <b><i>Conclusions:</i></b> The response to therapy at the initial evaluation is predictive of the long-term outcome. Most patients with the indeterminate response and some in the biochemically incomplete statuses spontaneously regress to an excellent status. Mortality and progression of DTC occur mostly in the structurally incomplete status.

scholarly journals Dynamic risk assessment in patients with differentiated thyroid cancer

2019 ◽  
Vol 26 (10) ◽  
pp. R553-R566 ◽  
Author(s):  
Fabian Pitoia ◽  
Fernando Jerkovich
Keyword(s):  
Risk Assessment ◽  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Response To Treatment ◽  
Risk Of Recurrence ◽  
Dynamic Risk ◽  
Radioiodine Ablation ◽  
Starting Point ◽  
Dynamic Risk Assessment

The stratification of patients with differentiated thyroid cancer based on their initial risk of recurrence, according to specific clinical, histopathological and perioperative data, is an important starting point for tailoring the follow-up during the first 1–2 years after initial therapy (surgery with or without radioiodine ablation). However, risk of recurrence re-stratification based on new clinical data that becomes available after considering the response to treatment (dynamic risk assessment) provides a more accurate prediction of the status at final follow-up and a more individualized approach. In this review, we summarized the available data regarding dynamic risk of recurrence and the suggested management of differentiated thyroid cancer patients according to the response to treatment. The use of this strategy is crucial to avoid overtreatment and intensive follow-up of the vast majority of patients who will have a very good prognosis and, on the other hand, focus therapeutic efforts on those patients who will have a worse prognosis. In the future, molecular biology analysis of the tumors and well-designed prospective studies will probably refine the risk of recurrence prediction.

Clinical usefulness of dynamic risk stratification in medullary thyroid cancer

2016 ◽  
Author(s):  
Ji Min Han ◽  
Hyemi Kwon ◽  
Won Gu Kim ◽  
Min Ji Jeon ◽  
Tae Yong Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Medullary Thyroid Cancer ◽  
Clinical Usefulness ◽  
Medullary Thyroid ◽  
Dynamic Risk

scholarly journals Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer

2013 ◽  
Vol 5 (2) ◽  
pp. 45-49
Author(s):  
Ian C Bennett ◽  
Magdalena Biggar ◽  
Clement Wong ◽  
Michael Law
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Differentiated Thyroid Cancer ◽  
Intraoperative Ultrasound ◽  
Surgical Excision ◽  
Ultrasound Guided ◽  
Cervical Lymph Nodes ◽  
Intraoperative Localization

ABSTRACT As a result of sensitive thyroglobulin assays and widespread use of cervical ultrasound, endocrine surgeons are encountering patients with impalpable suspicious or frankly metastatic cervical lymph nodes in the follow-up phase after treatment for welldifferentiated thyroid cancer. The surgical excision of impalpable disease of recurrent or persistent thyroid cancer can represent a significant challenge which may require some means of intraoperative localization to ensure that affected nodes are removed. Surgeon-performed intraoperative ultrasound (IOUS) can be used for guiding excision of suspicious but impalpable cervical nodes. The IOUS-guided excision technique is described. The successful application of IOUS to localize and guide resection of impalpable nodal recurrences of papillary thyroid carcinoma in two patients is reported. The utilization of IOUS to guide resection of impalpable pathological nodes in the context of thyroid carcinoma is a safe and practical technique which avoids the need for additional localization procedures and unnecessary potential morbidity for the patient. How to cite this article Biggar M, Wong C, Law M, Bennett IC. Intraoperative Ultrasound-guided Excision of Cervical Lymph Nodes for Recurrent Differentiated Thyroid Cancer. World J Endoc Surg 2013;5(2):45-49.

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