Narayana Superspeciality Hospital, Howrah, Kolkata, West Bengal, India.
Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India.
Eur Arch Otorhinolaryngol. 2020 Sep;277(9):2521-2526. doi: 10.1007/s00405-020-05946-4. Epub 2020 Apr 2.
The ATA guidelines for differentiated thyroid cancer (DTC) are one of the most widely referred to. Their 2015 edition proposed a new risk stratification system and modified the indications for radioactive iodine (RAI) ablation especially for the low risk category. We attempted to analyze whether the new guidelines altered referral practices for RAI ablation at our institute.
Patients who underwent total or completion thyroidectomy for DTC during 2016-2017 were included. Relevant demographical and pathological data was tabulated. Patients were classified as per the new stratification system and referral practice for RAI ablation documented.
238 patients were included. Of these 20.6% were low risk, 44.1% were intermediate and 35.3% were high risk as per modified guidelines. All patients within the intermediate and high-risk group and 77.8% of the low risk group were referred for RAI ablation. Analysis of risk factors revealed that within the low risk group there were three patients with < 5 metastatic nodes, all within 3 cm in size-a category that the ATA failed to stratify appropriately. Among those labeled as Intermediate risk due to microscopic extra thyroidal extension (ETE), 85% had no other risk factors and were upstaged solely due to microscopic ETE, which is interestingly no longer included in the TNM staging.
Majority of low risk patients continue to receive RAI ablation due to persistent belief emanating from literature that remnant ablation improves outcomes and aids in follow up. The issue of RAI ablation for low risk group and prognostic implications of microscopic ETE and limited nodal disease need to be revisited.
ATA 关于分化型甲状腺癌（DTC）的指南是最常被引用的指南之一。其 2015 年版提出了一种新的风险分层系统，并修改了放射性碘（RAI）消融的适应证，特别是对于低危类别。我们试图分析新指南是否改变了我们研究所对 RAI 消融的转诊实践。
纳入 2016-2017 年间因 DTC 行全甲状腺或近全甲状腺切除术的患者。记录相关的人口统计学和病理学数据。根据新的分层系统对患者进行分类，并记录 RAI 消融的转诊实践。
共纳入 238 例患者。根据改良后的指南，其中 20.6%为低危，44.1%为中危，35.3%为高危。所有中高危组患者和 77.8%的低危组患者均被转诊接受 RAI 消融。风险因素分析显示，在低危组中有 3 例患者转移淋巴结<5 个，且均<3cm，ATA 未能对此类患者进行适当分层。因显微镜下甲状腺外侵犯（ETE）而被归类为中危的患者中，85%无其他危险因素，只因显微镜下 ETE 而被升级，而这一因素在 TNM 分期中已不再包括。
由于从文献中得出的残余消融可改善预后并有助于随访的持续信念，大多数低危患者仍继续接受 RAI 消融。需要重新评估低危组患者进行 RAI 消融的问题，以及显微镜下 ETE 和有限的淋巴结疾病的预后意义。
