Second Academic Nuclear Medicine Department, "AHEPA" University hospital, Aristotle University of Thessaloniki, Greece, Thessaloniki 54621, Greece.
Hell J Nucl Med. 2024 May-Aug;27(2):121-130. doi: 10.1967/s002449912730.
Thyroid cancer (TC) is the most common endocrine malignancy with constantly growing incidence. Radioiodine ablation is a safe and effective method for managing TC. Recently various Guidelines (GL) have been published on whom should be ablated, when and under which circumstances. Our study compares 6 GL with a given patient cohort. Additionally, we evaluated each GL's quality via an independent tool.
We compared six Guidelines (GL) for TC ablation on a cohort of 336 patients, implementing GL retrospectively: 2009 and 2016 American Thyroid Association (ATA), European Thyroid Association's (ETA) Consensus Statement, UK's National Institute for Health and Care Excellence (NICE), German position paper from Surgery and Nuclear Medicine (German) and European Association of Nuclear Medicine and Society of Nuclear Medicine and Molecular Image (EANM/SNMMI). Quality assessment was conducted using the Appraisal of Guidelines, Research and Evaluation instrument II (AGREE II).
Results showed significant variability among GL. American Thyroid Association 2016, a clear improvement of the ATA 2009, presents a large grey area of "probable ablation candidates". European Thyroid Association and NICE agree that only a small portion of our ablated patients would benefit from it and the AGREE II tool shows a lack of applicability, but very good scores elsewhere. German and EANM/SNMMI GL agree that most of our clinical decisions to ablate were correct and their AGREE II scores are the highest in all six domains.
Considering that dynamic risk classification plays a major role in determining the most appropriate treatment, it appears that the guidelines should be updated in order to support individualized patient management. However, it is the experience of the individual physician that will determine the final decision.
甲状腺癌（TC）是最常见的内分泌恶性肿瘤，发病率不断上升。放射性碘消融是治疗 TC 的一种安全有效的方法。最近发布了各种关于哪些患者应该消融、何时以及在何种情况下进行消融的指南（GL）。我们的研究将 6 项 GL 与给定的患者队列进行了比较。此外，我们还使用独立工具评估了每个 GL 的质量。
我们比较了 336 例患者队列中 6 项 TC 消融 GL，回顾性实施 GL：2009 年和 2016 年美国甲状腺协会（ATA）、欧洲甲状腺协会共识声明（ETA）、英国国家卫生与保健卓越研究所（NICE）、德国外科和核医学立场文件（德国）和欧洲核医学协会和核医学与分子影像学会（EANM/SNMMI）。使用评估指南、研究和评估工具 II（AGREE II）进行质量评估。
结果表明 GL 之间存在显著差异。2016 年美国甲状腺协会，对 2009 年 ATA 的明显改进，呈现出“可能消融候选者”的大片灰色区域。欧洲甲状腺协会和 NICE 都认为，只有一小部分我们进行消融的患者会从中受益，AGREE II 工具显示缺乏适用性，但其他方面得分非常高。德国和 EANM/SNMMI GL 都认为我们大部分进行消融的临床决策是正确的，它们在所有六个领域的 AGREE II 评分最高。
考虑到动态风险分类在确定最合适的治疗方法方面起着重要作用，似乎应该更新指南以支持个体化患者管理。然而，最终的决定将取决于医生的个人经验。
