Lobectomy Rates for Low-Risk DTC Are Rising

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Adherence to the 2015 recommendation from ATA — to use lobectomy rather than complete thyroidectomy for low-risk differentiated thyroid cancer — is increasing.
Adherence to the 2015 recommendation from ATA — to use lobectomy rather than complete thyroidectomy for low-risk differentiated thyroid cancer — is increasing.
The following article features coverage from the American Thyroid Association (ATA) 2018 meeting. Click here to read more of Cancer Therapy Advisor's conference coverage.

Clinicians are increasingly following formal guideline recommendations and avoiding complete thyroidectomy in patients with low-risk differentiated thyroid cancer (DTC), according to a study presented at the 88th Annual Meeting of the American Thyroid Association in Washington, D.C.1

In 2015, the ATA revised its treatment guideline recommendation to suggest that low-risk DTCs of 1 cm to 4 cm be treated by lobectomy, rather than complete thyroidectomy, which was the previous recommendation. The goal of this study was to determine how the guideline change affected complete thyroidectomy rates in this population.

The study included 130 patients who underwent thyroid lobectomy for malignancy between 2014 and 2017 at a single institution. Patients were stratified into pre-guideline (2014–2015) and post-guideline (2016–2017) cohorts.

Overall, 65% of patients in the pre-guideline cohort underwent complete thyroidectomy compared with 52% of patients in the post-guideline cohort (P = .157). Patients with low-risk DTC, however, trended toward being less likely to receive a complete thyroidectomy following the guideline revision: the rate was 29% after the update, compared with 49% under the previous recommendations (P = .10).

Complete thyroidectomy was significantly associated with aggressive disease, lymph node involvement, extrathyroidal extension, and multifocality among patients in the post-guideline cohort (P < .05 for all). Complete thyroidectomy was not associated with gender, race, age, or tumor size.

The authors concluded that these data suggest a “gradual adherence to the 2015 ATA guidelines,” but noted that, “nearly one-third of these patients underwent completion thyroidectomy, suggesting additional factors influencing the decision for further treatment.”

Read more of Cancer Therapy Advisor's coverage of the ATA 2018 meeting by visiting the conference page.

Reference

  1. Kuo L, Angell TE, Alexander EK, et al. Completion thyroidectomy is less common following updated 2015 American Thyroid Association guidelines. Presented at: the 88th Annual Meeting of the American Thyroid Association; Washington, D.C.: October 3-7, 2018. Abstract poster 123.

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