Perioperative diagnostics of patients referred for radioiodine therapy of differentiated thyroid carcinoma: referral cen
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ORIGINAL ARTICLE
Perioperative diagnostics of patients referred for radioiodine therapy of differentiated thyroid carcinoma: referral center experience in an iodine-insufficient country Friederike Eilsberger Frederik A. Verburg3
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R. Michael Tuttle2 Damiano Librizzi1 Andreas Pfestroff1 Markus Luster1 ●
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Received: 29 July 2020 / Accepted: 23 September 2020 © The Author(s) 2020
Abstract Purpose The interdisciplinary “Martinique-Principles” of four international professional societies concerned with the patient management of differentiated thyroid cancer (DTC) patients were agreed upon. Differences in perioperative diagnostics can lead to differences in clinical decision founding regarding the treatment of thyroid carcinoma. Our aim was to analyze the perioperative diagnostics of patients referred for postoperative I-131 therapy of DTC. Methods We retrospectively examined the data of 142 patients who were referred to our center for the first course of postsurgical I-131 therapy. We extracted data on perioperative diagnostics. Results Fine-needle biopsy (FNB) was performed in 27/142 patients. In 17 patients, FNB yielded findings suspicious of malignancy, in 3 patients a follicular lesion was reported. An intraoperative frozen section analysis was performed in 79/142 patients. 5/63 patients showed already a cytologically proven malignancy. In 10/79 patients, the frozen section had a nonmalignant result, although DTC was found on final assessment. In 2/79 patients, frozen section analysis was indecisive, although the final report confirmed DTC. In the remaining 67 patients, frozen section yielded DTC. Conclusions There is room for improvement in perioperative diagnostics surrounding thyroid surgery, currently many procedures are performed without adequate information on potential presence of thyroid cancer. More frequent use of FNB might be able to decrease the number of unnecessary thyroid surgeries, increased use of frozen section might decrease the number of second operations and might contribute to less discordance between experts in the field of DTC treatment. Keywords Differentiated thyroid cancer Thyroidectomy Thyroid ultrasound Thyroid scintigraphy Fine-needle biopsy ●
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Introduction Generally, the recommended diagnostic cascade resulting in a diagnosis of differentiated thyroid cancer (DTC) involves neck ultrasound and fine-needle biopsy of any suspicious nodule. This is, depending on the results, followed by
* Friederike Eilsberger [email protected] 1
Department of Nuclear Medicine, University Hospital Marburg, 35043 Marburg, Germany
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Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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diagnostic or therapeutic thyroid surgery, with or without intraoperative frozen section analysis of suspicious nodules. The surgical procedure is heavily influenced by the known diagnosis at the time of the procedure. Generally spe
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