The 2009 revised american thyroid association guidelines for thyroid cancer: The extent of surgery for thyroid carcinoma less than one and one half centimeters or low-risk thyroid carcinoma

摘要

The 2009 publication "Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer" (1), referred to here as "ATA guidelines," is followed worldwide by a great number of physicians. The subsection "Surgery for a biopsy diagnostic for malignancy" starting on page 1178 discusses the extent of thyroid surgery required for differentiated thyroid carcinoma (DTC). Respectfully, we disagree with some of the recommendations in this section. On page 1179 of the ATA guidelines it is stated that older age (> 45) may be also a criterion for recommending near-total or total thyroidectomy even with tumors < 1-1.5 cm, because of the higher recurrence rates in this age group. References 112 by van Heerden et al. (2), 116 by Hay et al. (3), 122 by Hay et al. (4), 123 by Lin et al. (5), and 157 by Rubino et al. (6) are provided (1) in support of this. However, most of the cited references do not support this suggestion. Reference 112 by van Heerden et al. (2) analyzed the cause-specific mortality not the recurrence rates and suggested that for follicular thyroid carcinoma the dominant determinant of cause-specific mortality was the presence of distant metastases at diagnosis. They found that age >= 50 did not significantly increase the cause-specific mortality (p = 0.42), and did not make any suggestion about the extent of surgery for DTC. Reference 116 by Hay et al. (3) analyzed the risk factors for predicting survival in 1779 patients with papillary thyroid carcinoma (PTC) and introduced the MACIS scoring system (named for its predictive variables of Metastasis, Ages, Completeness of surgical excision, local Invasion, and tumor Size). This article does not mention recurrence. Age is an important component of the MACIS prognostic scoring system. Besides, there was no suggestion of near-total or total thyroidectomy specifically for patients >45 years with tumors < 1-1.5 cm.