New Paradigms Emerging in Diagnosis, Management of Thyroid Cancer

The incidence of thyroid cancer is increasing rapidly in the United States and the past few years have seen dramatic shifts in the management of papillary and follicular thyroid cancer. Knowledge of these emerging trends is important to optimize patient care and endocrine referral patterns for head and neck surgeons performing thyroid surgery.

We really need to look at where we stand in what I think is going to turn out to be a clinical epidemic, said Shereen Ezzat, MD, Professor of Endocrinology and Metabolism at the University of Toronto and a senior scientist in the Division of Applied Molecular Oncology at the Ontario Cancer Institute.

Dr. Ezzat was one of a distinguished roster of endocrine, imaging, and surgical experts on hand to update attendees on the most current trends and evolving paradigms in the diagnosis and management of thyroid cancer at the recent American Academy of Otolaryngology-Head and Neck Surgery annual meeting in Toronto.

It’s anticipated that, in the next five years, diagnoses of thyroid cancer are going to double, he said We have to look at the scope of the problem and where the deficiencies are-and, unfortunately, there are lots of them.

At the Molecular Level

Dr. Ezzat discussed the evolution of molecular diagnostic techniques and how those techniques are going to affect physicians’ understanding of the disease and, ultimately, how that will be translated into the therapeutic arena.

A thyroid nodule can be benign, it can be cystic, inflammatory, or it could represent an area of compensatory regeneration or hyperplasia, he said. But what we’re really most interested in is the area of neoplasia, where potentially clinical significance would have the greatest meaning.

Before subjecting a patient to diagnostic testing, as well as determining which tests to perform, Dr. Ezzat said physicians should consider the following statistics from a recent study: In nonirradiated patients, the risk of malignancy is 5%, while in irradiated patients, the risk increases to 30% to 40%. If there is some degree of autonomous function, the risk is less than 5%.

That’s what I already know, and if any test does not really add to this, then it’s kind of useless, he said. Part of the problem is that we like to rely on morphology. Morphology requires at least six criteria based on aspirate findings to make the diagnosis of papillary cancer. And only when all these criteria are met is the pathologist able to tell you that you’ve got papillary cancer. That’s the limitation, so I don’t think we should be too hard on the pathologist.