Endocrine Abstracts

Background: Thyroid cancer incidence is increasing, especially the cancers ≤1 cm (T1a). Previous evidence suggests underuse of FNA. Several international guidelines for the management of thyroid cancer have been published. Especially the year 2006 was a hallmark, with the publication of both the ETA consensus and ATA guidelines.

Aim: Compare thyroid cancer subtypes and management before and after 2006.

Methodology: Retrospective observational study of non-medullary thyroid cancer patients diagnosed after total thyroidectomy in two Belgian referral centres (University Hospital Leuven, General Hospital StJan Bruges), comparing pre/per/postoperative parameters of patient cohort1 (diagnosis 2004–2005, n=69) and cohort2 (diagnosis 2011, n=60).

Results: The histology and tumor dimensions were comparable, with papillary thyroid cancer (PTC) as main histologic subtype (86% of cohort1, 82% of cohort2) and T1a as most frequent dimension subtype (respectively 30 and 38%). In cohort2 a comparable low proportion first presented following incidental finding at imaging (21 vs 17% in cohort 1). Pre-surgical FNA was performed in 91% in cohort1 and 86% in cohort2. The indications for thyroidectomy were comparable, with Bethesda 5-6 as most frequent indication (44% in cohort1 and 53% in cohort2). The execution of a simultaneous lymph node dissection in the PTC subgroup was not different, neither the frequency of postoperative hypoparathyroidism and recurrent nerve paresis after 1 year. However, radioiodine ablation was less frequently given in cohort2 (58 vs 76% in cohort1, P=0.03) and neck ultrasonography at 1 year was performed in a higher proportion of >T1a patients (73 vs 49% in cohort1, P=0.02).

Conclusion: In two Belgian referral centres the use of FNA is high and established, and the proportion of T1a cancers is stable and low compared to the national data. A clear change in the postoperative management of thyroid cancer patients is observed towards more restrictive use of radioiodine ablation and increased use of neck ultrasound.