Paying attention to initial standardized surgical treatment of differentiated thyroid cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Yanjun ,  CHENG Ruochuan

Center for Diagnosis and Treatment of Thyroid Disease, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, P. R. China;

Corresponding author：

CHENG Ruochuan, Email: cruochuan@foxmail.com

Keywords：

differentiated thyroid cancer; surgical treatment; standardized treatment

DOI：

10.7507/1007-9424.202404115

Video：

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Initial surgical treatment plays an important role in the treatment of differentiated thyroid cancer, and standardized surgical treatment can help to reduce underdiagnosis and overtreatment. Accurate preoperative diagnosis is the premise of standardized surgical treatment, which helps to reduce the overtreatment of thyroid nodules. Preoperative clinical TN staging assessment for differentiated thyroid cancer should be highly valued, the extent of thyroidectomy should be individualized, and the cervical lymph nodes should be performed in a standardized manner. In addition, the indications for endoscopic thyroid surgery should be strictly selected to maximize the benefit of the patient.

Citation： SU Yanjun, CHENG Ruochuan. Paying attention to initial standardized surgical treatment of differentiated thyroid cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1289-1294. doi: 10.7507/1007-9424.202404115 Copy

1.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Nation Cancer Center, 2024, 4(1): 47-53.
2.	Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health, 2018, 6(5): e555-e567.
3.	Sherman SI. Thyroid carcinoma. Lancet, 2003, 361(9356): 501-511.
4.	中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南 (2022年版). 中国实用外科杂志, 2022, 42(12): 1343-1357, 1363.
5.	赫捷, 李进, 程颖, 等. 中国临床肿瘤学会 (CSCO) 分化型甲状腺癌诊疗指南2021. 肿瘤预防与治疗, 2021, 34(12): 1164-1201.
6.	中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南 (第二版). 中华内分泌代谢杂志, 2023, 39(3): 181-226.
7.	Wu J, Fan D, Shao Z, et al. CACA guidelines for holistic integrative management of breast cancer. Holist Integr Oncol, 2022, 1(1): 7. doi: 10.1007/s44178-022-00007-8.
8.	王宇, 田文, 李超, 等. 局部进展期甲状腺癌新辅助治疗中国专家共识 (2023版). 中国实用外科杂志, 2023, 43(8): 841-848.
9.	伍波, 樊友本. 我国甲状腺癌治疗现状: 不足、不规范和过度并存. 浙江医学, 2017, 39(11): 857-859, 870.
10.	Luster M, Weber T, Verburg FA. Differentiated thyroid cancer-personalized therapies to prevent overtreatment. Nat Rev Endocrinol, 2014, 10(9): 563-574.
11.	Papaleontiou M, Haymart MR. Too much of a good thing? A cautionary tale of thyroid cancer overdiagnosis and overtreatment. Thyroid, 2020, 30(5): 651-652.
12.	Li Y, Teng D, Ba J, et al. Efficacy and safety of long-term universal salt iodization on thyroid disorders: epidemiological evidence from 31 provinces of Mainland China. Thyroid, 2020, 30(4): 568-579.
13.	Gong L, Liu Y, Guo X, et al. BRAF p.V600E genetic testing based on ultrasound-guided fine-needle biopsy improves the malignancy rate in thyroid surgery: our single-center experience in the past 10 years. J Cancer Res Clin Oncol, 2023, 149(8): 4283-4291.
14.	Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM, 2007, 100(1): 29-35.
15.	中华医学会超声医学分会浅表器官和血管学组, 中国甲状腺与乳腺超声人工智能联盟. 2020甲状腺结节超声恶性危险分层中国指南: C-TIRADS. 中华超声影像学杂志, 2021, 30(3): 185-200.
16.	Jin Z, Pei S, Shen H, et al. Comparative study of C-TIRADS, ACR-TIRADS, and EU-TIRADS for diagnosis and management of thyroid nodules. Acad Radiol, 2023, 30(10): 2181-2191.
17.	田文, 孙辉, 贺青卿. 超声引导下甲状腺结节细针穿刺活检专家共识及操作指南 (2018版). 中国实用外科杂志, 2018, 38(3): 241-244.
18.	Xing M. Genetic-guided risk assessment and management of thyroid cancer. Endocrinol Metab Clin North Am, 2019, 48(1): 109-124.
19.	国家癌症中心, 国家肿瘤质控中心甲状腺癌质控专家委员会. 中国甲状腺癌规范诊疗质量控制指标 (2022版). 中华肿瘤杂志, 2022, 44(9): 902-907.
20.	Amin MB, Edge SB, Greene FL. AJCC cancer staging manual. 8th edition. New York: Springer, 2017: 1032.
21.	Heng Y, Feng S, Yang Z, et al. Features of lymph node metastasis and structural recurrence in papillary thyroid carcinoma located in the upper portion of the thyroid: a retrospective cohort study. Front Endocrinol (Lausanne), 2022, 12: 793997. doi: 10.3389/fendo.2021.793997.
22.	Lee JY, Yoo RE, Rhim JH, et al. Validation of ultrasound risk stratification systems for cervical lymph node metastasis in patients with thyroid cancer. Cancers (Basel), 2022, 14(9): 2106. doi: 10.3390/cancers14092106.
23.	Grani G, Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy. J Clin Endocrinol Metab, 2014, 99(6): 1970-1982.
24.	Liu Q, Mao L, Zhang Z, et al. Diagnostic efficacy of FNA-Tg in DTC cervical LN metastasis and its impact factors: a large retrospective study. J Clin Endocrinol Metab, 2023, 108(12): 3311-3319.
25.	Jeon MJ, Park JW, Han JM, et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J Clin Endocrinol Metab, 2013, 98(1): 153-160.
26.	Alabousi M, Alabousi A, Adham S, et al. Diagnostic test accuracy of ultrasonography vs computed tomography for papillary thyroid cancer cervical lymph node metastasis: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg, 2022, 148(2): 107-118.
27.	Xing Z, Qiu Y, Yang Q, et al. Thyroid cancer neck lymph nodes metastasis: meta-analysis of US and CT diagnosis. Eur J Radiol, 2020, 129: 109103. doi: 10.1016/j.ejrad.2020.109103.
28.	Kang BC, Roh JL, Lee JH, et al. Candidates for limited lateral neck dissection among patients with metastatic papillary thyroid carcinoma. World J Surg, 2014, 38(4): 863-871.
29.	Bongers PJ, Verzijl R, Dzingala M, et al. Preoperative computed tomography changes surgical management for clinically low-risk well-differentiated thyroid cancer. Ann Surg Oncol, 2019, 26(13): 4439-4444.
30.	Kim SK, Park I, Woo JW, et al. Total thyroidectomy versus lobectomy in conventional papillary thyroid microcarcinoma: analysis of 8,676 patients at a single institution. Surgery, 2017, 161(2): 485-492.
31.	Zhang C, Li Y, Li J, et al. Total thyroidectomy versus lobectomy for papillary thyroid cancer: a systematic review and meta-analysis. Medicine (Baltimore), 2020, 99(6): e19073. doi: 10.1097/MD.0000000000019073.
32.	Mehanna H, Al-Maqbili T, Carter B, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab, 2014, 99(8): 2834-2843.
33.	Wang LY, Migliacci JC, Tuttle RM, et al. Management and outcome of clinically evident neck recurrence in patients with papillary thyroid cancer. Clin Endocrinol (Oxf), 2017, 87(5): 566-571.
34.	Yang J, Han Y, Min Y, et al. Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis. Front Endocrinol (Lausanne), 2023, 14: 1176512. doi: 10.3389/fendo.2023.1176512.
35.	Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: core questions and recommendations for treatments of thyroid cancer. Endocr J, 2020, 67(7): 669-717.
36.	Kim SM, Kim HK, Kim KJ, et al. Thyroidectomy without lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases and negative intraoperative frozen section. Head Neck, 2016, 38(2): 285-289.
37.	Robbins KT, Shaha AR, Medina JE, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg, 2008, 134(5): 536-538.
38.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10): 779-797.
39.	Agrawal N, Evasovich MR, Kandil E, et al. Indications and extent of central neck dissection for papillary thyroid cancer: an American Head and Neck Society Consensus Statement. Head Neck, 2017, 39(7): 1269-1279.
40.	Orloff LA, Kuppersmith RB. American Thyroid Association’s central neck dissection terminology and classification for thyroid cancer consensus statement. Otolaryngol Head Neck Surg, 2010, 142(1): 4-5.
41.	Barczyński M, Konturek A, Stopa M, et al. Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer. Langenbecks Arch Surg, 2014, 399(2): 237-244.
42.	Stack BC, Ferris RL, Goldenberg D, et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid, 2012, 22(5): 501-508.
43.	徐震纲, 刘绍严. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版). 中国实用外科杂志, 2017, 37(9): 985-991.

1. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Nation Cancer Center, 2024, 4(1): 47-53.
2. Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health, 2018, 6(5): e555-e567.
3. Sherman SI. Thyroid carcinoma. Lancet, 2003, 361(9356): 501-511.
4. 中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南 (2022年版). 中国实用外科杂志, 2022, 42(12): 1343-1357, 1363.
5. 赫捷, 李进, 程颖, 等. 中国临床肿瘤学会 (CSCO) 分化型甲状腺癌诊疗指南2021. 肿瘤预防与治疗, 2021, 34(12): 1164-1201.
6. 中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南 (第二版). 中华内分泌代谢杂志, 2023, 39(3): 181-226.
7. Wu J, Fan D, Shao Z, et al. CACA guidelines for holistic integrative management of breast cancer. Holist Integr Oncol, 2022, 1(1): 7. doi: 10.1007/s44178-022-00007-8.
8. 王宇, 田文, 李超, 等. 局部进展期甲状腺癌新辅助治疗中国专家共识 (2023版). 中国实用外科杂志, 2023, 43(8): 841-848.
9. 伍波, 樊友本. 我国甲状腺癌治疗现状: 不足、不规范和过度并存. 浙江医学, 2017, 39(11): 857-859, 870.
10. Luster M, Weber T, Verburg FA. Differentiated thyroid cancer-personalized therapies to prevent overtreatment. Nat Rev Endocrinol, 2014, 10(9): 563-574.
11. Papaleontiou M, Haymart MR. Too much of a good thing? A cautionary tale of thyroid cancer overdiagnosis and overtreatment. Thyroid, 2020, 30(5): 651-652.
12. Li Y, Teng D, Ba J, et al. Efficacy and safety of long-term universal salt iodization on thyroid disorders: epidemiological evidence from 31 provinces of Mainland China. Thyroid, 2020, 30(4): 568-579.
13. Gong L, Liu Y, Guo X, et al. BRAF p.V600E genetic testing based on ultrasound-guided fine-needle biopsy improves the malignancy rate in thyroid surgery: our single-center experience in the past 10 years. J Cancer Res Clin Oncol, 2023, 149(8): 4283-4291.
14. Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM, 2007, 100(1): 29-35.
15. 中华医学会超声医学分会浅表器官和血管学组, 中国甲状腺与乳腺超声人工智能联盟. 2020甲状腺结节超声恶性危险分层中国指南: C-TIRADS. 中华超声影像学杂志, 2021, 30(3): 185-200.
16. Jin Z, Pei S, Shen H, et al. Comparative study of C-TIRADS, ACR-TIRADS, and EU-TIRADS for diagnosis and management of thyroid nodules. Acad Radiol, 2023, 30(10): 2181-2191.
17. 田文, 孙辉, 贺青卿. 超声引导下甲状腺结节细针穿刺活检专家共识及操作指南 (2018版). 中国实用外科杂志, 2018, 38(3): 241-244.
18. Xing M. Genetic-guided risk assessment and management of thyroid cancer. Endocrinol Metab Clin North Am, 2019, 48(1): 109-124.
19. 国家癌症中心, 国家肿瘤质控中心甲状腺癌质控专家委员会. 中国甲状腺癌规范诊疗质量控制指标 (2022版). 中华肿瘤杂志, 2022, 44(9): 902-907.
20. Amin MB, Edge SB, Greene FL. AJCC cancer staging manual. 8th edition. New York: Springer, 2017: 1032.
21. Heng Y, Feng S, Yang Z, et al. Features of lymph node metastasis and structural recurrence in papillary thyroid carcinoma located in the upper portion of the thyroid: a retrospective cohort study. Front Endocrinol (Lausanne), 2022, 12: 793997. doi: 10.3389/fendo.2021.793997.
22. Lee JY, Yoo RE, Rhim JH, et al. Validation of ultrasound risk stratification systems for cervical lymph node metastasis in patients with thyroid cancer. Cancers (Basel), 2022, 14(9): 2106. doi: 10.3390/cancers14092106.
23. Grani G, Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy. J Clin Endocrinol Metab, 2014, 99(6): 1970-1982.
24. Liu Q, Mao L, Zhang Z, et al. Diagnostic efficacy of FNA-Tg in DTC cervical LN metastasis and its impact factors: a large retrospective study. J Clin Endocrinol Metab, 2023, 108(12): 3311-3319.
25. Jeon MJ, Park JW, Han JM, et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J Clin Endocrinol Metab, 2013, 98(1): 153-160.
26. Alabousi M, Alabousi A, Adham S, et al. Diagnostic test accuracy of ultrasonography vs computed tomography for papillary thyroid cancer cervical lymph node metastasis: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg, 2022, 148(2): 107-118.
27. Xing Z, Qiu Y, Yang Q, et al. Thyroid cancer neck lymph nodes metastasis: meta-analysis of US and CT diagnosis. Eur J Radiol, 2020, 129: 109103. doi: 10.1016/j.ejrad.2020.109103.
28. Kang BC, Roh JL, Lee JH, et al. Candidates for limited lateral neck dissection among patients with metastatic papillary thyroid carcinoma. World J Surg, 2014, 38(4): 863-871.
29. Bongers PJ, Verzijl R, Dzingala M, et al. Preoperative computed tomography changes surgical management for clinically low-risk well-differentiated thyroid cancer. Ann Surg Oncol, 2019, 26(13): 4439-4444.
30. Kim SK, Park I, Woo JW, et al. Total thyroidectomy versus lobectomy in conventional papillary thyroid microcarcinoma: analysis of 8,676 patients at a single institution. Surgery, 2017, 161(2): 485-492.
31. Zhang C, Li Y, Li J, et al. Total thyroidectomy versus lobectomy for papillary thyroid cancer: a systematic review and meta-analysis. Medicine (Baltimore), 2020, 99(6): e19073. doi: 10.1097/MD.0000000000019073.
32. Mehanna H, Al-Maqbili T, Carter B, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab, 2014, 99(8): 2834-2843.
33. Wang LY, Migliacci JC, Tuttle RM, et al. Management and outcome of clinically evident neck recurrence in patients with papillary thyroid cancer. Clin Endocrinol (Oxf), 2017, 87(5): 566-571.
34. Yang J, Han Y, Min Y, et al. Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis. Front Endocrinol (Lausanne), 2023, 14: 1176512. doi: 10.3389/fendo.2023.1176512.
35. Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: core questions and recommendations for treatments of thyroid cancer. Endocr J, 2020, 67(7): 669-717.
36. Kim SM, Kim HK, Kim KJ, et al. Thyroidectomy without lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases and negative intraoperative frozen section. Head Neck, 2016, 38(2): 285-289.
37. Robbins KT, Shaha AR, Medina JE, et al. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg, 2008, 134(5): 536-538.
38. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华内分泌代谢杂志, 2012, 28(10): 779-797.
39. Agrawal N, Evasovich MR, Kandil E, et al. Indications and extent of central neck dissection for papillary thyroid cancer: an American Head and Neck Society Consensus Statement. Head Neck, 2017, 39(7): 1269-1279.
40. Orloff LA, Kuppersmith RB. American Thyroid Association’s central neck dissection terminology and classification for thyroid cancer consensus statement. Otolaryngol Head Neck Surg, 2010, 142(1): 4-5.
41. Barczyński M, Konturek A, Stopa M, et al. Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer. Langenbecks Arch Surg, 2014, 399(2): 237-244.
42. Stack BC, Ferris RL, Goldenberg D, et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid, 2012, 22(5): 501-508.
43. 徐震纲, 刘绍严. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版). 中国实用外科杂志, 2017, 37(9): 985-991.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Paying attention to initial standardized surgical treatment of differentiated thyroid cancer

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