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.	中華人民共和國國家衛生健康委員會醫政醫管局. 甲狀腺癌診療指南 (2022年版). 中國實用外科雜志, 2022, 42(12): 1343-1357, 1363.
5.	赫捷, 李進, 程穎, 等. 中國臨床腫瘤學會 (CSCO) 分化型甲狀腺癌診療指南2021. 腫瘤預防與治療, 2021, 34(12): 1164-1201.
6.	中華醫學會內分泌學分會, 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南 (第二版). 中華內分泌代謝雜志, 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. 局部進展期甲狀腺癌新輔助治療中國專家共識 (2023版). 中國實用外科雜志, 2023, 43(8): 841-848.
9.	伍波, 樊友本. 我國甲狀腺癌治療現狀: 不足、不規范和過度并存. 浙江醫學, 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.	中華醫學會超聲醫學分會淺表器官和血管學組, 中國甲狀腺與乳腺超聲人工智能聯盟. 2020甲狀腺結節超聲惡性危險分層中國指南: C-TIRADS. 中華超聲影像學雜志, 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, 孫輝, 賀青卿. 超聲引導下甲狀腺結節細針穿刺活檢專家共識及操作指南 (2018版). 中國實用外科雜志, 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.	國家癌癥中心, 國家腫瘤質控中心甲狀腺癌質控專家委員會. 中國甲狀腺癌規范診療質量控制指標 (2022版). 中華腫瘤雜志, 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.	中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 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.	徐震綱, 劉紹嚴. 分化型甲狀腺癌頸側區淋巴結清掃專家共識(2017版). 中國實用外科雜志, 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. 中華人民共和國國家衛生健康委員會醫政醫管局. 甲狀腺癌診療指南 (2022年版). 中國實用外科雜志, 2022, 42(12): 1343-1357, 1363.
5. 赫捷, 李進, 程穎, 等. 中國臨床腫瘤學會 (CSCO) 分化型甲狀腺癌診療指南2021. 腫瘤預防與治療, 2021, 34(12): 1164-1201.
6. 中華醫學會內分泌學分會, 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南 (第二版). 中華內分泌代謝雜志, 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. 局部進展期甲狀腺癌新輔助治療中國專家共識 (2023版). 中國實用外科雜志, 2023, 43(8): 841-848.
9. 伍波, 樊友本. 我國甲狀腺癌治療現狀: 不足、不規范和過度并存. 浙江醫學, 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. 中華醫學會超聲醫學分會淺表器官和血管學組, 中國甲狀腺與乳腺超聲人工智能聯盟. 2020甲狀腺結節超聲惡性危險分層中國指南: C-TIRADS. 中華超聲影像學雜志, 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, 孫輝, 賀青卿. 超聲引導下甲狀腺結節細針穿刺活檢專家共識及操作指南 (2018版). 中國實用外科雜志, 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. 國家癌癥中心, 國家腫瘤質控中心甲狀腺癌質控專家委員會. 中國甲狀腺癌規范診療質量控制指標 (2022版). 中華腫瘤雜志, 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. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華內分泌代謝雜志, 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. 徐震綱, 劉紹嚴. 分化型甲狀腺癌頸側區淋巴結清掃專家共識(2017版). 中國實用外科雜志, 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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