Micro-Papillary Thyroid Cancer: Too many unnecessary biopsies, and referrals to surgery.

Micro-Papillary Thyroid Cancer: Too many unnecessary biopsies, and referrals to surgery.

Micro-Papillary Thyroid Cancer: Too many unnecessary biopsies, and referrals to surgery.

Micro-Papillary Thyroid Cancer: Too many unnecessary biopsies, and referrals to surgery.

Lee et al

Endocrine Practice 26(9)Sept. 2020 ; page 1017-1025.

Dr.Guttler’s comments:

  1. 2700 patients referred to surgery for suspicious thyroid nodules in 2018 study from Korea.
  2. 35% or 950/2700 micronodules referred to surgery were found to not have ultrasound indications for the biopsy.

micro-cancer-1

Compared with nodules that fit ultrasound criteria for biopsy.

Top nodule taller than wide and microlobulated deserves a biopsy.

micro-cancer-2

Bottom nodule microlobulated and suspicious for extrathyroidal  extension deserves a biopsy.

 

 

  1. This is also the case in the USA. Every small nodule does not need a biopsy. These should be followed.
  2. However, the decision to biopsy may not be in the hands of an endocrinologist or thyroid physician.
  3. The number of micro cancers sent to surgery is way to high in this study.
  4. The patient with a micro-cancer should be given the option of either active surveillance of radiofrequency ablation.
  5. In the USA patients are reluctant to leave a small cancer in their neck for years. This has resulted in an increase in the use of non-surgical treatment to ablate the cancer.
  6. The method of ablation is RFA. The result is checked with a post ablation cutting needle biopsy or repeat FNA with #18 needle.
  7. If cancer cells are present the RFA is repeated.
  8. The patient needs follow up neck ultrasound for a few years to evaluate the neck lymph nodes and for rare tumor regrowth.
  9. Before biopsy determine if the biopsy is indicated. Get outside opinions.
  10. If you had a positive biopsy consider radiofrequency RFA instead of surgery or watchful waiting.
  11. Call Alicia for details.
  12. 310-393-8860 or secure email at [email protected]
  13. DR.G.
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