BACKGROUND
Thyroid cancer is common, especially in women. The major thyroid medical societies across the world have guidelines regarding treatment of thyroid cancer. The American Thyroid Association (ATA), the European Association of Nuclear Medicine (EANM), the European Thyroid Association (ETA), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) created a working group to annually assess current changes in the diagnosis and treatment of thyroid cancer. This task force has reviewed the latest evidence to develop a Consensus Statement for improving the diagnosis and treatment of thyroid cancer.

THE FULL ARTICLE TITLE
Gulec SA et al A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the European Thyroid Association, the Society of Nuclear Medicine and Molecular Imaging on Current Diagnostic and theranostic approaches in the management of thyroid cancer. Thyroid. Epub 2021 Apr 1. PMID: 33789450.

SUMMARY OF THE STUDY
The working group consisted of experts in basic, diagnostic, and clinical aspects of thyroid cancer from all of the involved societies. These multidisciplinary teams accurately assessed three important topics that were identified in 2019.

i. Risk stratification prior to surgery is needed to guide the extent of thyroid surgery and to determine the need to treat with radioactive iodine therapy after surgery.

Primary risk factors to determine the severity of thyroid cancer were determined as: the primary type of cancer; the age at diagnosis (< 55 vs. ≥55 years); primary cancer size (<4 cm vs. ≥ 4 cm); presence or absence of spread to the lymph nodes; presence or absence of extension of the cancer outside the thyroid; specific structures invaded by cancer; incomplete cancer resection with a known cancer left behind; presence or absence of spread of the cancer outside the neck; the level of thyroglobulin after surgery and radioactive iodine uptake outside thyroid bed, if performed.

These data should be routinely obtained to accurately assign patients to a specific prognostic stage for risk of death and ATA risk category (low, intermediate, or high) for risk of cancer recurrence risk. Additional information from molecular studies could help to individualize initial management decisions in patients with thyroid cancer.

ii. There is a restricted role of diagnostic radioactive iodine imaging in initial staging.

Diagnostic radioactive iodine imaging is important for clinical decision-making only in intermediate-risk patients. The multidisciplinary task force suggested selective use of diagnostic radioactive iodine imaging in ATA intermediate-risk patients, rather than routine use for all patients belonging to this category. The task force supported that posttreatment scans should always be obtained for staging thyroid cancer.

iii. Identifying indicators of response to radioactive iodine therapy in the setting of residual thyroid cancer.

The task force acknowledged that the current reporting system supported by the ATA guidelines (excellent response, indeterminate response, biochemically incomplete response, and structurally incomplete response) after initial radioactive iodine therapy is very helpful. However, they suggested that the evaluation of the response after radioactive iodine therapy should also include the use of a high-sensitivity serum thyroglobulin assay as a specific biomarker.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The existing risk-stratification models provide highly accurate predictive and prognostic information. Traditional risk-stratification systems should be improved by incorporating patient- and cancer-specific molecular markers to individualize treatment decisions. radioactive iodine imaging is an important component of risk stratification; post-treatment scans should always be obtained for cancer staging. There is the need for a uniform classification system that includes imaging criteria

— Alan P. Farwell, MD

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