Risk Stratification in thyroid cancer management (#161)
Thyroid Cancer management in 2013 has moved on from the “one size fits all” approach of 20 years ago. Risk stratification is complex and crucial to providing the best management and follow-up. The American Thyroid Association’s evidence-based guidelines are regularly updated to help clinicians understand new diagnostic tools, new scans, new therapies and the role of tumour genetics. These guidelines will form the basis of this talk, which will discuss risk in terms of patient factors, tumour factors, genetic factors and treatment factors. Specific issues covered will be the integration of the AJCC/TNM staging into 3 levels of low, intermediate and high risk and the concept of delayed risk stratification (DRS). Risk factors such as patient’s age, gender, the size of the primary tumour and presence of extra thyroidal spread are consistent in most studies, but the risks associated with cervical lymph node involvement and the presence of the BRAF V600E mutation in the tumour remain controversial. Tumour histology must be carefully analysed for aggressive variants including tall cell, columnar cell and insular carcinoma. Measurement of thyroglobulin (Tg) and Tg antibodies, both in the blood, with TSH stimulation, and in the nodal fine needle aspirate, are diagnostic tools with high sensitivity and specificity. These tools are assisted by the newer advances such as genetic analysis of the tumour, FDG-PET/CT scanning to complement neck ultrasound and the new targeted therapies. These advances will be illustrated from the perspective of our own thyroid cancer multidisciplinary unit.