Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

/pdf/2015-american-thyroid-association-management-guidelines-for-32kri8vrhd.pdf

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. Methods: Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. Results: The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, a...

/pdf/revised-american-thyroid-association-management-guidelines-3i6bt8nj9c.pdf

Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

/pdf/aasld-practice-guideline-management-of-hepatocellular-51bocalv0r.pdf

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

/pdf/management-guidelines-for-patients-with-thyroid-nodules-and-33wjxjfqag.pdf

Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.

BACKGROUND

The National Cancer Data Base (NCDB) represents a national electronic registry system now capturing nearly 60% of incident cancers in the U. S. In combination with other Commission on Cancer programs, the NCDB offers a working example of voluntary, accurate, cost-effective "outcomes management" on a both a local and national scale. In addition, it is of particular value in capturing clinical information concerning rare cancers, such as those of the thyroid.



METHODS

For the accession years 1985-1995, NCDB captured demographic, patterns-of-care, stage, treatment, and outcome information for a convenience sample of 53,856 thyroid carcinoma cases (1% of total NCDB cases). This article focuses on overall 10-year relative survival and American Joint Committee on Cancer (AJCC) (3rd/4th edition) stage-stratified 5-year relative survival for each histologic type of thyroid carcinoma. Care patterns also are discussed.



RESULTS

The 10-year overall relative survival rates for U. S. patients with papillary, follicular, Hurthle cell, medullary, and undifferentiated/anaplastic carcinoma was 93%, 85%, 76%, 75%, and 14%, respectively. For papillary and follicular neoplasms, current AJCC staging failed to discriminate between patients with Stage I and II disease at 5 years. Total thyroidectomy ± lymph node sampling/dissection represented the dominant method of surgical treatment rendered to patients with papillary and follicular neoplasms. Approximately 38% of such patients receive adjuvant iodine-131 ablation/therapy. At 5 years, variation in surgical treatment (i.e., lobectomy vs. more extensive surgery) failed to translate into compelling differences in survival for any subgroup with papillary or follicular carcinoma, but longer follow-up is required to evaluate this. NCDB data appeared to validate the AMES prognostic system, as applied to papillary cases. Younger age appeared to influence prognosis favorably for all thyroid neoplasms, including medullary and undifferentiated/anaplastic carcinoma. NCDB data also revealed that unusual patients diagnosed with undifferentiated/anaplastic carcinoma before age of 45 years have better survival.



CONCLUSIONS

The NCDB system permits analysis of care patterns and survival for large numbers of contemporaneous U. S. patients with relatively rare neoplasms, such as thyroid carcinoma. In this context, it represents an unsurpassed clinical tool for analyzing care, evaluating prognostic models, generating new hypotheses, and overcoming the volume-related drawbacks inherent in the study of such neoplasms. [See editorial on pages 2434-6, this issue.] Cancer 1998;83:2638-2648. © 1998 American Cancer Society.

A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995

BACKGROUND

In combination with other Commission on Cancer programs, the National Cancer Data Base (NCDB), a national electronic registry system currently capturing > 60% of incident cancers in the U. S., offers a working example of voluntary, accurate, cost-effective “outcomes management” on a both a local and national scale. In addition, it is proving to be of particular value in capturing clinical information concerning rare cancers.



METHODS

For accession years 1985–1995, the NCDB captured prospectively collected demographic, stage, treatment, and outcome information for a national hospital-based sample of 286 parathyroid carcinoma cases (0.005 % of the total NCDB cancer cases). This report describes clinical and demographic features as well as patterns of care and 5-year and 10-year relative survival rates.



RESULTS

The NCDB's 10-year accrual of parathyroid carcinoma cases exceeded the cumulative number reported in the English literature though 1991. Gender distribution was equal. The authors were unable to detect any disproportionate clustering by race, income level, or geographic region. Treatment overwhelmingly was surgical. The data from the current study suggest that neither tumor size nor lymph node status are significant prognostic factors. Overall relative survival at 5 years and 10 years was 85.5% and 49.1%, respectively.



CONCLUSIONS

At 5 years of follow-up, and possibly beyond, neither tumor size nor lymph node status were found to be significant prognostic factors and basing a staging system on them would be useless. Although complete, en bloc resection of all tumor represents the best opportunity for cure, a substantial proportion of patients fail to receive such treatment. The authors speculate that the rarity of this condition and late intraoperative recognition occasionally prevent optimal treatment. [See editorial on pages 378–80, this issue.] Cancer 1999;86:538–44. © 1999 American Cancer Society.

Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995 : A National Cancer Data Base Report

AJCC/TNM cancer staging, present and future.

BACKGROUND

American Joint Committee on Cancer (AJCC) staging procedures were first published in 1977. Since 1991 the Commission on Cancer (COC) has required AJCC staging of all nonpediatric cancers. The National Cancer Data Base (NCDB) encouraged recording of AJCC staging through analyses of selected aspects of staging completeness. We reviewed the trend toward the adoption of routine AJCC staging by hospitals for the 5-year period 1990-1994.



METHODS

NCDB reports for nearly 2 million stageable cancers diagnosed from 1990 through 1994 were examined with emphasis on the hospital cancer program environment. Staging was complete if the hospital submitted stage codes for ≥90% of stageable cases or absent if stage codes were submitted for <5%. Hospitals were classified by ownership and type of cancer program. Regional staging practices also were reviewed.



RESULTS

Overall staging increased from 78% to 88%, with increases for every site except carcinomas of the skin, cancers of the extrahepatic bile ducts and urethra, melanoma of the eyelid, and retinoblastoma. The percent of hospitals staging completely increased from 49% to 61%, and the percent not routinely staging decreased from 6% to 3%. Complete staging increased in all hospital categories except For-Profit. The trend toward complete staging was uneven among states and regions.



CONCLUSIONS

Hospital staging policies were affected by activities of the AJCC, COC, NCDB, clinical protocol procedures, and state policies. The varied completeness of staging at the hospital level by state, region, and type of hospital indicates that the adoption of routine staging is ongoing. Cancer 1997; 80:2305-10. © 1997 American Cancer Society.

The national cancer data base report on recent hospital cancer program progress toward complete American joint committee on cancer/TNM staging

BACKGROUND

American Joint Committee on Cancer (AJCC) staging is increasingly accepted as a prognostic standard for cancer management. The Commission on Cancer requires approved cancer programs to use AJCC staging for all cancers. Previous studies document increasing use of AJCC staging by hospitals with cancer programs. This review examines programmatic and clinical factors affecting AJCC staging completeness.



METHODS

The data are registry records submitted to the National Cancer Data Base (NCDB) for cases diagnosed during 1993 or, for comparison, 1988.



RESULTS

The mean facility staging rate was 87% in 1993, up from 65% in 1988. Approximately 64% of facilities staged greater than 90% of their stageable cases; 3% staged less than 5%. Even facilities with “complete” staging implementation were unable to stage substantial portions of some sites. Accessibility of tumor and overall prognosis affected the choice between pathologic and clinical staging. Staging completeness and the mix of pathologic and clinical staging also differed by state of the reporting facility.



CONCLUSIONS

AJCC staging use is high among common tumors for which treatment is dependent upon stage of disease. However, if accurate staging is not expected to affect the treatment or outcome of the case or the overall outcome is poor, staging is less frequently recorded. Cancer 1996;78:1498-504.

Irvin D. Fleming

Papers

A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995

Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995 : A National Cancer Data Base Report

AJCC/TNM cancer staging, present and future.

The national cancer data base report on recent hospital cancer program progress toward complete American joint committee on cancer/TNM staging

The National Cancer Data Base report on completeness of American Joint Committee on Cancer staging in United States cancer facilities