ANZ Journal of Surgery | 2021
Abstract Journal Endocrine Surgery
Abstract
Journal Endocrine Surgery ES001 THE RADIOLOGICALLY AND CYTOLOGICALLY DISCORDANT NODULE – A DILEMMA IN THE ERA OF TI-RADS AND BETHESDA CICI GUO, ALEXANDER PAPACHRISTOS, ANTHONY GLOVER, MARK SYWAK AND STAN SIDHU Royal North Shore Hospital, NSW Purpose: The management of suspicious thyroid nodules is based on cytological evaluation. Current guidelines recommend no further immediate treatment if the cytology is benign. We hypothesised that the pre-test probability of malignancy associated with highly suspicious ultrasound features should prompt surgeons to exercise caution in the interpretation of benign cytology. Methodology: We retrospectively reviewed thyroid ultrasound images and reports of consecutive patients with cytologically benign thyroid nodules who underwent thyroidectomy between 2015 and 2020. Nodules were classified according to the Thyroid Imaging Reporting and Data System (TIRADS). TI-RADS 5 (highly suspicious) nodules were included for analysis and final histopathology was reviewed. Patients with incidental papillary microcarcinomas were considered to have benign histopathology. Results: 632 patients with cytologically benign nodules underwent thyroidectomy between 2015 and 2020. The mean age was 56 years and 79% of the cohort were female. Of the 632 cases, 30 had TI-RADS 5 ultrasound characteristics, 7 (23%) of which were ultimately found to be papillary thyroid carcinomas. Conclusion: In the presence of highly suspicious ultrasound characteristics, the possibility of a false-negative benign cytology result must be considered. In such situations, a diagnostic hemithyroidectomy would be an appropriate management strategy. ES002 SURVEY ON MANAGEMENT OF PAPILLARY THYROID MICROCARCINOMA IN AUSTRALIA AND NEW ZEALAND GRACE YIN, SENARATH EDIRIMANNE, GUY ESLICK AND LAURA WANG University of Sydney, NSW Purpose: There is evidence that active surveillance (AS) is comparable to immediate surgery (IM) for low-risk papillary thyroid microcarcinoma (PTMC)(1). We aim to investigate utilisation of AS in Australia and New Zealand, and to assess the perceived barriers to its implementation. Methodology: An electronic survey (platform Survey Monkey) was distributed to the following medical societies: Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons, Australian and New Zealand Head and Neck Cancer Society, and New Zealand Association of General Surgery. Response data was collected and analysed 2 months after release date. Results: At preliminary analysis there were 70 respondents reporting on average 21 years of clinical experience. 61% of clinicians report discussing AS with PTMC patients, but only 20% would be managed with AS. Endocrinologists were more likely to recommend IM than surgeons, though this difference only holds borderline significance (p=0.088). The most top barriers perceived by all clinicians were patient anxiety and lack of patient compliance. Additionally, surgeons are concerned about lack of access to follow up, while endocrinologists report concerns about misclassifying patients as low risk. Overall, endocrinologists reported significantly higher levels of concern across all proposed potential barriers to AS. (p=0.005) Conclusion: There remain significant barriers for common application of AS in PTMC patients, including concern about patient anxiety and lack of follow up. Overall, surveyed endocrinologist expressed more concern regarding AS. Reference 1. Miyauchi A. Clinical Trials of Active Surveillance of Papillary Microcarcinoma of the Thyroid. World J. Surg. 2016;40(3):516-22. ES003 LESS EXTENSIVE SURGERY FOR LOW-RISK PAPILLARY THYROID CANCERS POST 2015 AMERICAN THYROID ASSOCIATION GUIDELINES IN AN AUSTRALIAN TERTIARY CENTRE MOHAMMADMEHDI ADHAMI, CHHAVI BHATT, SIMON GRODSKI, JONATHAN SERPELL AND JAMES C LEE Monash Uni Endocrine Surgery Unit, The Alfred, VIC Purpose: The 2015 American Thyroid Association guidelines (ATA15) consider hemithyroidectomy (HT) a viable treatment option for low-risk papillary thyroid cancers (PTCs) between 1 and 4cm. We aimed to examine the impact of ATA15 in a high-volume Australian endocrine surgery unit. Methodology: A retrospective study of all patients undergoing thyroidectomy from January 2010 to December 2019. Inclusion criteria: PTC histopathology, Bethesda V-VI, size 1-4cm, and absence of clinical evidence of lymph node or distant metastases pre-operatively. Primary outcome was rate of HT before and after ATA15. Results: Of 5,408 thyroidectomy patients, 339 (6.3%) met the inclusion criteria – 186 (54.9%) pre-ATA15 (2010-2015) and 153 (45.1%) postATA15 (2016-2019). The patient groups were similar; there were no significant differences between groups in age, sex, tumour size, proportion with Bethesda VI cytology, compressive symptoms, or thyrotoxicosis. PostATA15, there was a significant increase in HT rate from 5.4% to 19.6% (P=0.0001). However, there was no corresponding increase in completion thyroidectomy (CT) rate (50.0% versus 27.6%, P=0.2). The proportion managed with prophylactic central neck dissection (pCND) fell from 80.5% to 10.8% (P<0.0001). Pre-ATA15, the only factor significantly associated with HT was Bethesda V. In contrast, post-ATA15, HT was more likely in patients with younger age, smaller tumours, and Bethesda V. Conclusion: After the release of 2015 ATA guidelines, we observed a significant increase in HT rate and a significant decrease in pCND rate for low-risk PTCs in our specialised thyroid cancer unit. This reflects a growing clinician uptake of a more conservative approach as recommended by ATA15. ES004 FOLLOW-UP OF PATIENTS WITH LOW-RISK THYROID CANCER: A SURVEY OF CLINICIAN PREFERENCES JACOB HAMPTON, ELVINA WIADJI, CHRISTOPHER ROWE, LIZ FRADGLEY, DARON COPE, CHRISTINE PAUL AND CHRISTINE O’NEILL Department of Surgery, John Hunter Hospital, NSW Purpose: The 10-year survival rate of patients with differentiated thyroid cancer is ~98%. There are currently no clear guidelines for follow-up of such patients. An exploratory survey of clinicians was performed to ascertain patterns of follow-up care. Methodology: All Australian fellows of the Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons and the Australian Society of Otolaryngology, Head and Neck Surgery were invited to complete a survey with four clinical vignettes: (a) Incidental 4 mm micropapillary thyroid carcinoma following total thyroidectomy; (b) Solitary 15mm papillary thyroid carcinoma with no additional adverse features; (c) Solitary 18mm minimally invasive follicular thyroid carcinoma without vascular invasion; and (d) 35mm PTC without nodal metastases. Survey items explored clinician preferences for initial management and follow-up. Results: Data for 75 respondents (25 endocrinologists, 50 surgeons) are presented . For vignettes b,c and d, hemithyroidectomy was recommended by 73%, 63% and 14% respectively and radioactive iodine offered to 9%, 16% and 62% respectively. Clinicians offered long-term specialist followup to 23%, 75%, 87% and 97% respectively. 79% of clinicians would follow these patients annually. When asked how they felt patients perceived risk of recurrence, 78% of clinicians responded that patients’ fear of recurrence was greater than actual risk. Conclusion: There is marked inter-clinician variation in follow up within individual vignettes; and intra-clinician variation across all four vignettes. Further understanding of the impact of follow-up on patients’ quality of life may guide clinician practice. Editorial material and organization © 2021 Royal Australasian College of Surgeons. Copyright of individual abstracts remains with the authors. ANZ J. Surg. 2021; 91 (S1) 52–59