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Referral Practice for Radioactive Iodine Ablation (RAI) after ATA guidelines 2015: results from a Tertiary Cancer Care Centre

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Abstract

Introduction

The ATA guidelines for differentiated thyroid cancer (DTC) are one of the most widely referred to. Their 2015 edition proposed a new risk stratification system and modified the indications for radioactive iodine (RAI) ablation especially for the low risk category. We attempted to analyze whether the new guidelines altered referral practices for RAI ablation at our institute.

Methodology

Patients who underwent total or completion thyroidectomy for DTC during 2016–2017 were included. Relevant demographical and pathological data was tabulated. Patients were classified as per the new stratification system and referral practice for RAI ablation documented.

Results

238 patients were included. Of these 20.6% were low risk, 44.1% were intermediate and 35.3% were high risk as per modified guidelines. All patients within the intermediate and high-risk group and 77.8% of the low risk group were referred for RAI ablation. Analysis of risk factors revealed that within the low risk group there were three patients with < 5 metastatic nodes, all within 3 cm in size—a category that the ATA failed to stratify appropriately. Among those labeled as Intermediate risk due to microscopic extra thyroidal extension (ETE), 85% had no other risk factors and were upstaged solely due to microscopic ETE, which is interestingly no longer included in the TNM staging.

Conclusion

Majority of low risk patients continue to receive RAI ablation due to persistent belief emanating from literature that remnant ablation improves outcomes and aids in follow up. The issue of RAI ablation for low risk group and prognostic implications of microscopic ETE and limited nodal disease need to be revisited.

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Funding

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Authors and Affiliations

  1. Narayana Superspeciality Hospital, Howrah, Kolkata, West Bengal, India

    Harsh Dhar

  2. Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India

    Shivakumar Thiagarajan & Devendra Chaukar

  3. Department of ENT, Government Medical College, Srinagar, India

    Aamir Yousuf

  4. Department of ENT, Base Hospital, New Delhi, India

    Supreet Singh Nayyar

Authors
  1. Harsh Dhar
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  2. Shivakumar Thiagarajan
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  3. Aamir Yousuf
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  4. Supreet Singh Nayyar
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  5. Devendra Chaukar
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Contributions

Study concepts: ST, DC, HD. Study design: ST, HD. Data acquisition: AY, HD, SSN. Quality control of data and algorithms: ST, DC. Statistical analysis: ST, HD. Manuscript preparation: all authors. Manuscript editing: ST, HD, DC. Manuscript reviewing: all authors.

Corresponding author

Correspondence to Shivakumar Thiagarajan.

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The authors declare that they have no competing interest.

Ethical approval

Exempted, as it was a clinical audit of an existing database. No patient contact was made. All received the standard of care for their condition and was as per the ethical standards.

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No identifying information about participants is available in the article. However, all patients have given consent for the treatment they have received.

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Dhar, H., Thiagarajan, S., Yousuf, A. et al. Referral Practice for Radioactive Iodine Ablation (RAI) after ATA guidelines 2015: results from a Tertiary Cancer Care Centre. Eur Arch Otorhinolaryngol 277, 2521–2526 (2020). https://doi.org/10.1007/s00405-020-05946-4

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  • DOI: https://doi.org/10.1007/s00405-020-05946-4

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