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Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies

  • Original Article
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Abstract

Background

Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent.

Methods

Six scientific Italian societies entitled to cure thyroid cancer patients (the Italian Thyroid Association, the Medical Endocrinology Association, the Italian Society of Endocrinology, the Italian Association of Nuclear Medicine and Molecular Imaging, the Italian Society of Unified Endocrine Surgery and the Italian Society of Anatomic Pathology and Diagnostic Cytology) felt the need to develop a consensus report based on significant scientific advances occurred in the field.

Objective

The document includes recommendations regarding initial evaluation of thyroid nodules, clinical and ultrasound criteria for fine-needle aspiration biopsy, initial management of thyroid cancer including staging and risk assessment, surgical management, radioiodine remnant ablation, and levothyroxine therapy, short-term and long-term follow-up strategies, and management of recurrent and metastatic disease. The objective of this consensus is to inform clinicians, patients, researchers, and health policy makers about the best strategies (and their limitations) relating to the diagnosis and treatment of differentiated thyroid cancer.

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Abbreviations

PTMC:

Papillary thyroid microcarcinoma

DTC:

Differentiated thyroid cancer

Tg:

Thyroglobulin

TgAb:

Anti-thyroglobulin antibodies

rhTSH:

Recombinant human TSH

WBS:

Whole-body scan

RAI:

Radioactive iodine

US:

Ultrasound

FNA(C):

Fine-needle aspiration (cytology)

CCND:

Central compartment neck dissection

LID:

Low-iodine diet

MTA:

Maximum tolerated activity (of radioiodine)

CN0:

No clinical evidence of lymph nodes

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Author information

Authors and Affiliations

  1. Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100, Siena, Italy

    F. Pacini

  2. Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy

    F. Basolo & P. Miccoli

  3. U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy

    R. Bellantone & C. P. Lombardi

  4. Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy

    G. Boni

  5. Department of Medical and Surgical Sciences, Advanced Technologies “G.F.Ingrassia”, University of Catania, Catania, Italy

    M. A. Cannizzaro

  6. Dipartimento Chirurgico Generale e Polispecialistico Chirurgia 2, AORN Cardarelli, Naples, Italy

    M. De Palma

  7. Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy

    C. Durante

  8. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    R. Elisei & P. Vitti

  9. Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy

    G. Fadda

  10. Endocrinology Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy

    A. Frasoldati

  11. Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy

    L. Fugazzola

  12. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    L. Fugazzola

  13. Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy

    R. Guglielmi & E. Papini

  14. Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy

    G. Pellegriti

  15. Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori-IRCCS ‘Fondazione G. Pascale’, Naples, Italy

    L. Pezzullo

  16. Cattedra di Endocrinologia, Area di Endocrinologia e Malattie Metaboliche, Università Cattolica del Sacro Cuore, Rome, Italy

    A. Pontecorvi

  17. Istituto di Medicina Nucleare, Policlinico Gemelli, Rome, Italy

    M. Salvatori

  18. Struttura di Terapia Medico Nucleare ed Endocrinologia U.O. Medicina Nucleare Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy

    E. Seregni

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  1. F. Pacini
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  6. M. De Palma
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Corresponding author

Correspondence to F. Pacini.

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Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

This study complies with ethical standard of research. It does not involve data or treatment of human being nor animals.

Informed consent

For this type of study informed consent is not required.

Additional information

Joint statements of six Italian societies: The Italian Thyroid Association (AIT), the Medical Endocrinology Association (AME), the Italian Society of Endocrinology (SIE), the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN), the Italian Society of Unified Endocrine Surgery (SIUEC) and the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC).

Appendix 1: Reporting form for thyroid tumors

Appendix 1: Reporting form for thyroid tumors

Gross description (macroscopic)

Thyroid

  • Weight (size)

  • Multinodularity/uninodularity

  • Macroscopic appearance of the nodule:

    • diameter

    • homogeneous/heterogeneous

    • tumor color

    • expansive margins/infiltrative margins

    • presence/absence of a capsule

    • solid/colloid

    • cystic-hemorrhagic regression

    • calcifications (pattern and location).

  • Site

    • right lobe

    • left lobe

    • isthmus

    • pyramidal lobe

  • Distance from thyroid capsule/surgical margins

Lymph nodes

  • Site

  • Size of the specimen

  • Gross features of the largest nodes.

Microscopic examination

Thyroid nodule

  • Capsule (present/absent)

  • Structure (colloid/sclerotic/solid)

  • Histotype

    • NIFT-P

    • Papillary

      • Classical variant

      • Follicular variant

    • Follicular

      • Minimally invasive

      • Widely invasive

    • Oncocytic

    • Poorly differentiated (insular)

    • Anaplastic

    • Medullary

    • Thyroid lymphoma

    • Secondary tumors

  • Aggressive variants of PTC:

    • hobnail (report the presence)

    • tall cells (more than 10%)

    • solid (percentage value)

    • columnar cell (more than 10%)

    • diffuse sclerosing (report the presence)

  • Capsular invasion (tumor capsule/thyroid capsule)

  • Vascular invasion (no. of vessels: 4 or more) [19]

  • Minimal muscular invasion (strap muscles)

  • Extrathyroidal invasion (subcutaneous soft tissues, larynx, trachea, esophagus, recurrent laryngeal nerve, pre-vertebral fascia, neck muscles, large vessels) [20]

  • Immunohistochemistry and molecular analysis (if performed).

Lymph nodes

  • Total number

  • Number of metastatic nodes

  • Size of the largest metastatic area within the node, micro- (< 2 mm) or macrometastases Presence of extranodal invasion [75,76,77].

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Pacini, F., Basolo, F., Bellantone, R. et al. Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J Endocrinol Invest 41, 849–876 (2018). https://doi.org/10.1007/s40618-018-0884-2

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  • DOI: https://doi.org/10.1007/s40618-018-0884-2

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