Livia Lamartina1, Cosimo Durante1, Giuseppe Lucisano2, Giorgio Grani1, Rocco Bellantone3, Celestino Pio Lombardi3, Alfredo Pontecorvi4, Emanuela Arvat5, Francesco Felicetti5, Maria C Zatelli6, Roberta Rossi6, Efisio Puxeddu7, Silvia Morelli7, Massimo Torlontano8, Umberto Crocetti8, Teresa Montesano9, Raffaele Giubbini10, Fabio Orlandi11, Gianluca Aimaretti12, Fabio Monzani13, Marco Attard14, Cecilia Francese15, Alessandro Antonelli16, Paolo Limone17, Ruth Rossetto18, Laura Fugazzola19,20, Domenico Meringolo21, Rocco Bruno22, Salvatore Tumino23, Graziano Ceresini24, Marco Centanni25, Salvatore Monti26, Domenico Salvatore27, Giovanna Spiazzi28, Caterina Mian29, Luca Persani19,30, Daniele Barbaro31, Antonio Nicolucci2, Sebastiano Filetti1. 1. 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy . 2. 2 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy . 3. 3 Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy . 4. 4 Division of Endocrinology and Metabolic Diseases, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy . 5. 5 Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy . 6. 6 Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna , Ferrara, Italy . 7. 7 Department of Medicine, University of Perugia , Perugia, Italy . 8. 8 Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS , San Giovanni Rotondo, Italy . 9. 9 Department of Nuclear Medicine, University of Rome Sapienza , Rome, Italy . 10. 10 Nuclear Medicine Unit, Spedali Civili Università degli Studi di Brescia , Brescia, Italy . 11. 11 Department of Oncology, Division of Endocrinology and Metabolism, Humanitas-Gradenigo Hospital, University of Turin, Turin, Italy . 12. 12 Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale , Novara, Italy . 13. 13 Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy . 14. 14 Division of Endocrinology, Cervello Hospital , Palermo, Italy . 15. 15 Division of Endocrinology , Clinica Salus di Battipaglia, Salerno, Italy . 16. 16 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy . 17. 17 Division of Endocrinology, Diabetology, and Metabolism, Mauriziano Umberto I Hospital , Turin, Italy . 18. 18 Division of Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy . 19. 19 Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano , Milan, Italy . 20. 20 Department of Pathophysiology and Transplantation, University of Milan , Milan, Italy . 21. 21 Simple Operating Unit, Department of Endocrinology, Bentivoglio Hospital , Bologna, Italy . 22. 22 Unit of Endocrinology, Tinchi-Pisticci Hospital , Matera, Italy . 23. 23 Department of Clinical and Experimental Medicine, University of Catania , Catania, Italy . 24. 24 Department of Medicine and Surgery, University of Parma , Parma, Italy . 25. 25 Department of Medical and Surgical Sciences and Biotechnology, University of Rome Sapienza , Latina, Italy . 26. 26 Department of Endocrinology, Ospedale S. Andrea, Sapienza Università di Roma, Rome, Italy . 27. 27 Department of Clinical Medicine and Surgery, University of Naples "Federico II ," Naples, Italy . 28. 28 Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona , Verona, Italy . 29. 29 Endocrinology Unit, Department of Medicine-DIMED, University Hospital of Padua , Padua, Italy . 30. 30 Department of Clinical Sciences and Community Health, University of Milan , Milan, Italy . 31. 31 U.O. Endocrinologia, Livorno, ASL Nord Ovest Toscana , Livorno, Italy .
Abstract
OBJECTIVES: The goal of evidence-based practice guidelines is to optimize the management of emerging diseases, such as differentiated thyroid cancer (DTC). The aim of this study was to assess therapeutic approaches for DTC in Italy and to see how closely these practices conformed to those recommended in the 2009 American Thyroid Association (ATA) guidelines. METHODS: The Italian Thyroid Cancer Observatory was established to collect data prospectively on thyroid cancers consecutively diagnosed in participating centers (uniformly distributed across the nation). Data on the initial treatment of all pathologically confirmed DTC cases present in the database from January 1, 2013 (database creation) to January 31, 2016, were analyzed. RESULTS: A total of 1748 patients (77.2% females; median age 48.1 years [range 10-85 years]) were enrolled in the study. Most (n = 1640; 93.8%) were papillary carcinomas (including 84 poorly differentiated/aggressive variants); 6.2% (n = 108) were follicular and Hürthle cell carcinomas. The median tumor diameter was 11 mm (range 1-93 mm). Tumors were multifocal in 613 (35%) and presented extrathyroidal extension in 492 (28%) cases. Initial treatments included total thyroidectomy (involving one or two procedures; n = 726; 98.8%) and lobectomy (n = 22; 1.2%). A quarter of the patients who underwent total thyroidectomy had unifocal, intrathyroidal tumors ≤1 cm (n = 408; 23.6%). Neck dissection was performed in 40.4% of the patients (29.5% had central compartment dissection). Radioiodine remnant ablation (RRA) was performed in 1057 (61.2%) of the 1726 patients who underwent total thyroidectomy: 460 (41.2%) of the 983 classified by 2009 ATA guideline criteria as low-risk, 570 (87.1%) of the 655 as intermediate-risk, and 82 (93.1%) of the 88 as high-risk patients (p < 0.001). RRA was performed in 44% of the cases involving multifocal DTCs measuring ≤1 cm. CONCLUSIONS: The treatment approaches for DTCs used in Italy display areas of inconsistency with those recommended by the 2009 ATA guidelines. Italian practices were characterized by underuse of thyroid lobectomy in intrathyroidal, unifocal DTCs ≤1 cm. The use of RRA was generally consistent with risk-stratified recommendations. However, its frequent use in small DTCs (≤1 cm) that are multifocal persists, despite the lack of evidence of benefit. These data provide a baseline for future assessments of the impact of international guidelines on DTC management in Italy. These findings also illustrate that the dissemination and implementation of guideline recommendations, and the change in practice patterns, require ongoing education and time.
OBJECTIVES: The goal of evidence-based practice guidelines is to optimize the management of emerging diseases, such as differentiated thyroid cancer (DTC). The aim of this study was to assess therapeutic approaches for DTC in Italy and to see how closely these practices conformed to those recommended in the 2009 American Thyroid Association (ATA) guidelines. METHODS: The Italian Thyroid Cancer Observatory was established to collect data prospectively on thyroid cancers consecutively diagnosed in participating centers (uniformly distributed across the nation). Data on the initial treatment of all pathologically confirmed DTC cases present in the database from January 1, 2013 (database creation) to January 31, 2016, were analyzed. RESULTS: A total of 1748 patients (77.2% females; median age 48.1 years [range 10-85 years]) were enrolled in the study. Most (n = 1640; 93.8%) were papillary carcinomas (including 84 poorly differentiated/aggressive variants); 6.2% (n = 108) were follicular and Hürthle cell carcinomas. The median tumor diameter was 11 mm (range 1-93 mm). Tumors were multifocal in 613 (35%) and presented extrathyroidal extension in 492 (28%) cases. Initial treatments included total thyroidectomy (involving one or two procedures; n = 726; 98.8%) and lobectomy (n = 22; 1.2%). A quarter of the patients who underwent total thyroidectomy had unifocal, intrathyroidal tumors ≤1 cm (n = 408; 23.6%). Neck dissection was performed in 40.4% of the patients (29.5% had central compartment dissection). Radioiodine remnant ablation (RRA) was performed in 1057 (61.2%) of the 1726 patients who underwent total thyroidectomy: 460 (41.2%) of the 983 classified by 2009 ATA guideline criteria as low-risk, 570 (87.1%) of the 655 as intermediate-risk, and 82 (93.1%) of the 88 as high-risk patients (p < 0.001). RRA was performed in 44% of the cases involving multifocal DTCs measuring ≤1 cm. CONCLUSIONS: The treatment approaches for DTCs used in Italy display areas of inconsistency with those recommended by the 2009 ATA guidelines. Italian practices were characterized by underuse of thyroid lobectomy in intrathyroidal, unifocal DTCs ≤1 cm. The use of RRA was generally consistent with risk-stratified recommendations. However, its frequent use in small DTCs (≤1 cm) that are multifocal persists, despite the lack of evidence of benefit. These data provide a baseline for future assessments of the impact of international guidelines on DTC management in Italy. These findings also illustrate that the dissemination and implementation of guideline recommendations, and the change in practice patterns, require ongoing education and time.
Authors: G Grani; D Tumino; V Ramundo; L Ciotti; C Lomonaco; M Armillotta; R Falcone; P Lucia; M Maranghi; S Filetti; C Durante Journal: J Endocrinol Invest Date: 2019-06-15 Impact factor: 4.256
Authors: Eleonora Molinaro; Maria Cristina Campopiano; Letizia Pieruzzi; Antonio Matrone; Laura Agate; Valeria Bottici; David Viola; Virginia Cappagli; Laura Valerio; Carlotta Giani; Luciana Puleo; Loredana Lorusso; Paolo Piaggi; Liborio Torregrossa; Fulvio Basolo; Paolo Vitti; R Michael Tuttle; Rossella Elisei Journal: J Clin Endocrinol Metab Date: 2020-03-01 Impact factor: 5.958
Authors: L Dal Maso; C Panato; A De Paoli; V Mattioli; D Serraino; R Elisei; G Zoppini; C Gobitti; E Borsatti; E Di Felice; F Falcini; S Ferretti; S Francisci; P Giorgi Rossi; S Guzzinati; G Mazzoleni; D Pierannunzio; S Piffer; S Vaccarella; M Vicentini; M Zorzi; S Franceschi; U Fedeli Journal: J Endocrinol Invest Date: 2021-01-18 Impact factor: 4.256