A new study shows that individuals with indeterminate thyroid nodules may receive an inappropriate initial extent of surgery. Researchers evaluated 639 adults with indeterminate thyroid nodules to determine the accuracy of the extent of initial thyroidectomy. They concluded that tools are needed to identify benign and malignant disease before deciding on surgery. David Schneider, MD, MS in the Department of Surgery at the University of Wisconsin says, “Providers try to predict how much surgery is necessary for an indeterminate thyroid nodule by their estimation of its risk of being cancer…Even the high-volume providers in our study performed an oncologically incorrect amount of surgery 30% of the time.”
The goal of the study was to determine the accuracy and factors associated with the extent of initial thyroidectomy for indeterminate thyroid nodules. Dr. Schneider notes, “There are an ever-increasing number of adjuncts trying to help surgeons and endocrinologists preoperatively diagnose indeterminate nodules as cancer or benign…it’s important for institutions to understand their baseline accuracy in predicting cancer. This will help them evaluate and choose an adjunct that fits their specific needs.” Dr. Schneider mentions that the study was performed using the 2009 American Thyroid Association guidelines, so it would be worthwhile for another study to look at the accuracy of decision-making under the new 2015 guidelines, as lobectomy is now considered adequate treatment for many low-risk cancers.
The goal of the TCCC (Thyroid Cancer Care Collaborative) align with this study, as the TCCC uses the guidelines set by the American Thyroid Association to automatically provide users with the clinical course suggested by these national guidelines. Decision making plays an essential role in health outcomes, and the TCCC is dedicated to education both patients and physicians on up to date research to aid in the decision-making process.