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Thyroid Cancer: Current Diagnosis, Management, and Prognostication, An Issue of Otolaryngologic Clinics of North America, E-Book

Thyroid Cancer: Current Diagnosis, Management, and Prognostication, An Issue of Otolaryngologic Clinics of North America, E-Book

Robert L. Witt

(2014)

Additional Information

Abstract

This Otolaryngologic Clinics' publication’s intent is to provide standard and state of the art clinician performed thyroid ultrasound and ultrasound guided FNA technique. The subject area is evolving rapidly with new technologies being incorporated. This title integrates thyroid cytology, FNA and Ultrasound Guided FNA with inclusion of diagnostic molecular testing. Clinical Thyroid Molecular Testing has ushered in a new era to the diagnosis, management and prognostication of thyroid nodules. The discussion of this highly clinically applicable subject is described in terms of diagnostic process. This is a thyroid neoplasm clinical “game changer” for the General Otolaryngologist, Head and Neck Surgeon, General Surgeon, Endocrinologist, Pathologist, and Radiologist. This testing maximizes the number of patients who have cancer to receive the correct therapeutic surgery appropriately and minimizes the number of patients who do not need surgery (and avoid the potential complications and surgery) because they do not have cancer. Surgical management and prognostication have far reaching implications with fine needle aspiration driven molecular markers. Some topics include: Clinical evaluation of the thyroid nodule; Thyroid cytology; Clinician performed thyroid ultrasound; Clinician performed thyroid ultrasound guided FNA; Thyroid cancer molecular laterations - what the surgeon should know; Thyroid cancer multi-gene expression - what the surgeon needs to know; Incorporating molecular testing into your thyroid practice - five experts discuss; and others.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Thyroid Cancer: CurrentDiagnosis, Management,and Prognostication i
Copyright ii
Contributors v
Contents ix
Otolaryngologic Clinics\rof North America xii
Correction xiii
Preface xv
Evidence-Based Evaluation of the Thyroid Nodule 461
Key points 461
The thyroid nodule—scope of the problem 461
Patient presentation 462
Assessment of risk factors 464
Age 464
Gender 465
Radiation Exposure 465
Family History and Cancer Syndromes 465
Workup of the thyroid nodule 466
TSH and Other Laboratory Tests 466
Scintigraphy 466
Ultrasound 467
Needle Biopsy 468
Molecular Markers 469
Closing thoughts about thyroid nodule evaluation 470
Risk of Death for the Patient Found to Have a Thyroid Cancer 470
Active Monitoring of Small Nodules 470
Limitations of Existing Guidelines on Thyroid Nodule Management 470
References 471
Thyroid Cytology 475
Key points 475
Introduction 475
Nondiagnostic specimen 476
Benign thyroid lesions 476
Benign Follicular Nodule 477
Thyroiditis 477
Malignant thyroid lesions 478
Papillary Carcinoma 478
Medullary Carcinoma 478
Poorly Differentiated Carcinoma 480
Undifferentiated Anaplastic Carcinoma 480
Lymphoma 480
Metastatic Tumors to the Thyroid 481
Indeterminate thyroid lesions 482
Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance 482
Follicular Neoplasm/Suspicious for Follicular Neoplasm 483
Bethesda V Category (Suspicious for Malignancy) 484
Ancillary Studies 485
References 488
Clinician-Performed Thyroid Ultrasound 491
Key points 491
Introduction 491
Initial ultrasound training 492
Obtaining adequate experience: validation and assessment of competency 492
Essential equipment and the economics of clinic-based ultrasound 494
Monitor 495
Imaging Modes 495
Cineloop Capabilities 495
Transducer 495
Output Modalities 495
Peripherals 495
Display Dynamic Range 496
Frame Rate 496
Bottom line on technical specifications 496
Image documentation for medical billing 496
The essential ultrasound findings 497
Use of ultrasound in the operating room in the immediate preoperative setting 500
Ultrasound in Thyroid Surgery 500
Pre-incision Ultrasound 502
Ultrasound for the N0 Neck 503
Intraoperative Localization of Lymph Nodes 504
Head and Neck Anatomic Landmarks 504
Further readings 505
References 505
Clinician-Performed Thyroid Ultrasound-Guided Fine-Needle Aspiration 509
Key points 509
Introduction 509
Ultrasound-guided FNA 510
Thyroid FNA biopsy 510
Technical aspects of USGFNA 511
Summary 517
Supplementary data 517
References 517
Surgical Diagnosis 519
Key points 519
Overview 519
Relevant anatomy and pathophysiology and their impact on risk prediction 520
Clinical presentation/examination 521
Available procedures and choice of procedure 522
Planning primary thyroid surgery 522
Planning neck dissection 523
Diagnosis in the operating room 524
Clinical outcomes in the literature 525
Summary 525
References 526
Contemporary Surgical Techniques 529
Key points 529
Introduction 529
Background and history 530
Advantages and disadvantages of alternative approaches 531
Approaches 531
Minimally Invasive Anterior Cervical 531
Minimally invasive video-assisted thyroidectomy 531
Patient selection 533
Minimally invasive nonendoscopic thyroidectomy 534
Remote Access Endoscopic 535
Chest/Breast approaches 535
Axillary approaches 536
Remote Access Robotic Procedures 536
Bilateral axillo-breast approach 537
Robotic axillary thyroidectomy 538
Robotic facelift thyroidectomy 538
Summary 541
References 541
Management of the Neck in Thyroid Cancer 545
Key points 545
Introduction 545
Lymphadenectomy for thyroid cancer 546
Central Lymph Node Compartment 546
Lateral Node Involvement 546
Prophylactic Neck Dissection 547
Subtypes of Papillary Thyroid Carcinoma 548
Clinical Application of Molecular Testing of Fine-needle Aspiration Specimens in Thyroid Nodules 557
Key points 557
Introduction 557
Molecular causes of thyroid malignancies 559
Papillary Thyroid Carcinoma 559
FTC and FA 560
Poorly Differentiated Thyroid Carcinomas 561
Biomarkers used for tumor detection and prognostication 561
Molecular Testing of FNAB Specimens 561
BRAF 561
RAS 562
RET/PTC 562
Panel testing 563
Prognostication Using Biomarkers 563
Genetic Analysis of Multifocal PTC 565
Techniques for biomarker detection 566
NGS 566
Summary 567
References 567
Clinical Diagnostic Gene Expression Thyroid Testing 573
Key points 573
Thyroid cancer multigene expression classifiers: what the surgeon should know 573
Introduction 573
Cost, Morbidity, and Risk of Mortality from Surgery 574
Regulation of Molecular Diagnostic Tests 576
Veracyte Afirma GEC 576
Analytical Validity 578
Clinical Validity and Clinical Practice Experience 579
Diagnostic application 582
Clinical Decision-Making 582
False Negative Results Are the Most Important Diagnostic Error 583
Suspicious for Hürthle Cell Neoplasm Cytology 583
Rare Neoplasms 585
Clinical Utility and Cost-Effectiveness 586
Future Directions 587
Summary 588
References 588
The Prognostic Implications from Molecular Testing of Thyroid Cancer 595
Key points 595
Introduction 595
Relevant pathophysiology 596
Genetic Alteration of Mitogen-activated Protein Kinase Signaling Pathway 596
BRAF Mutation 597
RET/PTC Rearrangement 597
RAS Mutation 597
PAX8-PPAR Rearrangement 598
Clinical presentation and examination 598
Prognostic applications of molecular markers in thyroid cancer 599
BRAF Mutation and Prognosis of Thyroid Cancer 599
RAS Mutation, RET/PTC Rearrangement, PAX8/PPAR Rearrangement, and Prognosis of Thyroid Cancer 599
TERT Promoter Mutations and Prognosis of Thyroid Cancer 599
Therapeutic applications of molecular markers in thyroid cancer 600
BRAF Mutation in the Management of Thyroid Cancer 600
BRAF mutation, extrathyroidal extension, and multifocality 600
BRAF mutation and lymph node metastasis 600
BRAF mutation and distant metastasis 601
BRAF mutation, and American Joint Commission for Cancer stage of disease 601
RAS Mutation in the Management of Thyroid Cancer 601
RET/PTC and PAX8/PPAR Rearrangement in the Management of Thyroid Cancer 602
Implications of Molecular Markers for Targeted Therapy in the Management of Thyroid Cancer 602
Future trends and conclusions 602
References 603
Decision Making for Diagnosis and Management 609
Key points 609
Introduction 610
Cases for discussion 612
Case 1: Incidentally Noted Thyroid Nodule on Carotid Ultrasound 612
Bumpous 613
Pribitkin 614
Stack 614
Bumpous 614
Case 2: Asymptomatic Thyroid Mass 615
Stack 615
Bumpous 616
Pribitkin 616
Case 3: Rapidly Enlarging Thyroid Mass 616
Stack 616
Pribitkin 617
Stack 617
Bumpous 617
Index 625