Elevated incidence, reasonable interventions for papillary thyroid carcinoma

Over the past few decades, microscopic papillary thyroid carcinoma (mPTC) incidence has skyrocketed.

Despite the dramatic increase in cases, mortality rates have remained stable due to:

• Imaging advances
• Increased screening
• Environmental factors

"Medical centers have been doing much more imaging in the last two decades. CT of chest, neck or head; carotid ultrasound; spine MRI; and PET scans are all studies likely to include some thyroid images. Once you open this Pandora's box, you will likely find small thyroid nodules." Marius N. Stan, M.D., Endocrinologist at Mayo Clinic’s campus in Rochester, Minnesota

Treatment options for mPTCs

There are three approaches when an mPTC is found, and physicians must differentiate between high- and low-risk mPTCs.

• Watchful waiting for low-risk mPTC
  Results differ little over time between patients who experienced mPTC removal and patients placed on active surveillance.
• Surgical intervention for high-risk mPTC
  High-risk mPTC of less than or equal to 10 mm warrants surgery given these high-risk characteristics:
  • N+ of M+
  • High-grade malignancy, per cytology specimen analysis
  • Disease progression
  • Tracheal invasion or recurrent laryngeal nerve injury indications
• Ablative therapies for high-risk mPTC
  Percutaneous ethanol ablation, laser ablation, radiofrequency ablation (RFA), microwave ablation, and high-intensity focused ultrasound are all ablative therapies.

50% - 80% — Benefits of RFA for mPTC over surgery

Initially, RFA was used for golf ball-sized lesions that affected swallowing or altered the patient's aesthetics. These large lesions decreased 50% to 80% in the first year post-treatment, which led RFA to be used in smaller thyroid cancers as well.

RFA is currently the preferred ablative therapy.

Targeted treatment

RFA is highly focused and treats only the cancer, sparing the thyroid. Surgery entails removing half the thyroid, which often leads to hypothyroidism and lifelong treatment.

Cost

The cost of RFA is less than one-half the cost of surgical removal.

Reduced pain

Virtually all patients tolerate post-RFA pain with acetaminophen, and the pain rarely lasts past 2 to 3 days.

No scarring

RFA avoids long-term scarring.

For high-risk mPTCs, consider RFA.

More mPTCs are being discovered and it’s important to know how to treat them. For many high-risk mPTCs, RFA can be the best course of treatment. Differentiating by risk is the best first step when an mPTC is found.

Refer a patient

You can refer patients to Mayo Clinic securely online using the CareLink referral portal at CareLink.MayoClinic.org. To refer over the phone, contact your Mayo Clinic location.

• Phoenix/Scottsdale, Arizona: 866-629-6362
• Rochester, Minnesota: 800-533-1564
• Jacksonville, Florida: 800-634-1417

For more information

• Park S, et al. Association between screening and the thyroid cancer "epidemic" in South Korea: Evidence from a nationwide study. BMJ. 2016;355:i5745. Haugen BR, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules or differentiated thyroid cancer. Thyroid. 2016;26:1.