Abstract
Abstract
Introduction:
Risk stratification is the cornerstone of nearly all diagnostic and therapeutic management decisions in differentiated thyroid cancer. In this video, I review the current approach to risk stratification that emphasizes initial risk stratification using the American Thyroid Association risk stratification system and the American Joint Commission on Cancer staging systems augmented by ongoing risk stratification as new data become available over time. Although risk stratification can be divided into three general time frames (preoperative, intraoperative, and postoperative time periods), this video focuses on risk stratification in the preoperative period.
Materials and Methods:
Review of risk stratification as described in the American Thyroid Association guidelines for the management of thyroid nodules and thyroid cancer in adults with personal recommendations regarding practical application in clinical practice.1–7
Results:
Risk stratification is an active dynamic process that begins as soon as a potentially malignant thyroid nodule is detected and continues through all aspects of diagnosis and therapy. Risk stratification is used to inform decision-making with regard to (1) the need for surgical intervention, (2) the extent of initial thyroid surgery, (3) the extent of cervical lymph node dissection, (4) the need for surgical resection involving surrounding major neck structures, and (5) the need for treatment of distant metastases before thyroidectomy.
Conclusions:
Risk stratification should be used to inform nearly all diagnostic and therapeutic management decisions in differentiated thyroid cancer. Appropriate risk stratification allows the clinician to tailor the extent of therapy and follow-up to real-time assessments of risk for each individual patient.
Runtime of video: 9 mins 1 secs
Get full access to this article
View all access options for this article.