Evolution in the management of thyroid cancer: an observational study in two referral centres in Belgium

Objective Thyroid cancer incidence is increasing. The rise is most pronounced for microcancers (≤10 mm, T1a). In 2006, landmark European and American guidelines for the management of thyroid cancer were published. We studied thyroid cancer characteristics and initial management before and after 2006. Methods We conducted a retrospective observational study of non-medullary thyroid cancer patients that underwent thyroidectomy in two Belgian referral centres comparing pre-, per- and post-operative management in a cohort before and after 2006. Results Cancer subtypes and dimensions in cohort 1 (C1, n = 69) and cohort 2 (C2, n = 60) were comparable, with papillary thyroid cancer (PTC) as main subtype (86 and 82%, respectively), and T1a as main dimension (30 and 38%). In C2, a comparable proportion presented as incidentaloma (20 vs. 14% in C1). Pre-surgical fine needle aspiration (FNA) was performed in 75% in C1 and 83% in C2. The indications for thyroidectomy were comparable, with Bethesda 5-6 as main indication (43% in C1, 52% in C2). No differences were observed for execution of lymph node dissection in the PTC subgroup, hypoparathyroidism and recurrent nerve paresis after 1 year. Less radioiodine was administered in C2 (57 vs 74% in C1, p = 0.04). More neck ultrasonography at 1 year was performed in >T1aN0/x patients (73 vs 49% in C1, p = 0.02). Conclusion The use of FNA is high and established. The proportion of T1a cancers is stable. A shift in the post-operative management is observed towards more restrictive use of radioiodine and increased use of ultrasonography, in accordance with the international guidelines.