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Thyroid imaging identifies cancer recurrence, may not increase survival
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Recurrence of thyroid cancer may be identified with more imaging, but imaging may not increase survival rates, recent findings show.
“Despite a known rise in the incidence of low-risk thyroid cancer, we found a paradoxical rise in imaging after initial treatment for thyroid cancer,” Megan R. Haymart, MD, assistant professor of medicine at the University of Michigan Medical School in Ann Arbor, told Endocrine Today. “We found that this marked rise in imaging after primary treatment of differentiated thyroid cancer was associated with increased treatment for recurrence but with the exception of radioiodine scans in presumed iodine-avid disease, no clear improvement in disease specific survival.”
Megan R. Haymart
Haymart and colleagues evaluated data from the Surveillance, Epidemiology and End Results-Medicare linked database on 28,220 patients with differentiated thyroid cancer (DTC) diagnosed between 1998 and 2011 to determine whether imaging after primary treatment for DTC is associated with treatment for recurrence and increased survival. Follow-up was conducted until 2013 for a median follow-up of 69 months.
“With this posttreatment surveillance imaging, we’re picking up more recurrences,” Mousumi Banerjee, PhD, research professor of biostatistics at the University of Michigan School of Public Health, said in the release. “But is that clinically significant? We might be picking up really small lymph nodes that if left untreated wouldn’t have impacted survival.”
Mousumi Banerjee
Incident cancer (RR = 1.05; 95% CI, 1.05-1.06), imaging (RR = 1.13; 95% CI, 1.12-1.13) and treatment of recurrence (RR = 1.01; 95% CI, 1.01-1.02) all increased from 1998 to 2011, but there was no change in death rate. Specific treatment trends also rose after recurrence for additional radioactive iodine treatment (RR = 1.02; 95% CI, 1.01-1.03), additional neck surgery (RR = 1.01; 95% CI, 0.99-1.02) and additional radiotherapy (RR = 1.01; 95% CI, 0.99-1.02).
The likelihood of additional surgery (OR = 2.3; 95% CI, 2.05-2.58) and additional radioactive iodine treatment (OR = 1.45; 95% CI, 1.26-1.69) increased with ultrasound. Additional surgery (OR = 3.39; 95% CI, 30.6-3.76), radioactive iodine treatment (OR = 17.83; 95% CI, 14.49-22.16) and radiotherapy (OR = 1.89; 95% CI, 1.71-2.1) were all associated with radioiodine scans. Additional surgery (OR = 2.31; 95% CI, 2.09-2.55), radioactive iodine treatment (OR = 2.13; 95% CI, 1.89-2.4) and radiotherapy (OR = 4.98; 95% CI, 4.52-5.49) were all associated with PET scans.
Overall, 4.1% of participants died, and disease specific survival was not affected by neck ultrasound (HR = 1.14; 95% CI, 0.98-1.27) or PET scans (HR = 0.91; 95% CI, 0.77-1.07). Disease-specific survival was improved with radioiodine scans (HR = 0.7; 95% CI, 0.6-0.82).
“The findings of this study emphasize the importance of curbing unnecessary imaging and tailoring imaging to patient risk,” Haymart told Endocrine Today. “There is a role for imaging patients after initial treatment for thyroid cancer but the specific type of imaging and the frequency of imaging needs to be tailored to the patient.” – by Amber Cox
For more information:
Megan R. Haymart, MD, can be reached at University of Michigan Health System, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Room 408E, Ann Arbor, MI, 48109; email: meganhay@med.umich.edu.
Disclosure: The researchers report no relevant financial disclosures.
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