Variability in the management of differentiated thyroid cancer (DTC)
Reviewed by Thomas Jacques

This retrospective study analyses for the first time the management planning of thyroid surgeons across the specialties. A questionnaire was sent to members of ENT-UK, the British Association of Endocrine and Thyroid Surgeons, Association of Surgeons of Great Britain and Ireland, and the Association of Breast Surgery. Six clinical vignettes were given, describing DTC patients with differing levels of risk, with several options in terms of subsequent management. The available options were denoted either risk-stratified (RS) or non-risk-stratified (NRS) choices, as determined by expert consensus based on current evidence. NRS choices indicated under- or over-treatment of the patient. Data regarding the experience and practice of the surgeons was also collected. The study revealed considerable variability in practice, particularly in patients of intermediate risk (e.g. older patients with incidental, low-risk disease). The authors attribute this in part to a lack of consensus at guideline level. ENT surgeons had a tendency to perform more aggressive nodal dissection; this was conjectured to be due to the influence of their experience of squamous head and neck tumours. However, in common with specialised endocrine surgeons, they exhibited more RS preference overall when compared with other surgeons. Surgeons who perform a higher volume of thyroidectomies (>25/year), those who participated in an MDT, and those in the early and middle years of their consultant careers, were more likely to make appropriate RS choices. This is in keeping with previously-published literature. Overall the study provides useful insight into concerning levels of variation in the management of DTC, and makes a case for more concentrated, multi-disciplinary thyroid surgery practice. 

A cross-specialty survey to assess the application of risk stratified surgery for differentiated thyroid cancer in the UK.
Craig WL, Ramsay CR, Fielding S, Krukowski ZH.
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND
2014;96(6):466-74.