Referral Practice for Radio-active iodine Ablation in a Tertiary Cancer Care centre

  • Background:
    Prognosticators in Differentiated Thyroid Cancer have evolved over the last decade and they influence the decision for Radio-active Iodine (RAI) ablation. Referral practice for RIA after Total Thyroidectomy for DTC  varies among clinicians. The 2015 ATA guidelines proposed a new risk stratification system and have modified the indications for RAI ablation. We in this article have assessed the current referral practice for RIA being followed at our institute

    Patients who underwent total or completion thyroidectomy for DTC at our center for years 2016-17 were included. Relevant demographical, clinical and pathological data was tabulated. Patients were classified as per the new stratification system and referral practice for RIA ablation documented.

    Out of 572 DTC patients operated in the specified time period, 280 satisfied the eligibility criteria. As per the risk stratification 22.8% had low risk disease, 41.1 % had intermediate and 36.1 % were high risk as per ATA 2015 stratification. All patients with intermediate and high-risk group were referred for RIA ablation.

    Majority of the patients belonging to low risk disease (74%) were referred for RIA ablation. In the low risk group the most common causes  of referral was pT3 stage (>4 cm, even in absence of ETE) and even single node positive with or without ECS.

    Significant number of low risk patients continue to be referred for RIA ablation, most common cause being p T3 lesion (in view of size) .The risks and benefits of this referral practice needs to be weighed carefully.


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