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

    Methods:
    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.

    Results:
    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.

    Discussions:
    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.

    Conclusion:
    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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