Treatment
8
Recommendation 8
A. Preoperative use of cross-sectional imaging studies (computed
tomography [CT], magnetic resonance imaging [MRI]) of the neck
and mediastinum with intravenous contrast is recommended as
an adjunct to physical examination and ultrasound for patients
with clinical suspicion for advanced or invasive disease, including
primary tumors with gross extrathyroidal extension, extensive
(e.g., bulky or invasive) adenopathy, or disease concerning for
aerodigestive tract and/or thoracic involvement. (S-M)
B. Performing preoperative cross-sectional imaging of the chest,
abdomen, and pelvis in search for distant metastases is recommended
in situations when results will influence extent of surgery. (GPS)
C. Routine preoperative
18
F-fluorodeoxyglucose positron emission
tomography (
18
FDG-PET/CT) is not recommended prior to surgery.
(S-M)
Recommendation 9
➤ Routine preoperative measurement of serum Tg or TgAb levels is not
recommended. (C-L)
Recommendation 10
➤ Genomic evaluation of confirmed DTC prior to surgery is not
recommended routinely. However, if the genomic profile is known
or performed, the presence or absence of specific combinations
of abnormalities may be considered in the context of clinical,
radiographic, and cytopathologic data to inform extent of surgery. (C-L)
Recommendation 11
A. Active surveillance may be offered as an appropriate management
option for some patients with cT1aN0M0 papillary thyroid
carcinomas (PTCs). Shared clinical decision-making between
the patient and clinical team regarding risks and benefits of this
approach is essential. (C-L)
B. Ultrasound-guided percutaneous ablation may be considered as
an alternative to active surveillance or resection for cT1aN0M0
PTC in selected patients. Shared clinical decision-making between
the patient and clinical team regarding risks and benefits of this
approach is essential. (C-L)
Recommendation 12
➤ For patients undergoing active surveillance, neck ultrasound should
be used to monitor disease progression. (GPS)
