Redefining thyroid cancer treatment
Redefining thyroid cancer treatment
This thesis of Madelon Metman examines how thyroid cancer treatment can be organized in a safer, less burdensome way without affecting oncological safety. This study, based on Dutch population-based data, shows that a less extensive surgical approach is safe in carefully selected patients with low-risk papillary thyroid carcinoma and does not result in inferior oncological outcomes.
The first part compares diagnostic strategies in the Netherlands and the United States. Because of a more restrictive approach, thyroid tumors in the Netherlands tend to be larger on average. However, national data indicate that in carefully selected low-risk patients with papillary thyroid carcinoma, a hemithyroidectomy, in which only the affected thyroid lobe is removed, appears to be as safe as more extensive treatment. These results support a shift from standard procedures towards a more tailored approach with less impact on quality of life.
In addition, the data show that incidental thyroid findings, such as those detected on PET/CT scans performed for unrelated indications, rarely translate into meaningful clinical benefit. Instead, additional diagnostic procedures often create uncertainty, require repeated investigations, and may result in unnecessary surgery.
The second part of this thesis explores innovative imaging techniques used in diagnostics and surgery, such as fluorescence and optoacoustic imaging. These methods help surgeons more accurately identify tumor tissue and, in doing so, may reduce the potential for complications, including permanent parathyroid dysfunction. Developing a standardized model is therefore important to ensure that these techniques can be used reliably and consistently in clinical practice.
This thesis indicates that a less aggressive treatment approach is often sufficient: a personalized, restrained strategy, supported by innovative imaging techniques, can improve quality of life without affecting patient safety.