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Current management of papillary thyroid microcarcinoma in Canada . This has led to an increase in detection of the smallest tumors, particularly, microcarcinomas . This increased detection has had no impact on survival outcomes but has had a huge impact on patients and the health care system. Therefore, we sought to identify current practices in order to inform future guideline development, knowledge translation events, and quality improvement initiatives. According to our survey results, the current treatment recommendations of endocrinologists and OHNS coincide with the available guidelines (Table 3) . Respondents were closely divided between recommending hemithyroidectomy or total thyroidectomy for a newly diagnosed PTMC in a low risk patient. The controversy and lack of consistent strong evidence supporting either treatment option is reflected in our respondents' recommendations where close to half (4. The Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins specializes in ear. Get a Second Opinion; Pay My Bill; Health. Health Home; Healthy Aging. Observation was the preferred method for managing PTMC detected incidentally after hemithyroidectomy. Three- fourths (7. PTMC incidentally found on thyroid lobectomy while 2. These findings are similar to the results from a recent survey of thyroid surgeons in the United States . In their survey, Wu et al. Responses to the first two clinical scenarios in our survey demonstrate some inconsistencies amongst respondents. The majority of endocrinologists and OHNS would not recommend a completion thyroidectomy for patients with an incidental thyroid cancer, but a large proportion would recommend a total thyroidectomy upfront for patients with a confirmed cancerous subcentimeter lesion. Table 3. Summary of ATA, BTA and ETA PTMC management recommendations. Investigate> 5 mm if: Can be managed by primary care physician if: FNAC only if: 1. US findings (microcalcifications; hypoechoic; increased nodular vascularity; infiltrative margins; taller than wide on transverse view). N0 M0,Selective use if regional lymph node metastasis. Less than 2% of respondents in our survey recommended observation for a newly diagnosed PTMC on FNA whether or not the patient had any complicating factors. The current practices of Canadian OHNS and endocrinologist largely. Head & Neck Surgery Journal of Otolaryngology - Head & Neck Surgery.As far as we are aware, there is currently one observational study regarding the management of PTMC with close observation and no surgery. As more observational data get published, closely observing certain PTMCs might become a valid and safe option . This is not supported by strong evidence or guideline recommendations . Nodules 1 cm in their largest diameter would have been treated differently than 0. To the best of our knowledge, there are no randomized trials comparing long term outcomes of PTMC (T1a) and small PTC < 2 cm (T1b). This is likely due to difficulty accruing a large enough sample size to answer such a question. However, Sturgeon and colleagues reviewed the literature as well as retrospective data from major cancer registries showed a survival advantage for T1b patients who underwent total thyroidectomy compared to hemithyroidectomy. There was no survival advantage with the more extensive surgery in the T1a group . Volumetric measurements may also assist in defining significant nodular growth . The ability to cure the patient with surgery, and the low surgical morbidity associated with thyroid surgery were the second and third most important factors, respectively. The belief in the safety and efficacy of thyroid surgery for treating PTC seems to have a considerable effect on the current general practice favoring total thyroidectomies for patients with PTC of any size. Nonetheless, the currently available guidelines recognize hemithyroidectomy as an appropriate treatment option for low risk PTMC patients . Total thyroidectomy carries with it the risk of bilateral recurrent laryngeal nerve injury and higher risks of transient or permanent hypoparathyroidism. While total thyroidectomy has a generally low complication rate, a higher number of this procedure would likely translate into a higher absolute number of complications. In our opinion, decisions around the extent of thyroidectomy should be based on patient and tumor factors and the available evidence/guidelines rather than confidence in the safety for a given procedure. The preference of the referring physician was the factor identified as least important by respondents. Similarly, American OHNS and general surgeons, in a recent survey, identified the preference of the referring physician as the least important factor in their decisions surrounding the management of PTMC . In that survey multifocality of the disease, ease of follow up post total thyroidectomy, and the need to administer RAI were the three factors identified as most important in influencing the decision to proceed with thyroidectomy. Our study has some limitations. The response rate was relatively low which may have led to a response bias. We suspect that low- volume OHNS and endocrinologists and ones with different practice interests differentially did not reply to our survey and therefore this should not affect the generalizability of our results. Our sample size was relatively small for subgroup analysis based on age, practice type, and surgical/clinical volume. Nonetheless, this is one of the largest absolute number of responses reported in the literature addressing this question. Another important issue was that a survey may not accurately reflect true practice patterns. A country wide sampling of charts for assessment of actual management choices would have provided a more accurate reflection of practices, however, self- reported questionnaires offer an estimate of these decisions while being quick and less expensive. In summary, the current practices of Canadian OHNS and endocrinologists, for the most part, coincide with the available guidelines. The slight variation in recommendations might be explained by the lack of strong evidence addressing the management of PTMC within the guidelines, and the fact that there is contradicting evidence supporting different management options. These controversies need to be explained to the patients in order to allow them to be an integral part of the decision making process. Current Opinion in Cell Biology 17, 55. Otolaryngology–Head & Neck Surgery 138, 781 (2012). Pediatric head and neck malignancies Neil K. Chadha and Vito Forte. Department of Otolaryngology – Head and Neck Surgery. Current Opinion in Otolaryngology. Current Opinion Otolaryngol Head Neck. Otolaryngology Head Neck Surgery. Subscribe to JAMA Otolaryngology—Head & Neck Surgery and keep up with the latest peer-reviewed clinical and basic research. Male gender was the only factor with consistent and significant deviation from the guidelines with both OHNS and endocrinologists recommending a more aggressive treatment option for male patients compared to female patients. Long- term observational survival studies are needed to compare outcomes of PTMC in T1b (1- 2 cm) and T2 (2- 4 cm) nodules. The latest version of the ATA, BTA and ETA address the management of PTMC within the context of PTC. Given the dramatic increase in the incidence of PTMC, it might be prudent to allot PTMC a separate section within updated guidelines. PES 2. 01. 6 Data Pack 2 and Official Patch 1. PES 2. 01. 6 Data Pack 2 and Patch 1. Official Released December 3, 2. Includes: PES2. 01. PC Update 1. 0. 3 + Data Pack 2 For PC. 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