1、+NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)Thyroid CarcinomaVersion 1.2016ContinueNCCN.org Version 1.2016, 07/08/2016 National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the ex
2、press written permission of NCCNNCCN Guidelines IndexThyroid Table of ContentsDiscussion Version 1.2016, 07/08/2016 National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permissio
3、n of NCCN.NCCN Guidelines Version 1.2016 Panel MembersThyroid Carcinoma*Robert I. Haddad, MD/Chair Dana-Farber/Brigham and Womens Cancer CenterWilliam M. Lydiatt, MD/Vice-Chair Fred & Pamela Buffett Cancer Center Lindsay Bischoff. MD Vanderbilt-Ingram Cancer CenterNaifa Lamki Busaidy, MD The Univers
4、ity of Texas MD Anderson Cancer CenterDavid Byrd, MD Fred Hutchinson Cancer Research Center/Seattle Cancer Care AllianceGlenda Callender, MD Yale Cancer Center/Smilow Cancer HospitalPaxton Dickson, MD St. Jude Childrens Research Hospital/University of Tennessee Health Science CenterQuan-Yang Duh, MD
5、 UCSF Helen Diller Family Comprehensive Cancer CenterHormoz Ehya, MD Fox Chase Cancer CenterMegan Haymart, MD University of Michigan Comprehensive Cancer CenterNCCNKarin G. Hoffmann, RN, CCMMiranda Hughes, PhDCarl Hoh, MD UC San Diego Moores Cancer CenterJason P. Hunt, MD Huntsman Cancer Institute a
6、t the University of UtahAndrei Iagaru, MD Stanford Cancer InstituteFouad Kandeel, MD, PhD City of Hope Comprehensive Cancer Center Peter Kopp, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityDominick M. Lamonica, MD Roswell Park Cancer Institute Bryan McIver, MD Moffitt Canc
7、er CenterJeffrey F. Moley, MD Siteman Cancer Center at Barnes- Jewish Hospital and Washington University School of MedicineTobenna Nwizu, MD Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer InstituteChristopher D. Raeburn, MD University
8、of Colorado Cancer CenterJohn A. Ridge, MD, PhD Fox Chase Cancer CenterMatthew D. Ringel, MD The Ohio State University Comprehensive Cancer CenterJames Cancer Hospital andSolove Research InstituteRandall P. Scheri, MD Duke Cancer InstituteJatin P. Shah, MD, PhD Memorial Sloan Kettering Cancer Center
9、Robert C. Smallridge, MD Mayo Clinic Cancer CenterCord Sturgeon, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern UniversityThomas N. Wang, MD, PhD University of Alabama at Birmingham Comprehensive Cancer CenterLori J. Wirth, MD Massachusetts General Hospital Cancer CenterContinueNCCN
10、Guidelines Panel Disclosures Endocrinology Surgery/Surgical oncology Medical oncology Pathology Internal medicine Nuclear medicine Otolaryngology *Writing Committee MemberPrinted by Maria Chen on 7/11/2016 11:54:07 PM. For personal use only. Not approved for distribution. Copyright 2016 National Com
11、prehensive Cancer Network, Inc., All Rights R Version 1.2016, 07/08/2016 National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexThyroid Tabl
12、e of ContentsDiscussionClinical Trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. To find clinical trials online at NCCN Member Institutions, click here:nccn.org/clinical trials/physician.html.NCCN
13、 Categories of Evidence and Consensus: All recommendations are category 2A unless otherwise specified. See NCCN Categories of Evidence and Consensus.NCCN Thyroid Carcinoma Panel MembersSummary of the Guidelines UpdatesThyroid Carcinoma Nodule Evaluation (THYR-1) Principles of TSH Suppression (THYR-A
14、) Principles of Kinase Inhibitor Therapy in Advanced Thyroid Carcinoma (THYR-B) Papillary Carcinoma FNA Results, Diagnostic Procedures, Preoperative or Intraoperative Decision-Making Criteria, Primary Treatment (PAP-1)Follicular Carcinoma FNA Results, Diagnostic Procedures, Primary Treatment (FOLL-1
15、)Hrthle Cell Carcinoma FNA Results, Diagnostic Procedures, Primary Treatment (HRT-1)Medullary Thyroid Carcinoma Clinical Presentation, Diagnostic Procedures, Primary Treatment (MEDU-1) Germline Mutation of RET Proto-oncogene (MEDU-3) Anaplastic Carcinoma FNA or Core Biopsy Finding, Diagnostic Proced
16、ures, Establish Goals of Therapy, Stage (ANAP-1) Systemic Therapy For Anaplastic Thyroid Carcinoma (ANAP-A) Staging (ST-1) Staging (ST-2)The NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician see
17、king to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patients care or treatment. The National Comprehensive Cancer Network (NCCN) makes no representations or warranties of any kind regarding
18、their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without th
19、e express written permission of NCCN. 2016.NCCN Guidelines Version 1.2016 Table of ContentsThyroid CarcinomaPrinted by Maria Chen on 7/11/2016 11:54:07 PM. For personal use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc., All Rights RNote: All recommen
20、dations are category 2A unless otherwise indicated.Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version 1.2016, 07/08/2016 National Comprehensive Cancer Network, Inc. 2016, All rights
21、reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexThyroid Table of ContentsDiscussionNCCN Guidelines Version 1.2016 UpdatesThyroid Carcinoma Updates in Version 1.2016 of the NCCN Guidelines for Th
22、yroid Carcinoma from Version 2.2015 include:Thyroid Carcinoma THYR-1 Under Workup for “Thyroid nodule(s) with normal or elevated TSH” statement was revised: “Consider fine-needle aspiration (FNA) or ultra-sound-guided FNA based on clinical and sonographic features” Footnote “b” for “Evaluate and tre
23、at for thyrotoxicosis as indicated (malignancy is rare)” was revised: “For nodules not meeting criteria for FNA, or nodules that appear to be benign by scan ultrasound or FNA, surveillance should include repeat ultrasound after 612 months; if stable for 12 years, then subsequent ultrasound can be co
24、nsidered at 3- to 5-year intervals.” THYR-2 In box under “Threshold for FNA”:“With suspicious sonographic features” was revised: 1.52.0 cm “solid component 1 cm”“Without suspicious sonographic features” was revised: 2.0 cm “solid component 1.5 cm” Paragraph referring to “Sonographic Features” was re
25、vised: “The above criteria serve as general guidelines. In patients with high-risk clinical features, evaluations of nodules smaller than listed may be appropriate depending on clinical concern. Allowance for informed patient desires would include excisional biopsy (lobectomy or thyroidectomy) for d
26、efinitive histology, especially in larger nodules (4 cm) or higher risk clinical situations.” Footnote “c” and “d were combined and revised: “Suspicious sonographic features include hypoechoic, microcalcifications, increased central vascularity, infiltrative margins, and taller than wide in the tran
27、sverse plane. Sonographic features associated with a low risk of malignancy include spongiform nodules, isoechoic or hyperechoic solid nodules, and mixed solid-cystic nodules without any of the suspicious features listed above.” Footnote “d” was removed from, “Without suspicious sonographic features
28、”: “Ultrasound features associated with low suspicion of malignancy include: isoechoic or hyperechoic solid nodules; mixed solid/cystic nodules without microcalcification, irregular margins, or extrathyroidal extension; or spongiform nodules.”UPDATES 1 of 4Thyroid Carcinoma continuedTHYR-3 “Follicul
29、ar or Hrthle cell neoplasm” and “Atypia of undetermined significance/Follicular lesion of undetermined significance” under FNA results:Statement was revised: “High clinical and/or radiographic suspicion of malignancy”Footnote “k” was added: “Based on rapid growth of nodule, imaging, physical exam, a
30、ge, clinical history of radiation, and family history.” “Follicular or Hrthle cell neoplasm” and “Atypia of undetermined significance/Follicular lesion of undetermined significance” under treatment:1st bullet for “No” statements was added: “Consider diagnostic lobectomy”Footnote “l” was added: “Cons
31、ider second opinion pathology.” Footnote i” revised: “The diagnosis of follicular carcinoma or Hrthle cell carcinoma requires evidence of either vascular or capsular invasion, which cannot be determined by FNA. Molecular diagnostics may be useful to allow reclassification of follicular lesions (ie,
32、follicular neoplasm, Hrthle cell neoplasm, atypia of undetermined significance (AUS), follicular lesions of undetermined significance (FLUS) as either more or less likely to be benign or malignant based on the genetic profile. If molecular testing suggests papillary thyroid carcinoma, especially in
33、the case of BRAF V600E, see (PAP-1). If molecular testing, in conjunction with clinical and ultrasound features, predicts a risk of malignancy comparable to the risk of malignancy seen with a benign FNA cytology (approximately 5% or less), consider observation. Molecular markers should be interprete
34、d with caution and in the context of clinical, radiographic, and cytologic features of each individual patient.”Printed by Maria Chen on 7/11/2016 11:54:07 PM. For personal use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc., All Rights RNote: All reco
35、mmendations are category 2A unless otherwise indicated.Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version 1.2016, 07/08/2016 National Comprehensive Cancer Network, Inc. 2016, All rig
36、hts reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NCCN Guidelines IndexThyroid Table of ContentsDiscussionNCCN Guidelines Version 1.2016 UpdatesThyroid Carcinoma UPDATES 2 of 4Thyroid Carcinoma continuedTHYR-5 Foo
37、tnote “m” was added for nodule growth definition: “Growth defined as 50% increase in nodule volume or 20% increase in size of 23 dimensions. Size changes should be 2 mm and should be assessed by direct comparison of images”Papillary CarcinomaPAP-1 Under “FNA Results” statement was revised: “Papillar
38、y carcinoma FNA positive” 4th bullet under “Diagnostic Procedures” was added: “Suspicious nodes in lateral neck should be further evaluated by ultrasound-guided FNA for staging and guiding extent of surgery” “Preoperative or Intraoperative Decison-Making Criteria”2nd bullet was removed: “Bilateral n
39、odularity”7th bullet was revised: “Consider for prior radiation exposure history (category 2B)”8th bullet was added: “Consider bilateral nodularity”Statement was revised: “Indications for total thyroidectomy or lobectomy, if all criteria present”9th bullet was revised: “No prior radiation exposure”F
40、ootnote “c” removed from: “Cervical lymph node” “Primary Treatment” 1st bullet under for “All of the following” was revised: “Consider thyroglobulin measurement and anti-Tg antibodies 612 wks post-op”Footnote “d” revised: “Possible benefit to reduce recurrence for patients with T3-T4 lateral disease
41、 must be balanced with risk of hypoparathyroidism and recurrent laryngeal nerve damage.”PAP-2 Under “Any of the following” for post-lobectomy pathology results, a statement was revised: “Tumor 14 cm in diameter or Lymphovascular Lymphatic invasion” Under “Primary Treatment” for “Completion of thyroi
42、dectomy” 2 bullets were added:“Perform therapeutic neck dissection of involved compartments for clinically apparent/biopsy-proven disease”“Consider prophylactic central neck dissection (level VI) (category 2B)”Footnote “d” was added: “Possible benefit to reduce recurrence for patients with T3-T4 lat
43、eral disease must be balanced with risk of hypoparathyroidism.”Papillary Carcinoma continuedPAP-3 1st bullet for “Unresectable” residual disease in neck was revised: Radioiodine treatment (preferred)” (Also for FOLL-2, HRT-2)PAP-4 Title revised: “Consideration for Intial Postoperative RAI Therapy Af
44、ter Total Thyroidectomy” (Also for FOLL-3) “RAI selectively recommended (if any present)” 3rd bullet was revised: “Lymphovascular Lymphatic invasion”4th bullet removed: “Persistence of anti-Tg antibodies” (Also for FOLL-3, HRT-3)Paragraph revised: “RAI ablation is recommended when the combination of
45、 individual clinical factors (such as the size of the primary tumor, histology, degree of lymphovascular lymphatic invasion, lymph node metastases, postoperative thyroglobulin, and age at diagnosis) predicts a significant risk of recurrence, distant metastases, or disease-specific mortality.” (Also
46、for FOLL-3, HRT-3) Footnote “i” for “No detectable anti-Tg antibodies” was revised: “ie, poorly differentiated thyroid carcinoma, tall cell, columnar cell, and hobnail variants.”PAP-5 2nd bullet added: “No concerning findings on neck ultrasound” (Also for FOLL-4, HRT-4) Footnote “l” was added to “Cl
47、inically significant, indeterminate or suspicious cervical nodes”: “For example, round morphology, micro calcifications, multiplicity, or growing enlarging nodes.” (Also for FOLL-4, HRT-4) For “Tg 510 ng/dL (with negative anti-Tg antibodies)” statement was revised: “Consider additional cross-section
48、al imaging of the neck and chest CT or consider further surgery prior to RAI (without iodinated contrast)” (Also for HRT-4) Footnote removed: “If structural disease is identified, additional evaluation and/or treatment may be clinically indicated.” (Also for FOLL-4, HRT-4)Printed by Maria Chen on 7/
49、11/2016 11:54:07 PM. For personal use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc., All Rights RNote: All recommendations are category 2A unless otherwise indicated.Clinical Trials: NCCN believes that the best management of any cancer patient is in
50、a clinical trial. Participation in clinical trials is especially encouraged. Version 1.2016, 07/08/2016 National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN.NC
