title: [Current diagnostic method, prognosis estimation and therapy of papillary thyroid cancer: recommendations of the medical universities and the National Oncologic Institute of Budapest].
abstract: Physical examination, cervical ultrasonography (US) and aspiration cytology are the mainstays of the preoperative diagnostics of papillary thyroid carcinoma. For the staging of suspected malignant cases, cervical and mediastinal CT (MRI for inconclusive results) is indicated before any surgery. The end-result of primary treatment is assessed by total-body iodine scintigraphy and the serum human thyroglobulin (hTG) level. For long-term follow-up, physical examination and the serum hTG level are the most reliable tools (6-monthly), supplemented by cervical US and chest X-ray (yearly), and total-body iodine scintigraphy (2-yearly). If these furnish positive results, further examinations may be indicated. In suspected relapses of hTG non-producing and iodine non-accumulating papillary carcinomas, 201thallium chloride or 99mTc-sesta-MIBI (methoxy-isobutyl-isonitrile) scintigraphy, and positron emission tomography with 18fluoro-deoxyglucose or 11C-methionine may be of help. For estimation of the prognosis (cause-specific survival) of the patients, the MACIS score system of the Mayo Clinic is widely accepted, the patients being divided into low-risk and intermediate/high-risk categories. The recommended standard surgical intervention is near-total thyroidectomy (2-4 g residual glandular tissue left at the upper pole of the less-involved lobe), with a central cervical lymph node dissection for diagnostic purposes. In cases of lymph node dissemination, dissection (radical, modified radical, selective or microdissection) of any of the involved compartments (central, right or left cervical, or upper mediastinal) is indicated for therapeutic reasons, the method of which is depending on the extent of the metastatic involvement. Following adequate surgical intervention, no adjuvant radioiodine therapy is indicated for low-risk cases with a tumour of less than 1 cm diameter. For other low-risk or intermediate/high-risk patients, radioiodine ablation (R0N0M0) or a therapeutic radioiodine dosage (R2N1M1) is indicated. In cases at high-risk of local/regional relapse and in radioiodine non-accumulating tumorous cases, external radiotherapy may be applied. Thyroid hormone medication in a TSH suppressive dose is indicated during the first 5 postsurgical years: the goal is to achieve a TSH level below 0.1 (determined by a 3rd generation assay). If no relapse occurs or the case is a low-risk one, following the 5 years, it is enough to maintain the TSH level in a subnormal range (0.1-0.3).
authors.affiliation: Sugárterápiás Osztály, Országos Onkológiai Intézet, Budapest.
authors.forename: O
authors.initials: O
authors.lastname: Esik
authors.forename: C
authors.initials: C
authors.lastname: Balázs
authors.forename: A
authors.initials: A
authors.lastname: Boér
authors.forename: L
authors.initials: L
authors.lastname: Csernay
authors.forename: J
authors.initials: J
authors.lastname: Földes
authors.forename: M
authors.initials: M
authors.lastname: Füzy
authors.forename: O P
authors.initials: OP
authors.lastname: Horváth
authors.forename: J
authors.initials: J
authors.lastname: Julesz
authors.forename: M
authors.initials: M
authors.lastname: Kásler
authors.forename: F
authors.initials: F
authors.lastname: Laczi
authors.forename: A
authors.initials: A
authors.lastname: Leövey
authors.forename: G
authors.initials: G
authors.lastname: Lukács
authors.forename: G
authors.initials: G
authors.lastname: Németh
authors.forename: F
authors.initials: F
authors.lastname: Perner
authors.forename: I
authors.initials: I
authors.lastname: Repa
authors.forename: I
authors.initials: I
authors.lastname: Szabolcs
authors.forename: Z
authors.initials: Z
authors.lastname: Szentirmay
authors.forename: L
authors.initials: L
authors.lastname: Trón
authors.forename: G
authors.initials: G
authors.lastname: Balázs
mesh_terms: D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006814:Hungary; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012577:Schools, Medical; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery