title: Temporal analysis of thyroid cancer management in a Melbourne tertiary centre.
abstract: The American Thyroid Association (ATA) management guidelines for thyroid cancer were revised in 2009. The aim of this study was to determine if management of thyroid cancer in our institution has changed in accordance with the introduction of the revised ATA guidelines (ATA2009), and to compare the characteristics and management of thyroid cancer in a Melbourne endocrine surgery unit over a 7-year period.
  
  
  
  All patients treated by the Monash University Endocrine Surgery Unit for thyroid cancer between 2007 and 2013 were divided into two groups - the pre-ATA2009group (2007-2010) and the post-ATA2009group (2011-2013). Comparisons were made of the demographics, cytology, pathology, surgical outcome and adjuvant therapy using t-test and chi-squared tests.
  
  
  
  There were 333 patients in the pre-ATA2009group and 342 patients in the post-ATA2009group. Fewer non-diagnostic fine-needle aspiration cytology results were identified in the post-ATA2009group (4% versus 0.9%; P = 0.01), while the rates of other fine-needle aspiration cytology categories were similar. There was a reduction in the use of radioactive iodine ablation in the post-ATA2009group, both in the proportion of patients being treated (66% versus 48%; P < 0.001) and the dosages used (mean 96 mCi versus 80 mCi; P < 0.01), despite similar tumour size in both groups.
  
  
  
  The key changes in practice thought to be attributable to the 2009 revised ATA guidelines were the reduction in the use and dosage of radioactive iodine in the management of differentiated thyroid cancer.
authors.affiliation: Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: James C
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Paula
authors.initials: P
authors.lastname: Chang
authors.affiliation: Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Grodski
authors.affiliation: Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Meei
authors.initials: M
authors.lastname: Yeung
authors.affiliation: Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Johnson
authors.affiliation: Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D015994:Incidence; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000706:statistics & numerical data* / Q000639:trends; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D062211:Spatio-Temporal Analysis; D062606:Tertiary Care Centers; D000077273:Thyroid Cancer, Papillary / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods
chemical_list: D007457:Iodine Radioisotopes
keywords: 
  ATA guidelines; lymph node dissection; radioactive iodine; thyroid cancer; thyroidectomy