Differentiating Detectable Findings from Actionable Findings in Thyroid Cancer Management

👉As it is clear that not all detectable findings require immediate diagnostic or therapeutic intervention, it is imperative that we develop a risk-stratification decision-making framework to differentiate actionable findings from non-actionable findings.

👉Whether we are considering a highly suspicious subcentimeter thyroid nodule without cytologic confirmation of disease, a biopsy-proven thyroid nodule with low-risk thyroid cancer, or persistent/recurrent disease in the neck or elsewhere, we find it useful to consider five key factors that when taken together, allow us to predict the likelihood that a specific tumor focus represents clinically
important disease that may require additional evaluations, ongoing observation, or therapeutic intervention.

👉Both tumor size and tumor location are the
major factors that determine whether a tumor focus is
likely to cause clinically substantial invasion into local structures, such as the recurrent laryngeal nerve, airway, gastrointestinal tract, major vessels, or other important structures.

👉A third important factor is the tumor growth rate (measured as tumor volume doubling time), with an observational management approach being much more appropriate for tumors either anticipated
to have a slow tumor growth rate or with actual documented slow growth rates over time.

👉Obviously, tumors that are either symptomatic or likely to have symptomatic progression would be considered actionable.

👉Finally, patient preference plays a key role when
deciding whether a particular lesion is actionable or non-actionable, as it is important to integrate the patients understanding of the risks and benefits of intervention vs observation with their value system and goals.

👉In addition to providing initial guidance as to whether the detectable lesion is actionable at the time of detection, ongoing re-evaluation of these same factors, using the basic concepts of dynamic-risk stratification, can also assist the clinician in the determination of when it is time to transition from an observational management approach to active therapeutic intervention.

👉Thus, risk stratification has moved from a single
postoperative static assessment of the risk of disease-
specific mortality to an all-encompassing evaluation of the patient that is continually modified over time, beginning from the first detection of a suspicious thyroid nodule and continuing throughout the life of the patient.

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