ABSTRACT

ABSTRACT: Clinical practice guidelines (CPG) are systematically developed statements that assist physicians in clinical decision making. The development of CPG has evolved over the last several decades and incorporates evidence-based medicine (EBM). Since 2003, at least seven CPG have been developed that focus on aspects of thyroid cancer evaluation and management. There are many commonalities among these CPG: clinical risk stratiˆcation, nodule risk stratiˆcation, treatment algorithms for intermediate-risk scenarios, and follow-up algorithms commensurate with risk stratiˆcation. However, there are also divergences and “fuzzy” areas in the CPG. Although these might be accounted for by differences in, or absence of, EBM methodology, they most likely re°ect knowledge gaps. These fuzzy areas are principally in the low-risk patient, where “watchful waiting” is an option, and the high-risk patient recalcitrant to conventional therapy, where novel diagnostic tools and therapies are needed. Emergent biotechnologies may clarify these fuzzy areas and

6.1 Introduction ............................................................................................................................ 72 6.2 The Philosophy and Synthesis of CPG ................................................................................... 72 6.3 Current Thyroid Cancer CPG ................................................................................................. 73

6.3.1 American Institute of Ultrasound in Medicine (AIUM) Practice Guideline for the Performance of a Thyroid and Parathyroid Ultrasound (US) Examination5 ........ 73

6.3.2 American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules6 ...................................................... 74

6.3.3 American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer8 ....................................... 75

6.3.4 European Association of Nuclear Medicine (EANM) Guidelines for Radioiodine Therapy of Differentiated Thyroid Cancer12 ..........................................77