Patterns of care for patients with primary differentiated carcinoma of thethyroid gland treated in Germany during 1996

BACKGROUND. To determine current patterns of care and disease characteristi cs for patients with thyroid carcinoma, a Patient Care Evaluation Study was initiated in 1996 in the U.S. and Germany. This project addresses ongoing concerns with respect to the diagnostic evaluation and treatment of patient s diagnosed with thyroid carcinoma and raises questions concerning how phys icians are interpreting current standards and acting on the basis of these recommendations. METHODS. Patients with primary thyroid carcinoma were ente red into a prospective multicenter observational study with free choice of treatment (no control group) between January 1, 1996 and December 31, 1996 in Germany. This resulted in a total of 2537 cases under observation and an alysis; 1685 patients had papillary carcinoma (66.4%), 691 had follicular c arcinoma (27.2%), 70 had medullary carcinoma (2.8%), and 91 had anaplastic carcinoma (3.6%). The 2376 patients with carcinoma of either papillary or f ollicular histology were included in the current analysis. RESULTS. The maj or symptoms reported for patients with papillary and follicular thyroid car cinoma was neck mass (reported in 76% and 79%, respectively) followed by dy sphagia (reported in 25% and 27%, respectively), strider (reported in 9% an d 14%, respectively), and neck pain (reported in 7% and 8%, respectively). Greater than 50% of the patients with papillary thyroid carcinoma were repo rted to have American Joint Committee on Cancer/International Union Against Cancer Stage I disease. Between 37-39% of the follicular carcinoma patient s had Stage I and Stage II disease. Only slight differences in the diagnost ic approach to patients with papillary or follicular carcinoma were noted. The majority of patients underwent an ultrasound of the thyroid region (78. 1%), which was suggestive of carcinoma in only 39% of the cases. A thyroid scan was performed on 76.6% of patients, and the results were suggestive of carcinoma in 44.8% of the individuals. In contrast, fine-needle aspiration biopsy of the thyroid is highly recommended in the current Clinical Practi ce Guidelines (CPG) but results were obtained in only 27.4% of the patients . Total thyroidectomy without lymph node dissection was the most commonly u sed surgical procedure in the treatment of patients with papillary and foll icular thyroid carcinoma. Only approximately 2% of patients at low risk in the group with Stage I disease were treated with a lobectomy. In 80% of the patients with Stage I papillary thyroid carcinoma and approximately 90% of those patients diagnosed with Stage II, III, and IV disease treating physi cians chose to utilize radioiodine as adjuvant treatment after disease-dire cted surgery. External beam radiation was added to the treatment regimen fo r many patients diagnosed with Stage III and IV disease (30% in patients wi th papillary thyroid carcinoma and 33% in patients with follicular thyroid carcinoma). CONCLUSIONS. To the authors' knowledge no single effective diag nostic test for thyroid carcinoma currently is available and in the majorit y of cases a combination of ultrasound, thyroid scan, or fine-needle aspira tion biopsy together with the clinical findings (e.g., thyroid mass) led to a diagnosis of carcinoma. The authors suspect that the high prevalence of concomitant pathologic findings such as goiter, even in the healthy populat ion in Germany, reduces the accuracy of all diagnostic test methods and may account for the frequent use of imaging techniques. The majority of patien ts underwent a total or near-total thyroidectomy. Total thyroidectomy with radical lymph node dissection was used very frequently in those patients wi th papillary thyroid carcinoma (22%). German physicians tend to surgically treat early stage thyroid carcinoma so mewhat more radically than recommended in the CPG. With respect to other tr eatment options employed as part of the first course of treatment, radioiod ine appears to play the most important role. [See commentary on pages 1-4, this issue and communication on pages 202-17, this issue.] (C) 2000 America n Cancer Society.