Table 6.

Arguments for and against DTC surveillance modalities

Arguments for and against DTC surveillance with neck palpation Advantages: Quick, inexpensive, and non-invasive. High specificity (96–100%) for detecting a thyroid nodule that might represent DTC (many true negatives and few false positives for nodules).

Disadvantages: Low sensitivity (17–43%) for detecting a thyroid nodule that might represent DTC (few true positives and many false negatives for nodules). Increase in unnecessary invasive procedures due to false-positive screening results. Detection of DTC at a more advanced stage (compared to thyroid ultrasonography), possibly leading to increased morbidity, recurrence, and mortality rate. Diagnostic value depending on experience of the physician (high-interobserver variation).

Arguments for and against DTC surveillance with neck ultrasound Advantages: Non-invasive. High sensitivity (~95–100%) for detecting a thyroid nodule that might represent DTC (many true-positives and few false-negatives for nodules). High specificity (~95–100%) for detecting a thyroid nodule that might represent DTC (many true-negatives and few false-positives for nodules). Detection of DTC at an earlier stage (compared to neck palpation).

Disadvantages: Although the sensitivity and specificity to detect a thyroid nodule are high, the diagnostic value of ultrasound for predicting whether a detected nodule is DTC is poor: detection of a high number of benign thyroid nodules and small nonaggressive DTC. Increase in unnecessary invasive procedures due to false-positive screening results. Diagnostic value depends on the experience of the ultrasonographer (high-interobserver variation).

DTC, differentiated thyroid carcinoma.

Adapted from Cancer Treatment Reviews, Vol 63, Clement SC, Kremer LCM, Verburg FA, Simmons JH, Goldfarb M, Peeters RP, Alexander EK, Bardi E, Brignardello E, Constine LS, et al., Balancing the benefits and harms of thyroid cancer surveillance in survivors of childhood, adolescent and young adult cancer: recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium, pages 28–39, Copyright (2018), with permission from Elsevier (56).