Many of the surgical quality measures currently in use are not disease specific. For thyroid cancer, mortality and even recurrence are difficult to measure since mortality is rare and recurrence can take decades to occur. Therefore, there is a critical need for quality indicators in thyroid cancer surgery that are easily measured and disease specific. Here we will review recent research on two potential quality indicators in thyroid cancer surgery. The uptake percentage on postoperative radioactive iodine scans indicates the completeness of resection. Another measure, the lymph node ratio, is the proportion of metastatic nodes to the total number of nodes dissected. This serves as a more global measure of quality since it indicates not only the completeness of lymph node dissection but also the preoperative lymph node evaluation and decision-making. Together, these two quality measures offer a more accurate, disease-specific oncologic indicator of quality that can help guide quality assurance and improvement. 1. Introduction Survival from differentiated thyroid cancer (DTC) remains excellent, with 5-year disease-specific survival exceeding 95%. However, the incidence of DTC continues to rise. Based on trends over the last 10 years, researchers at the American Cancer Society estimate that there will be nearly 63,000 new cases of thyroid cancer diagnosed in 2014 in the United States [1]. Thyroid cancer preferentially affects women and is now the 5th most common cancer among females [1]. Although mortality from thyroid cancer is relatively low, recurrence is more common. Large series report recurrence rates between 2 and 14% [2–5]. Therefore, recurrence becomes a more relevant outcome measure for patients with thyroid cancer. Multiple factors influence recurrence including tumor histology, extent of disease at presentation, and the initial treatment. The mainstays of treatment include thyroidectomy and radioactive iodine (RAI) [6]. This review will focus on surgery. Specifically, we will discuss recent research that seeks to identify novel ways of measuring quality in thyroid cancer surgery. 2. Defining Quality In order to discuss the optimal measures of surgical quality for thyroid cancer, we must first define healthcare quality. The Institute of Medicine defines quality as the degree to which health services improve desired health outcomes. In short, this means doing the right thing for the patient in a timely manner while minimizing complications [7]. Therefore, quality healthcare delivery involves achieving desirable outcomes in a safe and timely
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