Prevalence of adverse pathological features in 1 to 4 cm low‐risk differentiated thyroid carcinoma

Murthy, Samskruthi; Balasubramanian, Deepak; Subramaniam, Narayana; Nair, Gopalakrishnan C; Babu, Merin; Rathod, Priyank; Thankappan, Krishnakumar; Iyer, Subramania; Vijayan, Smitha N.; Prasad, Chaya; Nair, Vasantha

doi:10.1002/hed.25099

Cited by 18 publications

(12 citation statements)

References 6 publications

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“…Our results are consistent with previous retrospective studies that have estimated that 40-60% of patients with lowrisk 1-4 cm PTCs, if initially treated with lobectomy, would require a CTx due to HRF in postoperative pathology reports (18)(19)(20)(21)(22)(23). However, a strength of this study is that it provides a uniform and realistic study population, limiting the study cohort to only those patients who had (I) adequate preoperative FNA tumor cytology; (II) documented preoperative US size, features, and LN assessment; and (III) documented absence of a family history of thyroid cancer and radiation exposure.…”

Section: Discussionsupporting

confidence: 92%

“…Kluijfhout et al determined tumor size from final histopathology for study inclusion rather than preoperative US (21). In other studies it is unclear whether the reported tumor size was determined by preoperative US or final histopathology (20), whether radiation exposure and family history were accounted for in their preoperative risk stratification (19,22), or whether the patients studied were confirmed Bethesda 5 or 6 lesions on preoperative FNA (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…Since the publication of the 2015 ATA guidelines, several retrospective studies have estimated the theoretical completion thyroidectomy (CTx) rate in low-risk PTC patients if initially treated with lobectomy, based on the identification of HRFs in TT specimens. These studies have reported that between 40% and 60% of patients with low-risk PTCs would require a CTx due to HRFs (18)(19)(20)(21)(22)(23). However, these studies are retrospective and may be limited by incomplete reporting of preoperative ultrasound (US) features and patient history.…”

Section: Introductionmentioning

confidence: 99%

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The Identification of Intraoperative Risk Factors Can Reduce, but Not Exclude, the Need for Completion Thyroidectomy in Low-Risk Papillary Thyroid Cancer Patients

Craig

Bysice

Nakoneshny

et al. 2020

Thyroid

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Background: The extent of initial surgical resection for low-risk papillary thyroid cancer (PTC) remains debatable. Since the 2015 American Thyroid Association (ATA) guidelines, several retrospective studies have reported that 40-60% of patients initially treated with lobectomy would require a completion thyroidectomy (CTx) due to high-risk pathological features (HRFs). These studies are limited by variable preoperative stratification and inability to quantify the value of intraoperative assessment. The study objectives were to determine whether diligent preoperative and intraoperative assessment improves the appropriateness of initial surgery for low-risk PTCs and whether varying the criteria for lobectomy reduces the need for CTx. Methods: A prospectively collected province-wide database was analyzed over a 10-year period (2008-2017) for patients who underwent a total thyroidectomy (TT) for PTC without preoperative HRFs. All patients had preoperative ultrasound and fine-needle aspirates. Unique to this database are mandatory synoptic operative fields that identify intraoperative risk factors such as positive lymph nodes and local invasion. Results: In total, 74% of patients (709/959) were deemed eligible for lobectomy. Of those eligible, 149 (21%) had intraoperative risk factors that would necessitate conversion to TT at the initial operation. A further 209 (30%) would require CTx due to HRFs on final pathology. Varying the preoperative criteria for lobectomy did not significantly affect intraoperative conversion or CTx rates. Conclusions: Although intraoperative assessment reduced the need for CTx in 21%, up to 30% of patients would still require a second operation. Altering the preoperative criteria does not influence this outcome. Patients deemed eligible for lobectomy should be informed that despite careful pre-and intraoperative assessment, there is up to a 30% risk of requiring CTx.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Identification of Intraoperative Risk Factors Can Reduce, but Not Exclude, the Need for Completion Thyroidectomy in Low-Risk Papillary Thyroid Cancer Patients

Craig

Bysice

Nakoneshny

et al. 2020

Thyroid

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“…A high prevalence of high-risk characteristics that can only be revealed at the final pathology is found in low-to-intermediate risk differentiated thyroid carcinoma (13, 14). Studies showed that nearly half of low-risk tumors may harbor pathological characteristics that are suggestive of a more radical treatment (i.e., total thyroidectomy, neck dissection, and subsequent radioiodine ablation) to lower the reoperation rate and achieve a better prognosis (15, 16). How frequently are the high-risk pathological features that may change the therapeutic strategy present in PTMC, and more importantly, how these factors may affect prognosis of the patients is unknown.…”

Section: Introductionmentioning

confidence: 99%

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

et al. 2019

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Background: The current management of papillary thyroid micro carcinoma (PTMC) has become more conservative. However, high-risk characteristics that can only be revealed post-surgically exist. Patients and clinicians need to estimate the risks and understand the prognostic meaning of these factors. Methods: We retrospectively analyzed 246 consecutive patients with PTMC who underwent surgery at our institution between 2015 and 2017. Clinical and histopathological parameters that may indicate recurrent disease were investigated. The responses to therapy in cases with different risks of recurrence were analyzed. Results: A total of 79.26% (195/246) of patients received total thyroidectomy (TT), of whom 177 (90.77%) also received central lymph node dissection. Radioiodine ablation (RAI) was applied in 64.23% (158/246) of patients. Intermediate-high risk features were identified in 27.64% (68/246) after primary treatment. After a median follow-up of 18 months (range, 6–39 months), 121 of 158 (76.58%) patients who received TT+RAI were evaluated as an excellent response. An incomplete response (IR) was observed in 14.56% (23/158) of this group of PTMC. Multivariate analysis identified extra thyroid extension ( P = 0.001) and intermediate-high risk stratification ( P = 0.014) as significant and independent risk factors for an IR. Conclusions: A total of 27.64% of PTMC cases evaluated as a low risk of recurrence pre-surgery showed intermediate to high risk disease post-surgery, and this leads to a higher rate of IR.

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“…According to several retrospective studies, multifocality can be observed in 15-63% of cancers of 1-4 cm [44,45] and microscopic extrathyroidal extension in up to 66% of these tumors [46,47]. If we follow the strict criteria of lobectomy only for unifocal tumors without microscopic extrathyroidal extension and without lymph node metastases or other intermediate or high-risk features (see above), 34-59% of patients undergoing initial lobectomy will require completion thyroidectomy due to finding intermediate-or high-risk features upon final pathology of the lobectomy specimen [48][49][50][51][52][53][54][55].…”

Section: Oncologic Considerations: Completion Thyroidectomy and Survivalmentioning

confidence: 99%

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Hartl

Guerlain

Breuskin

et al. 2020

Cancers

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Many recent publications and guidelines have promoted a “more is less” approach in terms of treatment for low to intermediate risk differentiated thyroid cancer (DTC), which comprise the vast majority of thyroid cancers: less extensive surgery, less radioactive iodine, less or no thyroid hormone suppression, and less frequent or stringent follow-up. Following this approach, thyroid lobectomy has been proposed as a means of decreasing short- and long-term postoperative morbidity while maintaining an excellent prognosis for tumors meeting specific macroscopic and microscopic criteria. This article will examine the pros and cons of thyroid lobectomy for low to intermediate risk cancers and discuss, in detail, criteria for patient selection and oncological outcomes.

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Prevalence of adverse pathological features in 1 to 4 cm low‐risk differentiated thyroid carcinoma

Abstract: Two thirds of the patients may require a completion thyroidectomy if unilateral lobectomy is done in tumors measuring 1 to 4 cm based on adverse pathological features.

Cited by 18 publications

References 6 publications

The Identification of Intraoperative Risk Factors Can Reduce, but Not Exclude, the Need for Completion Thyroidectomy in Low-Risk Papillary Thyroid Cancer Patients

The Identification of Intraoperative Risk Factors Can Reduce, but Not Exclude, the Need for Completion Thyroidectomy in Low-Risk Papillary Thyroid Cancer Patients

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

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