Reconsideration of tumor size threshold for total thyroidectomy in differentiated thyroid cancer

Cheng, Shih‐Ping; Chien, Ming-Nan; Wang, Tao‐Yeuan; Lee, Jie-Jen; Lee, Chun-Chuan; Liu, Chien‐Liang

doi:10.1016/j.surg.2018.04.019

Cited by 31 publications

(23 citation statements)

References 44 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%

“…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: Introductionmentioning

confidence: 99%

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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“…8 Recently, we reported that tumor size is a major predictor for intermediate-risk pathologic features in differentiated thyroid cancer. 9 Interestingly, the receiver operating characteristic curve analysis suggested that the probability of presenting intermediaterisk pathologic features greatly increased when the tumor size was larger than or equal to 1.1 cm. This finding raised an important question as to whether microcarcinoma is biologically different from larger carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Is papillary thyroid microcarcinoma a biologically different disease? A propensity score‐matched analysis

Hsu

Lee

Chien

et al. 2019

Journal of Surgical Oncology

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Background Papillary thyroid microcarcinoma exhibits an indolent clinical course and could be a candidate for active surveillance in the appropriate setting. It remains unknown whether papillary microcarcinoma is biologically different from larger papillary carcinoma >1 cm. Methods We analyzed clinicopathological information and transcriptome data of papillary thyroid cancer samples from The Cancer Genome Atlas. Propensity‐score matching was used to construct a matched cohort consisting of 29 microcarcinomas and 58 carcinomas. Principal component analysis and unsupervised hierarchical cluster analysis were carried out to investigate the similarity of gene expression profiles. Results After adjustment for differences in baseline clinicopathological and genetic factors, transcriptome could be grouped mainly on the basis of tumor class (BRAF‐like vs RAS‐like) and tumor size (microcarcinoma vs carcinoma). The gene set enrichment analysis showed that extracellular matrix‐associated pathways were enriched in the MSigDB database. Conclusion Papillary thyroid microcarcinomas display a distinct gene expression pattern different from the corresponding carcinomas. We hypothesize that tumor microenvironment may play a role in the microcarcinoma/carcinoma phenotypic divergence.

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“…In a study by Cheng et al of 700 patients, 26% were found to have unexpected ETE into the strap muscles . The study demonstrated that many patients who were lobectomy‐eligible ultimately had intermediate pathologic risk factors identified on the final pathology report.…”

Section: Discussionmentioning

confidence: 99%

Unexpected high‐risk pathologic features following thyroidectomy in the chinese immigrant population

et al. 2019

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Objective To compare rates of unexpected high‐risk pathologic features between Chinese and non‐Asian patients who underwent thyroidectomy for papillary thyroid cancer. Methods This was a retrospective cohort study at a tertiary academic urban medical center. Patients who underwent thyroidectomy for papillary carcinoma from 2015 to 2017 were included. Patient demographics, tumor characteristics, and tumor histopathology were analyzed. Primary outcome was the presence of adverse histopathologic features such as lymphovascular invasion (LVI) or microscopic/minimal extrathyroidal extension (mETE). Differences between the groups were analyzed using multivariate logistical regression analysis and propensity score‐weighted analysis. Results One hundred seventy‐nine patients were included: 58 Chinese‐born and 121 non‐Asian. The median age of the cohort was 47 years old (36–58). Twenty‐nine percent of patients were male, and 71% were female. There was no statistically significant difference between the two cohorts in rates of LVI, multifocality, extent of surgery, or presence of thyroiditis. Patients with mETE were more likely to have larger tumors (P = 0.00247). Both the multivariate and propensity‐weighted models demonstrated that Chinese ancestry was independently associated with an increased rate of unexpected mETE (adjusted prevalence ratio, 2.52; 95% confidence interval, 1.82–3.48). Conclusion mETE is significantly higher in the immigrant Chinese compared to the non‐Asian population. Given the high prevalence of unexpected mETE in the Chinese population, the added risk of this finding should be brought into the discussion during initial surgical planning. Level of Evidence 3 Laryngoscope, 130:1844–1849, 2020

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Reconsideration of tumor size threshold for total thyroidectomy in differentiated thyroid cancer

Cited by 31 publications

References 44 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

Is papillary thyroid microcarcinoma a biologically different disease? A propensity score‐matched analysis

Unexpected high‐risk pathologic features following thyroidectomy in the chinese immigrant population

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