Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Hartl, Dana M.; Guerlain, Joanne; Breuskin, Ingrid; Hadoux, Julien; Baudin, Éric; Ghuzlan, Abir Al; Terroir-Cassou-Mounat, Marie; Lamartina, Livia; Leboulleux, Sophie

doi:10.3390/cancers12113282

Cited by 24 publications

(13 citation statements)

References 115 publications

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“…The presence of suspicion of ETE represents an indication for surgery rather than for active surveillance, however (24,25). Hemithyroidectomy is considered as an effective treatment with lower rates of surgical complications for low risk DTC patients (26,27). Neck US plays a pivotal role in the preoperative workup for the selection of potential candidates for hemithyroidectomy as opposed to those who may benefit from more extensive initial surgery (28).…”

Section: Discussionmentioning

confidence: 99%

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Lamartina¹,

Bidault²,

Hadoux³

et al. 2021

European Journal of Endocrinology

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Objective The presence of extrathyroidal extension (ETE) is generally considered as an indication for total thyroidectomy for differentiated thyroid cancer. The accuracy of neck ultrasound for the diagnosis of ETE is controversial. The aim of this study was to assess the diagnostic accuracy of preoperative ultrasound evaluation of ETE. Methods The retrospective and observational study of consecutive patients operated between 2016 and 2019 for cytologically suspicious or indeterminate thyroid nodules were analyzed. US images obtained preoperatively were retrospectively reviewed to identify signs of minimal or gross ETE. Histology was considered as the golden standard for diagnosis of ETE. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US were evaluated. Results A cohort of 305 patients (75% females, median age 48 years) with 378 nodules (median size 18 mm) was studied. Seventy-five percent of the nodules (n = 228) were malignant on histology and ETE was present in 106 cases (28%): 83 minimal ETE and 23 gross ETE. Suspicion of minimal ETE on preoperative ultrasound was found in 50 (13%) with a sensitivity of 30%, a specificity of 93%, a PPV of 62% and an NPV of 78%, with an accuracy of 76%. Gross ETE on ultrasound was found in 19 (5%) nodules with a sensitivity of 78%, a specificity of 99.7% a PPV of 94.7% an NPV of 98.6% and an accuracy of 98%. Conclusions Preoperative US is very specific and accurate in diagnosing gross ETE which impacts the extent of initial surgery for thyroid cancers.

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Section: Discussionmentioning

confidence: 99%

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Lamartina¹,

Bidault²,

Hadoux³

et al. 2021

European Journal of Endocrinology

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“…The present study demonstrated that the operative extent of patients with unilateral multifocal PTC was not associated with risk of recurrence. Various guidelines and recent publications have promoted a “less is more” approach for the treatment of low-risk PTC, which represents the vast majority of thyroid cancers; this involves less extensive operation, less radioiodine, and less or no thyroid hormone suppression [ 23 ]. A global trend toward less radical surgical procedures, including thyroid lobectomy, has also gained traction in recent years [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Optimal Surgical Extent in Patients with Unilateral Multifocal Papillary Thyroid Carcinoma

Woo

Kwon

2022

Cancers

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Multifocality increases the risk of recurrence in patients with papillary thyroid carcinoma (PTC); however, it is unclear whether multifocality justifies more extensive or aggressive surgical treatment. Here, we evaluated the effect of the operative extent on the recurrence-free survival (RFS) of patients with multifocal PTC. Between 2010 and 2019, 718 patients with unilateral multifocal PTC were enrolled; 115 patients (16.0%) underwent ipsilateral thyroid lobectomy, and 606 patients (84.0%) underwent total thyroidectomy. With a mean follow up of 5.2 years, RFS was comparable between the total thyroidectomy and lobectomy groups (p = 0.647) after adjusting for potential confounders. Multivariable Cox regression analysis also demonstrated that the operative extent was not an independent predictor of recurrence (HR 1.686, 95% CI: 0.321–8.852). Subgroup analyses further indicated that both total thyroidectomy and thyroid lobectomy resulted in comparable RFS for multifocal PTC patients with other high-risk factors, including tumor size > 1 cm (p = 0.711), lymph node metastasis (p = 0.536), and intermediate ATA risk of recurrence (p = 0.682). In conclusion, thyroid lobectomy was not associated with the risk of recurrence in patients with multifocal PTCs. Multifocality in PTC may not always require aggressive surgery.

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“…In recent years, the clinical guideline recommendations were revised in order to avoid over-diagnosis in patients with low-risk thyroid nodules, aiming to promptly identifying patients with advanced or high-risk tumors requiring aggressive treatment approaches [16]. This involved discouraging screening programs [17,18], biopsy of suspicious subcentimeter nodules [10], and favoring less extensive surgery [19,20] and radioiodine use [21], as well as reducing the burden of post-surgical follow-up examinations [22,23]. These efforts are consistent with the general trend in reducing low-value care [24].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension?

Grani

Cera

Conzo

et al. 2021

JCM

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Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology.

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Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Cited by 24 publications

References 115 publications

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Optimal Surgical Extent in Patients with Unilateral Multifocal Papillary Thyroid Carcinoma

Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension?

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