Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Abstract

thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment.OBJECTIVE To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size.DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. MAIN OUTCOMES AND MEASURESFrequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. RESULTS Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, −16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, −1.2% to 35.2%]).CONCLUSIONS AND RELEVANCE Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.

Complication Rates of Total Thyroidectomy vs Hemithyroidectomy for Treatment of Papillary Thyroid Microcarcinoma

“…Whereas total thyroidectomy (TT) has historically been the primary treatment for PTMC, more recent guidelines recommend hemithyroidectomy (HT) and surveillance for low-risk differentiated cancers with specific sonographic features . Although the use of HT has increased from 3.7% to 21.9% for treatment of papillary thyroid carcinoma less than 4 cm following the release of the 2014-2015 American Thyroid Association guidelines, TT remains the most common surgical approach for all T-stage categories, used for 52% to 78% of PTMC . Among patients treated by endocrine surgeons, 75.8% of PTMC are treated using TT …”

Comprehensive analysis of cellular senescence and immune microenvironment in papillary thyroid carcinoma

“…It is estimated that there will be 224,023 new cases in China [1] and 43,800 new cases in the United States in 2022 [2]. The widespread use of high-resolution imaging techniques such as ultrasonography has led to a sharp increase in the incidence of papillary thyroid carcinoma (PTC) [3][4][5][6]. The primary treatment option for PTC patients is surgical, with thyroid hormone supplementation required in all thyroidectomy and more than two-thirds of lobectomies [7,8].…”