Completion thyroidectomy may not be required for papillary thyroid carcinoma with multifocality, lymphovascular invasion, extrathyroidal extension to the strap muscles, or five or more central lymph node micrometastasis

Heo, Da Beom; Piao, Yudan; Ju, Sang-Hyeon; Yi, Hyon‐Seung; Kim, Min Su; Won, Ho-Ryun; Chang, Jae Won; Koo, Bon Seok; Kang, Yea Eun

doi:10.1016/j.oraloncology.2022.106115

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…Similar to a recent study by Beom Heo et al, other adverse features found in our cohort do not seem to have a great impact on the clinical outcomes of the patients. Gross ETE was present in 1 patient and microscopic ETE occurred in 122 of 74 patients (30%).…”

Section: Discussionsupporting

confidence: 91%

Partial Thyroidectomy With Incidental Metastatic Lymph Nodes

Alameer,

Eagan,

Scholfield

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceThe need for completion thyroidectomy in patients with incidental metastatic lymph nodes after partial thyroidectomy is unclear.ObjectiveTo investigate the outcomes of patients with incidental metastatic lymph nodes following partial thyroidectomy.Design, Setting, and ParticipantsA retrospective review of a prospectively maintained thyroid cancer database from 1985 to 2015 was carried out at a head and neck surgery practice at a tertiary referral cancer center. A total of 74 patients who underwent thyroid lobectomy or thyroid isthmusectomy between 1985 and 2015 and were found to have incidental metastatic lymph nodes on final pathologic analysis and were selected to be observed without immediate completion thyroidectomy were included. A separate group of additional 11 patients who underwent immediate completion thyroidectomy was also identified and reviewed.Main Outcome and MeasureAnalysis took place from February to May 2022. Recurrence-free survival outcomes of patients found to have incidental metastatic lymph nodes on final pathologic analysis following partial thyroidectomy with no immediate completion thyroidectomy.ResultsA total of 74 patients were observed, with a median (IQR) age of 39 (28-49) years; 44 (59%) were women. Sixty-four patients underwent thyroid lobectomy and 10 patients had isthmusectomy. Classic papillary thyroid carcinoma was the most common histologic type (34 [46%]). Vascular invasion and microscopic extrathyroidal extension were present in 11 patients (16%) and 22 patients (30%), respectively. Positive margins were identified in 5 patients (7.8%). Size of metastatic lymph nodes ranged between 0.07 cm and 1.2 cm. No extranodal extension was reported. A total of 52 patients (70%) were classified as intermediate risk for recurrence based on the American Thyroid Association risk stratification system. The median (IQR) follow up was 48.15 (15.4-86.1) months, during which only 1 patient had a regional recurrence. Another patient underwent delayed completion thyroidectomy for a contralateral lobe malignant abnormality. Recurrence-free survival, disease-specific survival, and overall survival were 97.4%, 100%, and 96.2%, respectively. A separate group of 11 patients who underwent immediate completion thyroidectomy were reviewed. These patients were more likely to have tall-cell papillary thyroid carcinoma (6 [55%] vs 13 [18%]), multifocality (9 [82%] vs 28 [41%]), microscopic extrathyroidal extension (8 [73%] vs 22 [30%]), and positive margins (3 [30%] vs 5 [7.8%]) compared with patients who were under observation only.Conclusion and RelevanceCompletion thyroidectomy may not be necessary in appropriately selected patients who are found to have incidental metastatic lymph nodes (N1a) after partial thyroidectomy for localized well-differentiated thyroid cancer.

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Section: Discussionsupporting

confidence: 91%

Partial Thyroidectomy With Incidental Metastatic Lymph Nodes

Alameer,

Eagan,

Scholfield

et al. 2024

JAMA Otolaryngol Head Neck Surg

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“…In current clinical management guidelines, multifocality is not considered a stand-alone prognostic factor [4,9]. It has been reported in several large case series that multifocality is not related to recurrence or clinical outcomes in PTCs [10,[52][53][54]. On the other hand, some studies found a significant relationship between multifocality and adverse prognostic features, including higher tumor stage [25,28,42,44,55], higher risk for LNM [18,19,25,26,28,43,49,[55][56][57][58][59][60][61][62], and higher rate of recurrence [10,27,28,30,44,56,63].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas

Can,

Bulbul,

Ozyilmaz

et al. 2024

Diagnostics

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(1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs ≤ 10 mm, TTDs > 10 mm, TTDs ≤ 20 mm, and TTDs > 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of >10 mm and unifocal PTCs with a primary tumor diameter (PTD) of >10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD > 10 mm were found to be significant risk factors for LNM, and PNI, TTD > 10 mm, TTD > 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD > 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD > 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD > 10 mm along with unifocal PTCs with PTD > 10 mm may be more useful in terms of clinical management of the disease.

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“…In various studies, multifocality [14,15] lymph node involvement [16], extrathyroidal extension [17], and papillary thyroid carcinoma (PTC) [18] in initial surgical pathology, high serum thyroglobulin level [17] and middle age (30-49 years) [18] have been reported as factors that can predict malignancy in the contralateral lobe. However, a recent comprehensive retrospective study found that multifocality, lymphovascular invasion, extrathyroidal spread to the strap muscles, or 5 or more central lymph node micro-metastases may not require immediate CTx in patients whose thyroid lobectomy specimen was papillary thyroid carcinoma [19]. It is important to understand that current guidelines appear to recommend CTx in the presence of various factors that we and many other researchers have not identified to be risk factors for malignancy.…”

Section: Clinical Researchmentioning

confidence: 91%

“…There is no consensus on which patients should be administered CTx after HTx [14,15]. Studies on the subject offer contradictory results [14,[16][17][18][19] and the current guidelines [6,20,21] do not seem to meet the needs of clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Optimal Surgical Approaches for Thyroid Cancer: A Comparative Analysis of Efficacy and Complications

Aras,

Karayıl

2024

Med Sci Monit

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Background Completion thyroidectomy (CTx) is performed following hemithyroidectomy (HTx) when the risk of malignancy persists or is discovered postoperatively. Different surgical approaches, including CTx after HTx (CTx-HTx), total thyroidectomy (TTx), and revision surgery after TTx (RTx-TTx), offer varying risks and benefits, including pathological outcomes and complication rates. Understanding the predictors and rates of malignancy in these procedures is crucial for optimizing surgical management of thyroid disorders. Material/Methods This retrospective study analyzed data from January 2014 to October 2019, including 60 patients each in the CTx-HTx and TTx groups, and 47 in the RTx-TTx group. The CTx-HTx group was subdivided based on benign or malignant findings in CTx specimens. Clinicodemographic data and pathological features such as tumor type, size, side, capsular and vascular invasion, extrathyroidal spread, multifocality, and lymph node metastasis were reviewed. Results Age and sex distributions were similar across groups. In the CTx-HTx group, 76.7% of specimens were benign and 23.3% malignant. No significant predictors of malignancy were found between the benign and malignant subgroups in univariate and multivariable analyses. In the TTx group, 75.0% of initial lobes and 13.3% of contralateral lobes were malignant. TTx was associated with a significant postoperative decrease in calcium and longer hospital stays. Multivariable analysis identified TTx as an independent risk factor for hypocalcemia. Conclusions Reducing overtreatment in thyroid cancer may involve limiting CTx after HTx and considering more conservative initial surgeries, particularly when indications for TTx are not definitive.

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Completion thyroidectomy may not be required for papillary thyroid carcinoma with multifocality, lymphovascular invasion, extrathyroidal extension to the strap muscles, or five or more central lymph node micrometastasis

Cited by 8 publications

References 29 publications

Partial Thyroidectomy With Incidental Metastatic Lymph Nodes

Partial Thyroidectomy With Incidental Metastatic Lymph Nodes

The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas

Optimal Surgical Approaches for Thyroid Cancer: A Comparative Analysis of Efficacy and Complications

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