Is it time to reconsider lobectomy in low‐risk paediatric thyroid cancer?

Kluijfhout, Wouter P.; Pasternak, Jesse D.; Kaay, Danielle van der; Vriens, Menno R.; Propst, Evan J.; Wasserman, Jonathan D.

doi:10.1111/cen.13287

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…The prevalence of any multifocal disease and bilateral multifocal disease in this study population was consistent with reported rates in the pediatric literature up to 65% and 30%, respectively . In this study, the rate of detection of multifocal disease on preoperative imaging was lower than what has previously been reported in the literature . This finding may be because of variability in sensitivity of ultrasonography detection between multiple institutions and highlights the challenges of accurate preoperative detection of multifocal disease.…”

Section: Discussionsupporting

confidence: 89%

“…Preoperative knowledge of the presence of unilateral or bilateral multifocal disease is most relevant for decision-making in management of pediatric PTC given the rarity of multifocality in follicular thyroid carcinoma and the aggressiveness of medullary thyroid carcinoma, for which total thyroidectomy is uniformly performed. Still, the long-term overall survival benefit of total thyroidectomy in PTC remains unclear . Furthermore, these benefits must be weighed against the considerable risks of complications in total thyroidectomy, including hypoparathyroidism and recurrent laryngeal nerve injury.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Risk Factors for Multifocality in Pediatric Thyroid Cancer

Banik

Shindo

Kraimer

et al. 2021

JAMA Otolaryngol Head Neck Surg

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hyroid cancer is the most common endocrine cancer in children, with accelerating incidence over the past 2 decades. 1,2 Similar to thyroid cancer in adults, approximately 90% of pediatric thyroid cancer is composed of papillary thyroid carcinoma (PTC), while follicular thyroid carcinoma and medullary thyroid carcinoma account for the remaining 10% of cases. 3 However, pediatric PTC in particular frequently presents with more advanced disease and higher rates of recurrence and persistent disease than in adults. 3,4 Rates of extracapsular extension have been reported in up to 50% of children vs 30% of adults, regional nodal involvement in up to 80% vs 50%, and distant metastasis in up to 30% vs 5%. 4,5 Multifocal disease has been found in up to 65% of pediatric patients with thyroid cancer compared with approximately 38% of adults with thyroid cancer. 4,6 Associations between multifocal disease and higher risk of recurrence and persistent disease in children have been suggested in some studies. 7,8 Current guidelines and consensus statements recommend total thyroidectomy in nearly all pediatric patients with PTC, largely driven by the increased prevalence of multifocality and associated risk of recurrence and persistent disease. 3,9 When compared with lobectomy, total thyroidectomy has been shown in some studies to lower the risk of recurrence and persistent disease from 35% to 6% in pediatric IMPORTANCE Current guidelines recommend total thyroidectomy for the majority of pediatric thyroid cancer owing to an increased prevalence of multifocality. However, there is a paucity of information on the exact prevalence and risk factors for multifocal disease-knowledge that is critical to improving pediatric thyroid cancer management and outcomes.OBJECTIVE To determine the prevalence and risk factors for multifocal disease in pediatric patients with papillary thyroid carcinoma (PTC). DESIGN, SETTING, AND PARTICIPANTSThis multicenter retrospective cohort study included patients 18 years or younger who underwent thyroidectomy for PTC from 2010 to 2020 at 3 tertiary pediatric hospitals and 2 tertiary adult and pediatric hospitals in the US.MAIN OUTCOMES AND MEASURES Demographic and clinical variables, including age, family history of thyroid cancer, autoimmune thyroiditis, prior radiation exposure, cancer predisposition syndrome, tumor size, tumor and nodal stage, PTC pathologic variant, and preoperative imaging, were assessed for association with presence of any multifocal, unilateral multifocal, and bilateral multifocal disease using multiple logistic regression analyses. Least absolute shrinkage and selection operator analysis was performed to develop a model of variables that may predict multifocal disease. RESULTSOf 212 patients, the mean age was 14.1 years, with 23 patients 10 years or younger; 173 (82%) patients were female. Any multifocal disease was present in 98 (46%) patients, with bilateral multifocal disease in 73 (34%). Bilateral multifocal disease was more accurately predicted on preoperative imaging than unila...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors for Multifocality in Pediatric Thyroid Cancer

Banik

Shindo

Kraimer

et al. 2021

JAMA Otolaryngol Head Neck Surg

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“…Recent trends in the management of thyroid cancer call into question the need for routine total thyroidectomy in patients with low-risk PTC who have a nonsuspicious or cytologically benign contralateral nodule. The decrease in use of RAI ablation in patients with low-risk PTC enables lobectomy in a larger number of patients (20,21). Also, with better understanding of the epidemiology of thyroid cancer, we now know that many small thyroid cancers are "subclinical" and of little clinical significance, leading to the ATA recommendation not to perform fine-needle aspiration (FNA) for nodules smaller than 1 cm even with high-risk sonographic features and the option for active surveillance in patients with microscopic PTC (11,22).…”

mentioning

confidence: 99%

Natural History of Contralateral Nodules After Lobectomy in Patients With Papillary Thyroid Carcinoma

Ritter

Bachar

Hirsch

et al. 2017

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…However, selection bias may account for some of the lack of survival benefits from total thyroidectomy, and in some studies, follow-up may not have been sufficient to draw this conclusion ( Nice et al 2015 ). Nevertheless, there is some recent evidence to suggest there may be criteria by which to define very-low risk patients who may be candidates for lobectomy rather than total thyroidectomy ( Kluijfhout et al 2017 ).…”

Section: Resultsmentioning

confidence: 99%

Paediatric differentiated thyroid carcinoma: a UK National Clinical Practice Consensus Guideline

Howard

Freeston

Harrison³

et al. 2022

Endocrine-Related Cancer

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This guideline is written as a reference document for clinicians presented with the challenge of managing paediatric patients with differentiated thyroid carcinoma up to the age of 19 years. Care of paediatric patients with differentiated thyroid carcinoma differs in key aspects from that of adults, and there have been several recent developments in the care pathways for this condition; this guideline has sought to identify and attend to these areas. It addresses the presentation, clinical assessment, diagnosis, management (both surgical and medical), genetic counselling, follow-up and prognosis of affected patients. The guideline development group formed of a multi-disciplinary panel of sub-speciality experts carried out a systematic primary literature review and Delphi consensus exercise. The guideline was developed in accordance with The Appraisal of Guidelines Research and Evaluation Instrument II criteria, with input from stakeholders including charities and patient groups. Based on scientific evidence and expert opinion, 58 recommendations have been collected to produce a clear, pragmatic set of management guidelines. It is intended as an evidence base for future optimal management and to improve the quality of clinical care of Paediatric patients with differentiated thyroid carcinoma.

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Is it time to reconsider lobectomy in low‐risk paediatric thyroid cancer?

Cited by 15 publications

References 18 publications

Prevalence and Risk Factors for Multifocality in Pediatric Thyroid Cancer

Prevalence and Risk Factors for Multifocality in Pediatric Thyroid Cancer

Natural History of Contralateral Nodules After Lobectomy in Patients With Papillary Thyroid Carcinoma

Paediatric differentiated thyroid carcinoma: a UK National Clinical Practice Consensus Guideline

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