Lower Rates of Residual/Recurrent Disease in Patients With Incidentally Discovered Thyroid Carcinoma

Shakil, Jawairia; Ansari, Mohammed Z; Brady, Jett R.; Xu, Jiaqiong; Robbins, Richard J.

doi:10.4158/ep161497.or

Cited by 9 publications

(18 citation statements)

References 19 publications

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“…Around 23% of all patients with thyroid cancer had papillary thyroid microcarcinoma. Of 18 studies, 1 was cross-sectional [26] and 17 were cohort studies [8-10, 14, 27-39], mostly conducted in the United States [8,9,[31][32][33][34][35]39] and Italy [14,27,[36][37][38] (Appendix Table 2). Overall, in cohort studies, risk of bias seems to be low (12) to moderate (5), and low in the cross-sectional study (Appendix Table 3).…”

Section: Resultsmentioning

confidence: 99%

Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis

et al. 2021

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Purpose Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis. Methods We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included. Results In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant. Conclusions About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.

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Section: Resultsmentioning

confidence: 99%

Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis

et al. 2021

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“…In another study, a reported risk of mortality was less than 1%, locoregional recurrence rates were 2%‐6%, and distant recurrence rates were 1%‐2% in ITC patients . Shakil et al showed that when compared with NITC patients, ITC patients had a significantly less aggressive course and a trend toward longer progression‐free survival …”

Section: Discussionmentioning

confidence: 99%

“…28 Shakil et al showed that when compared with NITC patients, ITC patients had a significantly less aggressive course and a trend toward longer progression-free survival. 29 The limitation of this study was that it was a retrospective study with patients from a single center. Inspite of that the number of thyroid cancer patients was not small, it is possible that a higher number of patients would increase the reliability of the study results.…”

Section: Discussionmentioning

confidence: 99%

A cancer of undetermined significance: Incidental thyroid carcinoma

Evranos¹,

Polat

Cuhaci

et al. 2018

Diagnostic Cytopathology

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Introduction The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. Methods Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. Results Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non‐incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non‐complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). Conclusion ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.

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“…At the time of their initial diagnosis, our elderly patients with PTMC likewise showed significantly fewer cases of ETE and LNM, which led to a lower postoperative recurrence rate than was observed among those with non-PTMC, even with a relatively short followup interval. Accordingly, elderly patients with subclinical PTMC have been recommended as candidates for observation rather than immediate surgery [ 31 , 34 ]. In another study, Ito et al [ 35 ] concluded that thyroid surgery is not always necessary unless a patient exhibits LNM, multiplicity, a positive family history, or other pathological lesions in the contralateral lobe.…”

Section: Discussionmentioning

confidence: 99%

“…If they undergo total thyroidectomy for thyroid cancer, there is a small but significant risk of operative complications, such as vocal cord paralysis or hypoparathyroidism, and lifelong thyroid hormone replacement may be needed [ 21 ]. Based on our 10-year single-institution experience, we advocate a tailored approach to develop appropriate treatment or follow-up plans in elderly patients depending on the tumor size and the extent of ETE or LNM [ 2 , 21 , 34 ]. More aggressive treatment (total thyroidectomy and subsequent RAIT) or more frequent follow-up should be considered only for patients with a larger tumor, wide ETE, or lateral LNM, all of which can be predicted by preoperative radiologic assessment.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of recently diagnosed papillary thyroid carcinoma in elderly patients aged 65 and older based on 10 years of sonographic experience at a single institution in Korea

et al. 2017

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PurposeThe aim of this study was to assess the characteristics of papillary thyroid carcinoma (PTC) in patients aged 65 and older in order to predict postoperative recurrence based on the results of ultrasonographic surveillance.MethodsAmong 1,494 patients (200 male and 1,294 female; mean age, 46.6±11.3 years) who underwent surgery for thyroid cancer at our institution between 2006 and 2015, we retrospectively enrolled 150 PTC patients (29 male and 121 female; mean age, 69.4±4.2 years). To identify the risk factors for recurrence, we analyzed age, gender, multiplicity, size, number, extrathyroidal extension (ETE) of the tumor, lymph node metastasis (LNM), type of surgery, and the dose of radioactive ablation using a Cox regression model to identify hazard ratios (HRs).ResultsAmong the 115 asymptomatic patients with PTCs detected by screening ultrasonography (n=86), other cross-sectional imaging modalities (computed tomography or positron emission tomography-computed tomography, n=13), or incidentally through a surgical specimen (n=16), 78 patients were confirmed to have papillary thyroid microcarcinomas (PTMCs). The other 35 patients presented with palpable neck masses (n=25), vocal cord palsy (n=9) or blood-tinged sputum (n=1). During the follow-up period (mean, 43.6 months), 17 patients (12.5%) experienced recurrence in the neck. None of the patients died due to PTC-related recurrence or distant metastasis during the follow-up period. Cox regression analysis demonstrated that tumor size (HR, 2.12; P<0.001) and LNM (central LNM: HR, 9.08; P=0.004; lateral LNM: HR, 14.71; P=0.002; both central and lateral LNM: HR, 58.41; P<0.001) significantly increased the recurrence rate. ETE, LNM, and recurrence were significantly less frequent in PTMCs than in non-PTMC (all P<0.001).ConclusionPTCs of small size and absent LNM showed significantly better prognoses in patients 65 years and older.

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Lower Rates of Residual/Recurrent Disease in Patients With Incidentally Discovered Thyroid Carcinoma

Cited by 9 publications

References 19 publications

Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis

Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis

A cancer of undetermined significance: Incidental thyroid carcinoma

Clinical features of recently diagnosed papillary thyroid carcinoma in elderly patients aged 65 and older based on 10 years of sonographic experience at a single institution in Korea

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