Papillary thyroid carcinoma of the isthmus: Total thyroidectomy or isthmusectomy?

Vasileiadis, Ioannis; Boutzios, Georgios; Karalaki, Maria; Misiakos, Evangelos P.; Karatzas, Theodore

doi:10.1016/j.amjsurg.2017.09.008

Cited by 66 publications

(53 citation statements)

References 31 publications

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“…Central compartment dissection is a well-established treatment of clinical N1a (cN1a) and, coupled with lateral dissection, N1b (cN1b) disease, although its role as prophylaxis in cN0 disease is unclear [3]. Additional factors, including lesion location, multifocality, bilaterality, thyroid capsule invasion, and BRAF V600E and TERT mutation status, should also be considered to refine surgical planning [20][21][22]. Overall, we agree with the ATA 2015 recommendations on neck dissection and total thyroidectomy in intermediate-to high-risk DTC; however, the use of lobectomy for low-to intermediate-primary tumors ≤4 cm may be too broad.…”

Section: Thyroid Surgerymentioning

confidence: 99%

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

et al. 2020

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Purpose The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. Methods A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. Results We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. Conclusions In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.

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Section: Thyroid Surgerymentioning

confidence: 99%

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

et al. 2020

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“…The incidence of PTC presenting in the thyroid isthmus is reported to be between 1.0% and 9.2%. 5 Several studies have shown isthmic PTCs to be associated with more aggressive histopathological features including a higher rate of capsular invasion, 4,12,13 ETE, 14 multifocality, 4,13 and regional nodal metastases 4,13,15,16 when compared to PTCs located in the lateral lobes.…”

Section: Discussionmentioning

confidence: 99%

“…4,[12][13][14]17,19 However, there are no specific data available in the literature for the management of WDTC confined to the thyroid isthmus with a long-term follow-up. 5 Current guidelines, including the 2015 ATA guidelines, 6 Korean Thyroid Association Guidelines, 7 Korean Association of Thyroid and Endocrine Surgeons Guidelines, 8 and British Thyroid Association guidelines 9 do not mention isthmusectomy as an acceptable procedure in the management of WDTC. 6 Therefore, the role of isthmusectomy in the treatment of WDTC has remained controversial.…”

Section: Discussionmentioning

confidence: 99%

Isthmusectomy in selected patients with well‐differentiated thyroid carcinoma

et al. 2019

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Background: Isthmusectomy in the treatment of well-differentiated thyroid carcinoma (WDTC) is controversial. In this study, we analyze the outcomes of WDTC managed by isthmusectomy alone. Methods: Forty-three patients treated with isthmusectomy alone were identified from an institutional database of 6259 surgically treated patients with WDTC. Patient and tumor characteristics were analyzed. Disease-specific survival (DSS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method. Results: The pT classification was T1 for 41 and T2 for two patients. All were clinical N0, but 10 pts were pN1a. Using the American Thyroid Association risk stratification system, 9 patients were low-risk and 22 were intermediate-risk. One patient developed local recurrence, and two developed regional lymph node metastases; the 5-and 10-year DSS was 100.0%. The 5-and 10-year RFS was 93.1%. Conclusions: Isthmusectomy alone is an acceptable procedure in selected patients with low-and intermediate-risk WDTC limited to the isthmus. K E Y W O R D Sisthmectomy, isthmus, isthmusectomy, low risk cancer, well-differentiated thyroid carcinoma

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“…Papillary thyroid carcinoma (PTC) is the most common histological type of differentiated thyroid malignancy and is considered to be the least aggressive of the thyroid carcinomas, given a 5‐year survival rate of over 95% . Despite the dramatic rise in incidence, the mortality rate of patients with PTC remains stable, at approximately 0.5 per 100,000 people …”

Section: Introductionmentioning

confidence: 99%

The optimal surgical approach for papillary thyroid carcinoma with pathological n1 metastases: An analysis from the SEER database

Chen

Mou

et al. 2019

The Laryngoscope

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Objectives/Hypothesis: The definition of large-volume pathologic N1 metastases has been changed in the 2017 version 2 of the National Comprehensive Cancer Network guidelines, leading to a controversy over the optimal surgical approach selection for patients with biopsy-proven papillary thyroid carcinoma (PTC). The aim of this study was to investigate the therapeutic efficacy of total thyroidectomy (TT) and thyroid lobectomy (TL) for these patients.Study Design: Retrospective population-based database analysis.Methods: A total of 906 consecutive PTC patients with pathologic N1 metastases (>5 involved nodes with metastases ≤5 mm in the largest dimension) were retrieved from the Surveillance, Epidemiology, and End Results database, and divided into two groups (≤2 mm, >2-5 mm) based on the size of the extent of disease. Overall survival (OS) was then compared between patients treated with TT and TL, followed by Cox proportional hazards regression analysis to explore multiple prognostic factors.Results: OS favored TT compared with TL in patients with more than five involved nodes and metastases >2 to 5 mm in the largest dimension (P < .05). Cox analysis showed that the TL was not an independent factor associated with poorer OS than TT in these patients (P > .05).Conclusions: TT showed better survival than TL for patients with more than five involved nodes and metastases >2 to 5 mm in the largest dimension. For patients with more than five involved nodes and metastases ≤2 mm in the largest dimension, either TT or TL can be recommended because there was no difference in survival.

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Papillary thyroid carcinoma of the isthmus: Total thyroidectomy or isthmusectomy?

Cited by 66 publications

References 31 publications

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Isthmusectomy in selected patients with well‐differentiated thyroid carcinoma

The optimal surgical approach for papillary thyroid carcinoma with pathological n1 metastases: An analysis from the SEER database

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