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Does the ATA Risk Stratification Apply to Patients with Papillary Thyroid Microcarcinoma?

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Abstract

Background

The incidence of papillary thyroid microcarcinoma (PTMC) has increased over the past decade. The American Thyroid Association (ATA) suggests that these patients may undergo either thyroid lobectomy or active surveillance. It remains unclear whether there exists a subgroup of PTMC patients who may benefit from more aggressive treatment due to increased risk of recurrence.

Methods

We retrospectively reviewed 357 patients with PTMC who underwent surgery at a single institution from 2004 to 2016. Patients were classified according to 2015 ATA risk stratification for structural disease recurrence. Demographic, oncologic, and clinicopathologic data were compared between groups.

Results

Out of 357 patients, 246 were classified as low-risk PTMC, 93 were intermediate-risk, and 18 were high-risk. There were more male patients in the high-risk group (38.9%) than the intermediate- (31.2%) or low-risk groups (15.4%) (p < 0.001). Patients with low-risk microcarcinomas were more likely to have an incidental PTMC when compared to intermediate- or high-risk groups (98[39.8%], 15[16.1%], 1[5.6%], respectively, p < 0.001). Patients with high-risk PTMCs, compared to those with intermediate- and low-risk PTMCs, were more likely to have rising postoperative thyroglobulin levels after total thyroidectomy (6[40.0%], 4[5.1%], 9[5.7%], respectively, p = 0.001) and structural recurrence after lobectomy or total thyroidectomy (3[16.7%], 0[0%], 0[0%], respectively, p < 0.001). The median follow-up time was 17.5 (IQR 3–55) months.

Conclusions

Patients with high-risk PTMC have an increased risk of recurrence when compared to low- and intermediate-risk microcarcinomas, whereas intermediate-risk PTMC may behave similarly to low-risk tumors. ATA risk stratification may inform clinical decision making for patients with PTMC.

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Authors and Affiliations

  1. Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 E. 68th St, F-2024, New York, NY, 10065, USA

    Dessislava I. Stefanova, Arpita Bose, Timothy M. Ullmann, Jessica N. Limberg, Brendan M. Finnerty, Rasa Zarnegar, Thomas J. Fahey III & Toni Beninato

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  1. Dessislava I. Stefanova
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Correspondence to Toni Beninato.

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The study was approved by the institutional review board at Weill Cornell Medicine.

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Stefanova, D.I., Bose, A., Ullmann, T.M. et al. Does the ATA Risk Stratification Apply to Patients with Papillary Thyroid Microcarcinoma?. World J Surg 44, 452–460 (2020). https://doi.org/10.1007/s00268-019-05215-4

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