Abstract
Purpose
Recent clinical practice guidelines consider thyroid lobectomy a viable alternative for low-risk papillary thyroid carcinoma PTC measuring 1–4 cm in size. We aimed to assess the likelihood of finding postoperatively determined high-risk histopathologic features that would lead to the recommendation of completion thyroidectomy.
Methods
A retrospective review of patients who underwent total thyroidectomy for PTC measuring 1–4 cm in size between Jan 2012 and Jan 2018 was conducted. Patients with pre-operative high-risk characteristics were excluded: history of radiation exposure, positive family history, clinically suspicious cervical lymphadenopathy, and gross extrathyroidal extension (ETE). A hypothetical group of 245 patients remained eligible for lobectomy. The pathology specimens from the cancer-containing lobes were evaluated for high-risk features: aggressive histology, capsular and/or vascular invasion, microscopic ETE, and multifocality. A subgroup analysis was performed with 2 cm being the cut-off size.
Results
The average age was 39 years with 73% being females. Mean cancer size was 16 mm. Evaluation of the cancer-containing lobe for high-risk features revealed: aggressive histology (33%), ETE (12%), capsular invasion (33%), vascular invasion (17%), and ipsilateral multifocality (30%). The cumulative risk of having ≥1 high-risk feature mandating completion thyroidectomy was 59%. The risk was considerably higher for lesions ≤2 cm compared to larger lesions (64% vs.48%; p = 0.049; RR = 1.3).
Conclusions
A considerable proportion of patients initially eligible for lobectomy have high-risk features that only become evident at pathology. Therefore, a comprehensive approach is advocated to determine the extent of surgery for PTC incorporating patient preferences regarding risks and benefits.
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Data availability
The data supporting the findings of this study are available from the corresponding author upon request.
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Author contributions
Corresponding author S.B.: study concept and design, data interpretation, article writing, final approval, accountability for all aspects of the work. K.A., G.D., Q.A. and T.P.: data collection and interpretation, final approval, accountability for all aspects of the work. G.M., P.M.: critical revision, final approval, accountability for all aspects of the work.
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Bakkar, S., Al-Omar, K., Donatini, G. et al. Postoperatively determined high-risk histopathologic features in papillary thyroid carcinoma initially eligible for thyroid lobectomy: a game changer. Endocrine 74, 611–615 (2021). https://doi.org/10.1007/s12020-021-02788-w
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DOI: https://doi.org/10.1007/s12020-021-02788-w