Ioannis Vasileiadis1, Georgios Boutzios2, Maria Karalaki2, Evangelos Misiakos3, Theodore Karatzas4. 1. Department of Otolaryngology/Head and Neck Surgery, Venizeleio - Pananeio General Hospital, Herakleion, Greece; Department of Otolaryngology - Head and Neck Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom. Electronic address: j.vasileiadis@yahoo.gr. 2. Endocrine Unit, Department of Pathophysiology, Medical School, University of Athens, Laikon General Hospital, Athens, Greece. 3. Third Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece. 4. Second Department of Propedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Abstract
BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common histological type of differentiated thyroid malignancy. Although the majority of PTC is located in the thyroid lobes, a small minority arise from the thyroid isthmus. The reported incidence of PTC arising in the thyroid isthmus ranges from 1% to 9.2%, probably reflecting variation in the study populations. PURPOSE: This review aimed to analyze the data about the optimal management of PTC arising in the isthmus. DATA SOURCES: We performed a systematic review of PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials to identify eligible studies analyzing surgical management strategies and published outcomes of isthmic PTC. RESULTS: Most reports support that papillary thyroid carcinomas originating in the isthmus are more likely to have multiple foci, invasion of thyroid capsule and adjacent tissues with increased rate of central node involvement, compared to carcinomas located in other parts of the thyroid. CONCLUSIONS: The extent of the surgical resection, the role of prophylactic central neck dissection and the extent of central neck dissection in surgery for isthmic PTC remain highly controversial. However, total thyroidectomy and central node dissection may be an appropriate treatment for these patients.
BACKGROUND:Papillary thyroid carcinoma (PTC) is the most common histological type of differentiated thyroid malignancy. Although the majority of PTC is located in the thyroid lobes, a small minority arise from the thyroid isthmus. The reported incidence of PTC arising in the thyroid isthmus ranges from 1% to 9.2%, probably reflecting variation in the study populations. PURPOSE: This review aimed to analyze the data about the optimal management of PTC arising in the isthmus. DATA SOURCES: We performed a systematic review of PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials to identify eligible studies analyzing surgical management strategies and published outcomes of isthmic PTC. RESULTS: Most reports support that papillary thyroid carcinomas originating in the isthmus are more likely to have multiple foci, invasion of thyroid capsule and adjacent tissues with increased rate of central node involvement, compared to carcinomas located in other parts of the thyroid. CONCLUSIONS: The extent of the surgical resection, the role of prophylactic central neck dissection and the extent of central neck dissection in surgery for isthmic PTC remain highly controversial. However, total thyroidectomy and central node dissection may be an appropriate treatment for these patients.
Authors: Yoo Jin Lee; Dong Wook Kim; Gi Won Shin; Jin Young Park; Hye Jung Choo; Ha Kyoung Park; Tae Kwun Ha; Do Hun Kim; Soo Jin Jung; Ji Sun Park; Sung Ho Moon; Ki Jung Ahn; Hye Jin Baek Journal: Front Endocrinol (Lausanne) Date: 2020-06-04 Impact factor: 5.555