Emma Anda Apiñániz1,2,3, Carles Zafon3,4, Irati Ruiz Rey5, Carolina Perdomo5, Javier Pineda1,2, Juan Alcalde6, Marta García Goñi5, Juan C Galofré7,8,9. 1. Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Pamplona, Spain. 2. IdiSNA (Instituto de investigación en la Salud de Navarra), Pamplona, Spain. 3. SEEN (Sociedad Española de Endocrinología y Nutrición) Thyroid Task-Force, Pamplona, Spain. 4. Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 5. Department of Endocrinology and Nutrition, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain. 6. Department of Otorhinolaryngology, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain. 7. IdiSNA (Instituto de investigación en la Salud de Navarra), Pamplona, Spain. jcgalofre@unav.es. 8. SEEN (Sociedad Española de Endocrinología y Nutrición) Thyroid Task-Force, Pamplona, Spain. jcgalofre@unav.es. 9. Department of Endocrinology and Nutrition, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain. jcgalofre@unav.es.
Abstract
PURPOSE: The adequate extent of surgery for 1-4 cm low-risk papillary thyroid carcinoma (PTC) is unclear. Our objective was to analyze the applicability of the 2015 ATA Guidelines recommendation 35B (R35) for the management low-risk PTC. METHODS: This multicentre study included patients with low-risk PTC who had undergone total thyroidectomy (TT). Retrospectively we selected those who met the R35 criteria for the performance of a thyroid lobectomy (TL). The aim was to identify the proportion of low-risk PTC patients treated using TT who would have required reintervention had they had a TL in accordance with R35. RESULTS: We identified 497 patients (400 female; 80.5%). Median tumor size (mm): 21.2 (11-40). A tumor size ≥2 cm was found in 252 (50.7%). Most of them, 320 (64.4%), were in Stage I (AJCC 7th Edition). Following R35, 286 (57.5%) would have needed TT. Thus, they would have required a second surgery had they undergone TL. The indications for reintervention would have included lymph node involvement (35%), extrathyroidal extension (22.9%), aggressive subtype (8%), or vascular invasion (22.5%). No presurgical clinical data predict TT. CONCLUSIONS: The appropriate management of low-risk PTC is unclear. Adherence to ATA R35 could lead to a huge increase in reinterventions when a TL is performed, though the need for them would be questionable. In our sample, more than half of patients (57.5%) who may undergo a TL for a seemingly low-risk PTC would have required a second operation to satisfy international guidelines, until better preoperative diagnostic tools become available.
PURPOSE: The adequate extent of surgery for 1-4 cm low-risk papillary thyroid carcinoma (PTC) is unclear. Our objective was to analyze the applicability of the 2015 ATA Guidelines recommendation 35B (R35) for the management low-risk PTC. METHODS: This multicentre study included patients with low-risk PTC who had undergone total thyroidectomy (TT). Retrospectively we selected those who met the R35 criteria for the performance of a thyroid lobectomy (TL). The aim was to identify the proportion of low-risk PTC patients treated using TT who would have required reintervention had they had a TL in accordance with R35. RESULTS: We identified 497 patients (400 female; 80.5%). Median tumor size (mm): 21.2 (11-40). A tumor size ≥2 cm was found in 252 (50.7%). Most of them, 320 (64.4%), were in Stage I (AJCC 7th Edition). Following R35, 286 (57.5%) would have needed TT. Thus, they would have required a second surgery had they undergone TL. The indications for reintervention would have included lymph node involvement (35%), extrathyroidal extension (22.9%), aggressive subtype (8%), or vascular invasion (22.5%). No presurgical clinical data predict TT. CONCLUSIONS: The appropriate management of low-risk PTC is unclear. Adherence to ATA R35 could lead to a huge increase in reinterventions when a TL is performed, though the need for them would be questionable. In our sample, more than half of patients (57.5%) who may undergo a TL for a seemingly low-risk PTC would have required a second operation to satisfy international guidelines, until better preoperative diagnostic tools become available.
Authors: Jung Bum Choi; Seul Gi Lee; Min Jhi Kim; Tae Hyung Kim; Eun Jeong Ban; Cho Rok Lee; Jandee Lee; Sang-Wook Kang; Jong Ju Jeong; Kee-Hyun Nam; Woong Youn Chung; Cheong Soo Park Journal: Head Neck Date: 2018-12-10 Impact factor: 3.147
Authors: Juan J Díez; Victoria Alcázar; Pedro Iglesias; Ana Romero-Lluch; Julia Sastre; Begoña Pérez Corral; Carles Zafón; Juan Carlos Galofré; María José Pamplona Journal: Gland Surg Date: 2021-02