Alvaro Sanabria1, Luiz P Kowalski2, Iain J Nixon3, Ricard Simo4. 1. Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello, Cra. 51d #62-29, Medellín, Colombia. alvarosanabria@gmail.com. 2. Head and Neck Surgery Department, University of Sao Paulo Medical School and Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil. 3. Department of Otolaryngology Head and Neck Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK. 4. Department of Otorhinolaryngology, Head and Neck Surgery, Thyroid Oncology Unit Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
Abstract
PURPOSE: In the case of well-differentiated thyroid cancer, the importance of microscopic margin status remains controversial. We discuss the relevance of the effect of microscopic positive surgical margins in the early stages of differentiated thyroid cancer. METHODS: A comprehensive literature search and review of available evidence in English literature was undertaken. RESULTS: A previous meta-analysis did not find an association between microscopic positive surgical margins and local recurrence. Heterogeneity of definitions and differences between microscopic surgical margins and extrathyroid extension are discussed. Impact on clinical decision-making is explored. CONCLUSION: The finding of microscopic positive surgical margins in a patient with a thyroid tumor without intraoperative evidence of macroscopic invasion to adjacent structures, with complete resection made by the surgeon and without pathological report of extrathyroid extension, does not have a worse prognostic effect. We present a classification of surgical margins that may help thyroid oncology teams to tailor further management in patients with thyroid cancer.
PURPOSE: In the case of well-differentiated thyroid cancer, the importance of microscopic margin status remains controversial. We discuss the relevance of the effect of microscopic positive surgical margins in the early stages of differentiated thyroid cancer. METHODS: A comprehensive literature search and review of available evidence in English literature was undertaken. RESULTS: A previous meta-analysis did not find an association between microscopic positive surgical margins and local recurrence. Heterogeneity of definitions and differences between microscopic surgical margins and extrathyroid extension are discussed. Impact on clinical decision-making is explored. CONCLUSION: The finding of microscopic positive surgical margins in a patient with a thyroid tumor without intraoperative evidence of macroscopic invasion to adjacent structures, with complete resection made by the surgeon and without pathological report of extrathyroid extension, does not have a worse prognostic effect. We present a classification of surgical margins that may help thyroid oncology teams to tailor further management in patients with thyroid cancer.
Entities:
Keywords:
Margins of excision; Pathology; Prognosis; Recurrence; Survival; Thyroid neoplasm
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