Additional Surgery for Occult Risk Factors After Lobectomy in Solitary Thyroid Nodules is Predicted by Cytopathology Classification and Tumor Size |
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| Institution: | 1. Johns Hopkins University School of Medicine, Department of Psychiatry, Baltimore, Maryland;2. Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Maryland;3. Johns Hopkins University School of Medicine, Department of Radiology, Baltimore, Maryland;4. Johns Hopkins University School of Medicine, Division of Otolaryngology, Baltimore, Maryland;5. Johns Hopkins University School of Medicine, Division of Endocrinology, Diabetes and Metabolism, Baltimore, Maryland;6. Johns Hopkins University School of Medicine, Department of Surgical Oncology, Division of Endocrine Surgery, Baltimore, Maryland;7. Mayo Clinic, Department of Pathology and Laboratory Medicine, Jacksonville, Florida;8. University of Texas Southwestern, Pathology Department, Dallas, Texas.;2. Tandem Diabetes Care, Information Technology, San Diego, California;3. University of California San Diego, Design Lab, La Jolla, California;4. Tandem Diabetes Care, Behavioral Sciences, San Diego, California.;1. Department of Endocrinology, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates;2. Department of Pharmacy, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates;3. Research Department, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.;1. Department of Endocrinology and Nutrition, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain;2. Department of Endocrinology and Nutrition, Hospital Universitario Príncipe de Asturias, Madrid, Spain;3. Department of Medicine, Emory University School of Medicine;4. School of Public Health, Emory University, Atlanta, Georgia.;1. From the Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, New York;2. Department of Pathology, NYU Langone Medical Center, New York, New York;3. Department of Radiology, NYU Langone Medical Center, New York, New York;4. Department of Computational systems and Biology, UPMC, Pittsburgh, Pennsylvania;5. Department of Surgery, Division of Endocrine Surgery, NYU Langone Medical Center, New York, New York;6. Department of Otolaryngology, Head and Neck Surgery, NYU Langone Medical Center, New York, New York.;1. Department of Endocrinology, Endocrine Key Laboratory of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, and;2. Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. |
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| Abstract: | Objective: Clinical practice for differentiated thyroid cancer is moving towards lobectomy rather than total thyroidectomy in patients at low risk of recurrence. However, recurrence risk assessment depends on post-operative findings, while the surgical decision is based on preoperative factors. We determined the preoperative predictors of occult higher-risk pathology and rates of completion thyroidectomy among surgical candidates with nonbenign thyroid nodules 10 to 40 mm and no evidence of extrathyroidal extension or metastasis on preoperative evaluation.Methods: Thyroid surgery cases at a single institution from 2005–2015 were reviewed to identify those meeting American Thyroid Association (ATA) criteria for lobectomy. ATA-based risk stratification from postoperative surgical pathology was compared to preoperative cytopathology, ultrasound, and clinical findings.Results: Of 1,995 thyroid surgeries performed for nonbenign thyroid nodules 10 to 40 mm, 349 met ATA criteria for lobectomy. Occult high-risk features such as tall cell variant, gross extrathyroidal invasion, or vascular invasion were found in 36 cases (10.7%), while intraoperative lymphadenopathy led to surgical upstaging in 13 (3.7%). Intermediate risk features such as moderate lymphadenopathy or minimal extrathyroidal extension were present in an additional 44 cases. Occult risk features were present twice as often in Bethesda class 6 cases (35%) as in lower categories (12 to 17%). In multivariable analysis, Bethesda class and nodule size, but not age, race, sex, or ultrasound features, were significant predictors of occult higher-risk pathology.Conclusion: Most solitary thyroid nodules less than 4 cm and with cytology findings including atypia of undetermined significance through suspicious for papillary thyroid cancer would be sufficiently treated by lobectomy.Abbreviations: ATA = American Thyroid Association; CND = central neck dissection; DTC = differentiated thyroid cancer; ETE = extrathyroidal extension; FNA = fine needle aspiration; FTC/HCC = follicular thyroid carcinoma/Hurthle cell carcinoma; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; OR = odds ratio; PTC = papillary thyroid cancer; US = ultrasound |
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