Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1cm.

Lutske Lodewijk,Guillaume Hoch,Jacobus W A Burger,Laurent Brunaud,Schelto Kruijff,Wayne S Lee,Anna Aronova,Rasa Zarnegar,Michael D Jones,Els J Nieveen Van Dijkum,H Jaap Bonjer,Nicole D Bouvy,Inge Stegeman,Gerlof D Valk,Elliot J Mitmaker,Menno R Vriens,Wen T Shen,Daniel T Ruan,Marlon A Guerrero,Wouter P Kluijfhout,Jakob W Kist,Raymon H Grogan,Johannes H W De Wilt,Gavin Ho,Jos A Van Der Hage,Abbey Schepers,Ahmad Aniss ,Inne H.m Borel Rinkes ,Romana T Netea‐Maier ,John Theodorus Plukker ,Cassandre Bénay ,Benjamin C James ,Mark Sywak ,C Pandolfi

doi:10.1007/s00423-016-1393-4

Abstract

PurposeTraditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm.MethodsA retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma.ResultsA total of 1313 patients were included, of whom 426 (32 %) had a contralateral carcinoma. The contralateral carcinomas consisted of 288 (67 %) papillary thyroid carcinomas (PTC), 124 (30 %) follicular variant of a papillary thyroid carcinoma (FvPTC), 5 (1 %) follicular thyroid carcinomas (FTC), and 3 (1 %) Hürthle cell carcinomas (HTC). Ipsilateral multifocality was strongly associated with the presence of contralateral carcinomas (OR 2.62). Of all contralateral carcinomas, 82 % were ≤10 mm and of those 99 % were PTC or FvPTC. Even if the primary tumor was a FTC or HTC, the contralateral carcinoma was (Fv)PTC in 92 % of cases.ConclusionsThis international multicenter study performed on patients with DTC larger than 1 cm shows that contralateral carcinomas occur in one third of patients and, independently of primary tumor subtype, predominantly consist of microPTC.

Highlights

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and its incidence is rising
Even if the primary tumor was a follicular thyroid carcinomas (FTC) or Hürthle cell carcinomas (HTC), the contralateral carcinoma was (Fv)papillary thyroid carcinomas (PTC) in 92 % of cases. This international multicenter study performed on patients with DTC larger than 1 cm shows that contralateral carcinomas occur in one third of patients and, independently of primary tumor subtype, predominantly consist of microPTC
In western countries, treatment of DTC was similar for all stages of macroDTC (DTC larger than 1 cm): total thyroidectomy followed by radioactive iodine ablation (RAI) therapy [2, 3]

Summary

Introduction

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and its incidence is rising. In the last decade, single-center studies performed in large-volume centers showed no significant differences in recurrence and survival rates in patients diagnosed with macroDTC, who were either treated with lobectomy or total thyroidectomy [4,5,6,7]. Supporters of total thyroidectomy argue that contralateral carcinomas could affect disease recurrence and survival [12,13,14,15] These data are mainly based on patients with microDTC (DTC smaller than 1 cm) and data on the incidence of contralateral carcinomas in macroDTC is currently scarce [16,17,18,19,20,21]

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