Reduction of overtreatment without reduction of overdiagnosis in patients with differentiated thyroid cancer: mission impossible

Tjasa Oblak,Marko Hocevar,Andraz Perhavec,Barbara Peric

doi:10.1007/s00423-021-02216-7

Tjasa Oblak, Marko Hocevar + Show 2 more

Open Access

https://doi.org/10.1007/s00423-021-02216-7

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Abstract

PurposeLateral neck nodal metastases are common in patients with differentiated thyroid cancer (DTC) and usually have an indolent nature. They may be detected via neck palpation or preoperative ultrasound (US) of the neck. We hypothesized that preoperative neck metastases detected with US did not affect regional recurrence or long-term survival.MethodsA retrospective analysis of patients’ records treated for DTC at our institution between January 2006 and December 2016 was performed. Information about preoperative US of the neck, treatment, demographics, staging, and histopathology was obtained. The endpoints for the study were nodal recurrence and survival. Differences in survival were analyzed between three groups of patients divided by presence or lack of preoperative US and/or palpable cervical lymph nodes (PLN). Furthermore, the prognostic value of multiple variables was tested by univariate and multivariate analysis.ResultsThere were 1108 patients with DTC, 221 males and 887 females. The median age was 48.3 years (range 3 to 86), the median time of observation was 68 months (range 0 to 142). Eight hundred sixty-two patients without PLN or preoperative US represented group 1, 112 patients with PLN were in group 2, and 134 patients without PLN and with preoperative US were in group 3. Only five patients had a regional recurrence, one died due to distant metastases. There was no statistically significant difference in survival between the groups (p = 0.841) and neck US was not significantly associated with overall survival neither in univariate nor in multivariate analysis.ConclusionIn patients with DTC, the benefits of preoperative US of cervical lymph nodes are probably limited and “less is more” approach is advised.

Highlights

Differentiated thyroid cancer (DTC) is one of the most common endocrine cancers and its incidence in the developed countries has increased steeply over the last decades [1]
Lateral neck lymph node metastases are present in 20–60% of patients with DTC [5,6,7]
Lateral neck lymph node metastases that are greater than 3 cm in size lead to a decrease in recurrence-free survival and in disease-specific survival [10, 11]

Summary

Introduction

Differentiated thyroid cancer (DTC) is one of the most common endocrine cancers and its incidence in the developed countries has increased steeply over the last decades [1]. Major rise in DTC incidence is largely attributed to overdiagnostics due to the increasing availability of different imaging tools, mostly ultrasound (US), CT, and PET-CT, that allowed detection of otherwise undetectably small or indolent neoplasms [3, 4]. Lateral neck lymph node metastases are present in 20–60% of patients with DTC [5,6,7]. While clinically occult lymph node metastases have little prognostic value, macroscopic metastatic lymph nodes increase the risk of both local and distant recurrence in patients older than 55 years. Lateral neck lymph node metastases that are greater than 3 cm in size lead to a decrease in recurrence-free survival and in disease-specific survival [10, 11]

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