Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma?

Tengfei Ma,Shixi Liu,Haiyang Wang,Jian Zou,Jifeng Liu

doi:10.3389/fendo.2021.723631

Tengfei Ma, Shixi Liu + Show 3 more

Open Access

https://doi.org/10.3389/fendo.2021.723631

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Abstract

ObjectiveTo determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe.MethodsAdult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group.Results370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16–85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%.ConclusionPTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.

Highlights

The prevalence of thyroid nodules among asymptomatic persons is about 19–70% [1,2,3]
In recent years, many experts have called for less aggressive treatment of papillary thyroid cancers (PTCs), as studies have shown that total thyroidectomy does not provide a better clinical outcome than unilateral lobectomy for patients with low or intermediate risk PTC [6,7,8,9]
370 patients diagnosed with unilateral PTC after undergoing lobectomy and ipsilateral central-compartment neck dissection met the inclusion criteria for this retrospective study

Summary

Introduction

The prevalence of thyroid nodules among asymptomatic persons is about 19–70% [1,2,3]. In recent years, many experts have called for less aggressive treatment of PTC, as studies have shown that total thyroidectomy does not provide a better clinical outcome than unilateral lobectomy for patients with low or intermediate risk PTC [6,7,8,9]. In agreement with this conservative trend, most clinical guidelines currently recommend lobectomy as a valid treatment option for patients with a tumor < 4 cm, without gross extrathyroidal extension (ETE), and non-metastatic disease [10,11,12]. Given the striking prevalence of thyroid nodules and the increasing incidence of PTC, it is common to detect bilateral thyroid nodules by ultrasonography (US) in patients with pathologically confirmed PTC in one lobe [15]

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