Extent Of Thyroidectomy In Patients Research Articles

Clinical Characteristics-Assisted Risk Stratification for Extent of Thyroidectomy in Patients With 1-4 cm Solitary Intrathyroidal Differentiated Thyroid Cancer.

BackgroundDifferentiated thyroid cancer (DTC) is the most common type of thyroid cancer. The 2015 American Thyroid Association (ATA) guidelines recommend that lobectomy is suitable for solitary intrathyroidal DTC (SI-DTC) of 1–4 cm. However, some SI-DTC patients with other high-risk characteristics still have poor prognosis and require more aggressive surgical methods. This study aimed to explore the clinical characteristics that are important for the identification and treatment of high-risk patients with SI-DTC of 1–4 cm.MethodsThe study cohort was obtained from the SEER database, consisting of data between 2004 and 2013. The outcome measures were thyroid carcinoma-specific mortality (CSM) and all-cause mortality (ACM). Patient survival curves were examined using Kaplan–Meier analyses with log-rank tests and Cox proportional hazards regression analyses. Hazard ratios (HRs) were used to show the magnitude of the effect of disease stage on DTC-specific patient mortality.ResultsThe study included 55,947 patients with SI-DTC of 1–4 cm and 4,765 patients with DTC >4 cm. Tumor size, surgical approach, age, sex, race, and radiation exposure were independent risk factors for CSM and ACM. SI-DTC patients with female, age ≤45, and 1 cm< tumor size ≤2 cm were at low risk of CSM [HR = 0.014 (0.002–0.115)] and ACM [HR = 0.115 (0.077–0.171)] when stratified by age, sex, and tumor size. Compared to T3 patients, CSM was not significantly different in male patients, age >45, 2 cm< tumor size ≤3 cm [HR = 0.839 (0.414–1.700)] and male patients, age >45, 1 cm< tumor size ≤2 cm [HR = 0.751 (0.410–1.377)]. Furthermore, compared to T3 patients without extrathyroidal extension (ETE) and lymph node metastasis (LNM), more subgroups of SI-DTC of 1–4 cm had a similar prognosis. In addition, patients with SI-DTC of 1–4 cm showed similar rates of CSM and ACM to T3 patients without ETE, LNM, and distant metastasis (DM). Similar results were obtained when we set the age cut-off value as 55 years, according to the 8th edition of AJCC TNM system.ConclusionsOur study demonstrated that sex, age, and tumor size clearly differentiate SI-DTC of 1–4 cm into low-and high-risk categories. Survival rates were significantly lower in subgroups containing old males with larger tumors compared to younger females with small tumors. Total thyroidectomy may be favored in these high-risk subgroup patients.

The Effect of ThyroidߚStimulating Hormone on Stage of Differentiated Thyroid Carcinoma

IntroductionThyroid cancer is the most common endocrine malignancy, and it has the fastest increase rate in incidence in both sexes, with a yearly increase of 3% over the last decade. Thyroid‐stimulating hormone (TSH) is the main driver for the thyroid gland to produce thyroid hormone. The main purpose of this study was to assess the relationship between serum TSH level and the stage of malignancy in patients with differentiated thyroid cancer.MethodsThis cross‐sectional study was performed on 77 patients with thyroid cancer. The demographic characteristics, TSH level and stage of malignancy were recorded for all patients in the data collection form. The data analysis was conducted by descriptive statistics using SPSS 20.0 software.ResultsThe results show a significant relationship (p‐value = .025) between the malignancy stage and serum TSH level. The mean TSH level in patients of stage 3 (5.70 ± 2.03) was significantly higher than patients in stage 2 (2.58 ± 0.52) and stage 1 (2.33 ± 0.28). No significant relationship was observed between the age of patients and serum TSH level. Although the mean serum TSH level in men (3.61 ± 0.98) was higher than in women (2.52 ± 0.25), the difference was not statistically significant.ConclusionsAccording to the results of this study, serum TSH level can be considered as a predictor of the stage of differentiated thyroid cancer. Therefore, it can be used to predict the likelihood of cancer and improve the outcome and extent of thyroidectomy in patients with thyroid cancer.

TERT Promoter Mutation and Extent of Thyroidectomy in Patients with 1-4 cm Intrathyroidal Papillary Carcinoma.

There are concerns regarding overtreatment in papillary thyroid carcinoma (PTC). BRAF V600E and TERT promoter mutations play important roles in the development of PTC. However, initial surgical approaches for PTC based on genetic characteristics remain unclear. The present study aimed to identify genetic mutations as predictors of prognosis and to establish proper indications for lobectomy (LT) in patients with 1–4 cm intrathyroidal PTC. Prospectively accumulated data from 685 consecutive patients with PTC who underwent primary thyroid surgery at the Cancer Institute Hospital, Tokyo, Japan, between 2001 and 2012 were retrospectively reviewed. Of the 685 patients examined, 538 (78.5%) had BRAF V600E mutation and 133 (19.4%) had TERT promoter mutations. Patients with TERT promoter mutations displayed significantly worse outcomes than those without mutations (10-year cause-specific survival (CSS): 73.7% vs. 98.1%, p < 0.001; 10-year disease-free survival (DFS): 53.7% vs. 93.3%, p < 0.001). As for extent of thyroidectomy among TERT mutation-negative patients with 1–4 cm intrathyroidal PTC, patients who underwent LT showed no significant differences in 10-year CSS and 10-year DFS compared to patients who had total thyroidectomy (TT) under propensity score-matching. Avoiding TT for those patients indicates a possible pathway to prevent overtreatment and reduce postoperative complications.

Papillary thyroid microcarcinoma: decision-making, extent of surgery, and outcomes

BackgroundThe optimal extent of surgery for patients with papillary thyroid microcarcinoma (PTMC), tumors ≤1 cm, is controversial because survival is excellent regardless of approach. The objective of this study was to investigate patient and surgeon decision-making about the extent of surgery for PTMC. Materials and methodsWe conducted a retrospective review of thyroid cancer patients operated on at a single institution from 2008-2016. To examine decision-making about the extent of surgery, we performed a discourse analysis on all available documentation looking for patient or surgeon reasons. ResultsOf the 853 thyroid cancer patients, 125 (14.7%) had a PTMC as their largest tumor. Overall, 27.2% of the PTMC patients underwent a thyroid lobectomy, whereas 72.8% had a total thyroidectomy (TT). Of those patients diagnosed with PTMC preoperatively (19/125), a significantly higher proportion underwent a TT (94.7% versus 68.9%, P = 0.02). In all cases, documentation indicated that these preoperatively diagnosed patients followed the surgeon's recommendation regarding the extent of surgery. Reasons surgeons cited for recommending a TT included patient and disease factors (34.6%), belief that TT was the standard treatment (21.7%), ease of follow-up (8.7%), and referring provider preference (4.3%). Of the 19 patients diagnosed preoperatively, four (21.1%) patients had a complication, one (5.3%) of which was permanent and potentially avoidable with less extensive surgery. ConclusionsThese data suggest that surgeons drive decision-making about the extent of thyroidectomy in patients with preoperatively diagnosed PTMC. With recent guidelines recommending thyroid lobectomy, closer examination of decision-making is needed to ensure that patients make well-informed, preference-based decisions.

The utility of frozen section examination for determining the extent of thyroidectomy in patients with a thyroid nodule and “atypia/follicular lesion of undetermined significance”

BackgroundThe purpose of this study was to evaluate the role of frozen section examination (FSE) for determining the extent of thyroidectomy in patients with nodular thyroid disease and fine-needle aspiration categorized as atypia/follicular lesion of undetermined significance (AFLUS). MethodsA retrospective review of all patients operated on for a thyroid nodule and AFLUS was completed to determine the role of clinical examination and FSE in intraoperative decision making. ResultsOne hundred twenty patients with AFLUS underwent thyroidectomy; 18 (15%) had carcinoma. FSE altered management in 36 (62%) of the 58 patients—32 with benign disease and 4 with cancer who underwent lobectomy and total thyroidectomy, respectively. Total thyroidectomy without FSE was performed in 61 (51%) patients with sonographically confirmed bilateral disease. FSE had a 36.4% sensitivity, 100% specificity, 100% positive predictive value, 87% negative predictive value, and 88% accuracy. ConclusionUltrasound in combination with FSE is of value for determining the extent of thyroidectomy in patients with AFLUS.

Extent of Thyroidectomy in Patients with Dominant Bethesda III Nodules

Extent of Thyroidectomy in Patients with Dominant Bethesda III Nodules

The utility of preoperative serum thyroid-stimulating hormone level for predicting malignant nodular thyroid disease

Introduction The aim of this study was to assess whether serum thyroid-stimulating hormone (TSH) levels are of value in predicting malignancy in patients with nodular thyroid disease (NTD). Methods Patients with NTD and a preoperative TSH level who underwent thyroidectomy between 1990 and 2008 were identified from a prospective database. Age, sex, TSH concentration, nodule size, and pathology were evaluated. Logistic regression analysis was used to determine which factors were predictive of malignancy. Results Six hundred fifty-three patients were analyzed. The overall rate of malignancy was 20%; the rate was highest in patients <30 years (32%). The mean TSH level was higher in the malignant group (5.5 μIU/mL vs 1.4 μIU/mL, P < .0001). The rate of malignancy was 65% in patients with TSH levels >5.5 μIU/mL. Logistic regression analysis revealed that TSH level was the only significant risk factor for malignancy. Conclusion The serum TSH level may be useful in predicting the probability of cancer and optimizing the extent of thyroidectomy in patients with NTD.

Papillary thyroid carcinoma: Debate at rest

Papillary thyroid cancer (PTC) is the most common well-differentiated cancer of the thyroid and is one of the fastest growing group of cancers probably because of the increased use of ultrasound (HRUSG) in the evaluation of the thyroid in recent years. A MEDLINE and OVID database search was performed to collect information on papillary thyroid carcinoma. Recently published consensus guidelines were also used as an additional resource. The controversy regarding the extent of thyroidectomy in patients of PTC is relatively settled, with total thyoidectomy being the preferred approach with nodules> 1.5 cm in size. Lymph node (LN) metastases do not seem to affect the overall survival, but they do increase the recurrence rate. It is worthwhile to offer LN dissection at initial surgery if LNs are ultrasonologically diagnosed to harbor malignancy. In experts hands, the rate of recurrent laryngeal nerve injury and hypoparathyroidism is negligible in a neck dissection in initial surgery and remains negligible if carried out in a redo or completion scenario.

Role of Surgeon-Performed Ultrasound in Predicting Malignancy in Patients with Indeterminate Thyroid Nodules

Certain ultrasound features can predict malignancy in patients with thyroid nodules. The purpose of this study was to determine the value of surgeon-performed ultrasound (SUS) in predicting thyroid malignancy in patients with indeterminate fine-needle aspiration (FNA) cytology. 477 consecutive patients with dominant thyroid nodules were referred to our institution from 2002 to 2007. Of these, 180/477(38%) were judged to have indeterminate cytology: follicular neoplasm (FN, n = 108), Hürthle neoplasm (HN, n = 29), and suspicious for papillary thyroid cancer (SPTC, n = 43). SUS characteristics for thyroid nodules were recorded in a prospective database prior to thyroidectomy. Variables analyzed included patients' age and sex, nodule size, shape, echogenicity, consistency, borders, multiplicity/multicentricity, and presence of microcalcifications. SUS features of thyroid nodules were correlated with final pathology. The accuracy of individual SUS features as well as the presence of two or more adverse features in predicting malignancy was also examined. There were 144 females and 36 males. Mean age was 52 years (range 17-87 years). Mean tumor size was 2.7 cm (range 0.65-6.6 cm). Overall, final pathology revealed cancer in 92/180 (51%) patients. Malignancy was present in 40/108 (37%) FN, 12/29 (41%) HN, and 40/43 (93%) SPTC. Nodule borders (irregular), shape (height > width), hypoechogenicity, and presence of microcalcifications were significantly associated with malignancy. The presence of 2 or >/=3 adverse SUS thyroid nodule features was associated with a >/=55% or >/=78% risk of malignancy, respectively. Adverse thyroid nodule features seen on SUS may predict malignancy and help determine the initial extent of thyroidectomy in patients with indeterminate FNA cytology.

Influence of surgical and postoperative treatment on survival in differentiated thyroid cancer

The extent of thyroidectomy in patients with differentiated thyroid cancer (DTC) remains controversial. The aim of this study was to identify how surgical technique and postoperative treatments influence survival and locoregional recurrence in DTC. A nested case-control study was conducted in a cohort of 5123 patients diagnosed with DTC in Sweden between 1958 and 1987. One matched control subject was selected randomly for each patient who died from DTC. Details regarding surgery and postoperative treatments were obtained from medical records. The effect of treatment on survival was estimated by conditional logistic regression. Patients not treated surgically had a poorer prognosis, but the risk of death from DTC was not affected by the choice of surgical technique. The extent of surgery influenced survival only in patients with TNM stage III disease. Locoregional recurrence resulted in a fivefold increased risk of death. Postoperative treatment was not associated with improved survival. In operated patients, the most important prognostic factor was complete removal of the tumour. The extent of removal of remaining thyroid tissue was of prognostic importance in stage III disease only. Adjuvant postoperative treatment did not influence the prognosis favourably.

Role of fine-needle aspiration biopsy and frozen section examination in determining the extent of thyroidectomy.

Traditionally the extent of thyroidectomy in patients with nodular thyroid disease has been based on peroperative frozen section examination (FS). Fine-needle aspiration biopsy (FNAB) and FS were evaluated with regard to the reliability to determine whether an operation for cancer is necessary. Both methods were performed in 240 patients operated for nodular thyroid disease and compared with the final histology on paraffin sections. Altogether 72 (30%) patients were found to have a malignant lesion on final histology. Only a malignant FNAB diagnosis and a malignant FS diagnosis were considered positive results for determining the extent of thyroidectomy. The test characteristics were equal: the sensitivity of FNAB and FS was 67%, the specificity 99%, and the accuracy 89%. The positive predictive value was 96% for FNAB and 98% for FS; the negative predictive values were 88% and 87%, respectively. Further analysis of the results indicates that FS is not necessary for patients with a malignant FNAB result. These patients should undergo a therapeutic operation for malignancy. When the FNAB result is uncertain, patients should undergo diagnostic surgery, and definitive surgery should be based on the final histology. Routine use of FS can be omitted.

Fine Needle Aspiration and Frozen Section Diagnosis in the Management of Thyroid Nodules

Fine needle aspiration (FNA) is a valuable technique in the evaluation of thyroid nodules. A total of 182 FNAs of the thyroid performed at the Sultan Qaboos University Hospital were reevaluated and 153 were found to be adequate (84%). The cytological results of FNA were divided into neoplastic and non-neoplastic groups. Subsequent histology was obtained in 53 patients with an intraoperative frozen actions (FS) in 27 patients. Papillary carcinoma was found to be the most common, accounting for 70% of these cases with histological follow-up in the neoplastic group. The utility of performing FNA in all thyroid nodules and an intraoperative frozen section only in selected cases is discussed.