Low-risk Papillary Thyroid Carcinoma Patients Research Articles

Efficacy of postoperative radioactive iodine therapy for patients with low and intermediate risk papillary thyroid carcinoma.

This study aimed to evaluate the efficacy of postoperative radioactive iodine (RAI) and its impact on recurrence rates and survival benefits in low- to intermediate-risk papillary thyroid carcinoma (PTC). This retrospective study involved the examination of 1286 patients diagnosed with low- to intermediate-risk PTC who underwent total thyroidectomy with or without neck dissection, supplemented with postoperative RAI therapy or not between the years 2000 and 2021. From the patient pool, 589 (45%) were classified as low-risk and 697 (55%) as intermediate-risk according to the 2015 American Thyroid Association guidelines. Among the low-risk group, 375 (63.7%) underwent postoperative RAI, while in the intermediate-risk group, 566 (82.2%) underwent the procedure. The overall survival and disease-free survival rates were not statistically different between the groups that received RAI and those that did not, in both the low- and intermediate-risk categories. In a subgroup analysis, within the intermediate-risk category, postoperative RAI was significantly correlated with decreased recurrence in two subgroups: patients over 55 years with pN1b disease (hazard ratio 0.043, 95% confidence interval 0.004-0.500, p = 0.012) and patients over 55 years with five or more metastatic lymph nodes (hazard ratio 0.060, 95% confidence interval 0.005-0.675, p = 0.023). Our findings suggest that, while post-total thyroidectomy RAI does not substantially influence recurrence or survival rates in most low-risk and intermediate-risk PTC patients, it may be beneficial in specific subgroups, particularly patients over 55 with pN1b disease or those presenting with five or more metastatic lymph nodes.

Combined clinical variable and radiomics of post-treatment total body scan for prediction of successful I-131 ablation in low-risk papillary thyroid carcinoma patients

To explore the feasibility of combined radiomics of post-treatment I-131 total body scan (TBS) and clinical parameter to predict successful ablation in low-risk papillary thyroid carcinoma (PTC) patients. Data of low-risk PTC patients who underwent total/near total thyroidectomy and I-131 ablation 30 mCi between April 2015 and July 2021 were retrospectively reviewed. The clinical factors studied included age, sex, and pre-ablative serum thyroglobulin (Tg). Radiomic features were extracted via PyRadiomics, and radiomic feature selection was performed. The predictive performance for successful ablation of the clinical parameter, radiomic, and combined models (radiomics combined with clinical parameter) was calculated using the area under the receiver operating characteristic curve (AUC). One hundred and thirty patients were included. Successful ablation was achieved in 77 patients (59.2%). The mean pre-ablative Tg in the unsuccessful group (15.50 ± 18.04 ng/ml) was statistically significantly higher than those in the successful ablation group (7.12 ± 7.15 ng/ml). The clinical parameter, radiomic, and combined models produced AUCs of 0.66, 0.77, and 0.87 in the training sets, and 0.65, 0.69, and 0.78 in the validation sets, respectively. The combined model produced a significantly higher AUC than that of the clinical parameter (p < 0.05). Radiomic analysis of the post-treatment TBS combined with pre-ablative serum Tg showed a significant improvement in the predictive performance of successful ablation in low-risk PTC patients compared to the use of clinical parameter alone.Thai Clinical Trials Registry TCTR identification number is TCTR20230816004 (https://www.thaiclinicaltrials.org/show/TCTR20230816004).

Estimating the risk of completion total thyroidectomy using real-world data to guide initial surgical decision-making for patients with clinical low-risk papillary thyroid carcinoma

BackgroundContinuing controversy exists in different guidelines’ recommendations regarding whether total thyroidectomy (TT) or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma (PTC). Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.MethodsPatients who underwent thyroidectomy and prophylactic central lymph node dissection for ≤ 4 cm PTC (January 2007 to December 2020) by high-volume surgeons were included. Patients with preoperatively known high-risk characteristics or suspicious bilateral multifocality were excluded. The pathological findings were defined as the risk stratifications of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.ResultsOf 4965 consecutive patients met lobectomy criteria as the initial operation. Aggressive histological subtypes were found in 2.5% of patients, T3b disease in 1.1%, T4 disease in 3.1%, LNs involved ≤ 5 in 29.5%, LNs involved > 5 in 3.1%, and incidental bilateral multifocality in 7.9%. According to our defined risk stratification system, TT and lobectomy would be considered the optimal initial procedure in 12.0% and 67.2% PTC patients with a tumor ≤ 1 cm and 28.7% and 36.6% in the 1–4 cm groups in our real-world cohort, respectively.ConclusionLobectomy alone, as an initial procedure, could allow more low-risk PTC patients with a tumor either ≤ 1 cm or 1–4 cm to achieve the optimal surgical extent. Moreover, surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making.

Exploring Somatic Alteration Associating With Aggressive Behaviors of Papillary Thyroid Carcinomas by Targeted Sequencing.

Wisely differentiating high-risk papillary thyroid carcinoma (PTC) patients from low-risk PTC patients preoperatively is necessary when comes to making a personalized treatment plan. It is not easy to stratify the risk of patients according to sonography or lab results before surgery. This study aims to seek out potential mutation gene markers that may be helpful in stratifying the risk of PTC. A custom panel of 439 PTC relevant and classic tumor metabolic pathway relevant genes was designed. Targeted capture sequencing was performed on 35 pairs of samples from 35 PTC tumors and 35 para-tumor thyroid tissues obtained during surgery. Variant calling and detection of cancer gene mutations were identified by bio-information analysis. Ingenuity Pathway Analysis (IPA) was performed to do functional enrichment analysis of high-frequency mutant genes. Immunohistochemistry (IHC) was performed on 6 PTC patients to explore the expression of protein associated with interested genes. Event-free survival (EFS) was calculated to determine which genes might affect the prognosis of patients. We have identified 32 high-frequency mutant genes in PTC including BRAF. RBL2 was found to be significantly correlated to event-free survival, FOXO1, MUC6, PCDHB9, NOTCH1, FIZ1, and RTN1 were significantly associated with EFS, while BRAF mutant was not correlated to any of the prognosis indicators. Our findings in this study might open more choices when designing thyroid gene panels used in FNA samples to diagnose PTC and predict the potentially aggressive behavior of PTC.

The Recovery of Thyroid Function in Low-Risk Papillary Thyroid Cancer After Lobectomy: A 3-Year Follow-Up Study.

PurposeManagement strategies after lobectomy for low-risk papillary thyroid carcinoma (PTC) are controversial. This study aimed to identify the proportion of patients among low-risk PTC patients who do not require hormone replacement therapy and to evaluate the risk factors for postoperative hypothyroidism after lobectomy.Patients and MethodsThe records of 190 PTC patients who underwent thyroid lobectomy from January 2017 to December 2018 were retrospectively reviewed. Clinicopathological characteristics and follow-up data were collected. Univariate and multivariate analyses were performed to identify the risk factors associated with postoperative hypothyroidism and the recovery of thyroid function.ResultsIn summary, 74.21% of patients (141/190) had normal thyroid function without levothyroxine supplementation, while 40.53% (77/190) developed temporary or permanent hypothyroidism. Multivariate analysis indicated that higher preoperative thyroid-stimulating hormone (TSH) levels (>2.62 mIU/L), Hashimoto’s thyroiditis (HT), and right lobectomy were associated with hypothyroidism (all P<0.05). The Area Under Curve (AUC) by logistic analysis was 0.829. Twenty-eight (28/77, 36.4%) patients recovered to the euthyroid state in the first year after surgery, and this recovery was significantly associated with preoperative TSH level. Forty-nine (49/77, 63.6%) patients developed persistent hypothyroidism. The thyroid function of most patients (11/28, 39.3%) recovered in the third month after surgery.ConclusionPatients with a lower level of preoperative TSH, with left lobectomy and without Hashimoto’s thyroiditis had a higher chance of normal thyroid function within the first year after lobectomy. The recovery of thyroid function was associated with the level of preoperative TSH.

The extent of surgery for low-risk 1-4 cm papillary thyroid carcinoma: a catch-22 situation. A retrospective analysis of 497 patients based on the 2015 ATA Guidelines recommendation 35.

The adequate extent of surgery for 1-4 cm low-risk papillary thyroid carcinoma (PTC) is unclear. Our objective was to analyze the applicability of the 2015 ATA Guidelines recommendation 35B (R35) for the management low-risk PTC. This multicentre study included patients with low-risk PTC who had undergone total thyroidectomy (TT). Retrospectively we selected those who met the R35 criteria for the performance of a thyroid lobectomy (TL). The aim was to identify the proportion of low-risk PTC patients treated using TT who would have required reintervention had they had a TL in accordance with R35. We identified 497 patients (400 female; 80.5%). Median tumor size (mm): 21.2 (11-40). A tumor size ≥2 cm was found in 252 (50.7%). Most of them, 320 (64.4%), were in Stage I (AJCC 7th Edition). Following R35, 286 (57.5%) would have needed TT. Thus, they would have required a second surgery had they undergone TL. The indications for reintervention would have included lymph node involvement (35%), extrathyroidal extension (22.9%), aggressive subtype (8%), or vascular invasion (22.5%). No presurgical clinical data predict TT. The appropriate management of low-risk PTC is unclear. Adherence to ATA R35 could lead to a huge increase in reinterventions when a TL is performed, though the need for them would be questionable. In our sample, more than half of patients (57.5%) who may undergo a TL for a seemingly low-risk PTC would have required a second operation to satisfy international guidelines, until better preoperative diagnostic tools become available.

Positive Lymph Node Counts in American Thyroid Association Low-Risk Papillary Thyroid Carcinoma Patients.

Current American Thyroid Association (ATA) guidelines state that patients with intermediate-risk papillary thyroid cancer (PTC) may benefit from remnant ablation. One criterion for intermediate-risk classification is >5 positive lymph nodes (LNs). We investigate whether performing step-sectioning of LNs increases the metastatic detection rate, thereby influencing ATA risk of recurrence (ROR) classification. A retrospective review was conducted of cases in which ≥ 5 LNs were removed during thyroidectomy and ≤5 LNs were found positive for PTC. Step-sectioning was performed on the original tissue blocks. All slides were re-reviewed by a senior pathologist. Twenty patients met study criteria. Step-sectioning significantly increased LN yield compared to standard sectioning. In total, we found 12 new positive lymph nodes; seven (58%) were in totally new lymph nodes, while five (42%) were in lymph nodes previously read as negative. All newly discovered metastases were classified as micrometastases (≤2mm). Of the 15 patients originally classified as low-risk, the step-sectioning protocol impacted two patients (13%), increasing ROR stratification. Intensive step-sectioning reveals additional micrometastases. More detailed analysis did not identify clinically significant nodal disease likely to impact the clinical course of patients in this study. Our study supports current standards of pathology specimen handling related to LN assessment and the impact on ATA ROR classification. Nonetheless, it is important for clinicians to understand their institution's sectioning protocol utilized to report positive and total LN counts, which could impact ATA risk stratification and denote the comprehensive nature of the LN dissection that was performed.

Active Surveillance for T1bN0M0 Papillary Thyroid Carcinoma.

Prospective trials of active surveillance for asymptomatic papillary microcarcinoma (T1aN0M0) since the 1990s have shown progression rates of only 5-10%. Late rescue surgery after progression had no deleterious effects on mortality and morbidity. The 2015 American Thyroid Association guidelines approved active surveillance for very low-risk papillary thyroid carcinoma (PTC) as an alternative method to immediate surgery. However, there is no study that evaluates long-term active surveillance for T1b tumors. A prospective trial of active surveillance with 360 very low-risk PTC (T1aN0M0) patients has been conducted since 1995. Of the 392 T1bN0M0 patients, 61 selected active surveillance over surgery and eventually participated in this trial, while the remaining 331 patients underwent surgery. To find an appropriate management strategy for patients with T1bN0M0 PTC, the outcomes of active surveillance for T1bN0M0 to T1aN0M0 PTC were investigated and compared, and the outcomes of surgery for T1bN0M0 PTC were studied. After a mean of 7.4 years of active surveillance, 29 (8%) T1aN0M0 tumors and four (7%) T1bN0M0 tumors had increased in size (p = 0.69). Development of lymph node metastasis was seen in three (0.8%) patients and two (3%) patients, respectively (p = 0.10). No significant difference in progression rate was seen between groups. Among T1bN0M0 tumors, weak calcification and rich vascularity were risk factors for tumor-size increase, and younger age was a predictor for the development of lymph node metastasis. Mean initial tumor size was significantly greater in T1bN0M0 patients who underwent immediate surgery (14.5 ± 2.8 mm) than it was in patients who chose observation (11.7 ± 1.1 mm; p < 0.0001). No postoperative recurrence was seen in patients with tumor <15 mm in diameter. Active surveillance is an option for selected patients with T1bN0M0 PTC.

Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis.

The current trend in the management of low risk differentiated thyroid carcinoma is to follow less aggressive strategies. To assess the long-term morbidity and mortality outcomes of low-risk papillary thyroid carcinoma (PTC) patients undergoing minimal intervention. We retrospectively analyzed 137 patients with low-risk PTC (stage I: n=77; stage II: n=60). Of these patients, 107 (Group 1) had macro-PTC and underwent near-total thyroidectomy and received postoperatively 50mCi RAI. The remaining 30 patients (Group 2) had micro-PTC (<1cm) and were treated only by means of near-total thyroidectomy. The median follow-up for Group 1 patients was 10 years (range: 3-30). At 1-year evaluation, 8 patients of Group 1 had indeterminate or incomplete biochemical response, of whom 4 had also incomplete structural response to initial therapy. Only 1 of 4 patients with structural incomplete response underwent cervical lymph node dissection and then received an additional dose of 100mCi RAI. The remaining 7 patients received only an additional dose of 100mCi RAI. These patients have been continuously followed till the present time with no recurrences or deaths (median follow-up: 17.5 years; 3-30 years). At 15 years, 2 patients of Group 1 experienced biochemical recurrence and they received 100mCi RAI. Three patients of Group 2 experienced recurrence, with 2 receiving 50mCi RAI and 1 undergoing cervical lymph node dissection with 50mCi RAI. Patients with low-risk macro-PTC treated by means of near-total thyroidectomy without PCCLND and receiving postoperatively a low dose of 50mCi RAI have excellent long-term prognosis.

Risk Factors Associated with Disease Recurrence among Patients with Low-Risk Papillary Thyroid Cancer Treated at the University of the Philippines-Philippine General Hospital.

BackgroundThe management of papillary thyroid carcinoma (PTC) in high-risk patients is well-standardized. However, this is not the case for low-risk patients. Filipinos show a high incidence of recurrence of thyroid cancer. Thus, the identification of risk factors for recurrence in this population could potentially identify individuals for whom radioactive iodine (RAI) therapy might be beneficial.MethodsWe reviewed the medical records of adult Filipinos with low-risk PTC who underwent near-total or total thyroidectomy at the University of the Philippines-Philippine General Hospital. Multivariate logistic regression analysis was used to determine risk factors for recurrence.ResultsRecurrence was documented in 51/145 of patients (35.17%) included in this study. Possible risk factors such as age, sex, family history, smoking history, tumor size, multifocality, prophylactic lymph node dissection, initial thyroglobulin (Tg) level, initial anti-thyroglobulin (anti-Tg) antibody concentration, suppression of thyroid stimulating hormone production, and RAI therapy were analyzed. Multivariate analysis revealed that a tumor diameter 2 to 4 cm (odds ratio [OR], 9.17; 95% confidence interval [CI], 1.62 to 51.88; P=0.012), a tumor diameter >4 cm (OR, 16.46; 95% CI, 1.14 to 237.31; P=0.04), and a family history of PTC (OR, 67.27; 95% CI, 2.03 to 2228.96; P=0.018) were significant predictors of recurrence. In addition, RAI therapy (OR, 0.026; 95% CI, 0.01 to 0.023; P≤0.005), an initial Tg level ≤2 ng/mL (OR, 0.049; 95% CI, 0.01 to 0.23; P≤0.005), and an anti-Tg antibody level ≤50 U/mL (OR, 0.087; 95% CI, 0.011 to 0.67; P=0.019) were significant protective factors.ConclusionA tumor diameter ≥2 cm and a family history of PTC are significant predictors of recurrence. RAI therapy and low initial titers of Tg and anti-Tg antibody are significant protective factors against disease recurrence among low-risk PTC patients.

In Search of an Unstimulated Thyroglobulin Baseline Value in Low-Risk Papillary Thyroid Carcinoma Patients Not Receiving Radioactive Iodine Ablation

The clinical use of serum thyroglobulin (Tg) as a tumor marker in papillary thyroid cancer (PTC) patients following total thyroidectomy continues to evolve, due in part to the introduction of more sensitive (second generation) Tg immunometric assays (Tg(2G)IMA, functional sensitivity ≤ 0.10 ng/mL), and the implementation of new recommendations against radioactive iodine ablation (RAIA) for patients at the lowest risk of recurrence. As a result, there is a need to establish the optimal timing and interpretation of serum Tg values while on levothyroxine-induced suppression of thyrotropin (TSH) in thyroidectomized PTC patients with a thyroid remnant. This study examines the pattern of decline and eventual baseline value of unstimulated Tg (uTg) concentrations following total thyroidectomy in patients with low-risk PTC who did not receive RAIA. The medical records of consecutive patients with thyroid cancer seen at the Los Angeles County + USC Medical Center were retrospectively reviewed. Serial uTg and TSH values from Tg-antibody negative low-risk PTC patients treated with total thyroidectomy and no RAIA were analyzed. Patients were stratified by degree of TSH suppression to assess the effect on uTg. Serial postoperative uTg values were evaluated for the temporal pattern of decline and ultimate baseline. Patients with medullary thyroid cancer (MTC) were studied as a surgical reference group. Records from 577 consecutive thyroid cancer patients were reviewed, of which 36 met all criteria for inclusion. By 6 months, uTg fell to <0.5 ng/mL in 61% of patients and all patients demonstrated uTg < 0.5 ng/mL 2 years after surgery. During a median follow up of 5.7 years, uTg values remained below this level. The median uTg values in patients with papillary microcarcinoma, PTC, and MTC were similar at 0.11, 0.12, and 0.09 ng/mL, respectively. Further decline in uTg was not observed once the TSH was <0.5 mIU/L. The uTg values during TSH suppression in Tg antibody-negative, low-risk PTC patients who did not receive RAIA were below 0.5 ng/mL by 6 months postoperatively in most cases and remained stable over the duration of patient follow-up.

The role of BRAF(V600E) mutation as poor prognostic factor for the outcome of patients with intrathyroid papillary thyroid carcinoma

BackgroundBRAF(V600E) mutation, which represents the most frequent genetic mutation in papillary thyroid carcinoma (PTC), is widely considered to have an adverse outcome on PTC outcome, however its real predictive value is not still well stated. The aim of the present study was to evaluate if BRAF(V600E) mutation could be useful to identify within patients with intrathyroid ultrasound-N0 PTC those who require more aggressive treatment, by central neck node dissection (CLND) or subsequent postoperative 131I treatment. MethodsAmong the whole series of 931 consecutive PTC patients operated on at 2nd Clinical Surgery of University of Padova and at General Surgery Department of University of Trieste during a period from January 2007 to December 2012, we selected 226 patients with an intrathyroid tumor and no metastases (preoperative staging T1–T2, N0, M0). BRAF(V600E) mutation was evaluated by PCR-single-strand conformation polymorphism analysis and direct genomic sequencing. We analyzed the correlation between the presence/absence of the BRAF(V600E) mutation in the fine-needle aspiration (FNA) and the clinical-pathological features: age, gender, extension of surgery, node dissection, rate of cervical lymph node involvement, tumor size, TNM stage, variant of histotype, mono/plurifocality, association with lymphocitary chronic thyroiditis, radioactive iodine ablation doses, and outcome. ResultsThe BRAF(V600E) mutation was present in 104 of 226 PTC patients (47.8%). BRAF(V600E) mutation correlated with multifocality, more aggressive variants, infiltration of the tumoral capsule, and greater tumor's diameter. BRAF(V600E) mutation was the only poor prognostic factor in these patients. DiscussionIn our series, BRAF(V600E) mutation demonstrated to be an adverse prognostic factor indicating aggressiveness of disease and it could be useful in the management of low-risk PTC patients, as supplementary prognostic factor to assess the preoperative risk stratification with the aim to avoid unnecessary central neck node dissection (BRAF pos.) or to perform complementary 131I-therapy (BFAF neg.).

Does Extracapsular Extension Impact the Prognosis of Papillary Thyroid Microcarcinoma?

Extracapsular (EC) extension is a pejorative factor in papillary thyroid carcinoma (PTC). However, the impact of EC extension in microcarcinoma (micro-pT3) remains controversial, and all pT3 patients are currently considered to be at high risk of recurrence. This study sought to determine the risk of recurrence in patients with micro-pT3 and to compare their outcomes with other pT3 (macro-pT3) and low-risk patients. All consecutive patients who received surgery for PTC in our department from January 1978 to December 2011 were included in this study. We compared three patient groups: micro-pT3 (≤10 mm with EC extension), macro-pT3, and low risk, including pT1a-b s N0-x, pT1a-b m N0-x, and pT2 N0-x. Total thyroidectomy was performed with lymph node (LN) dissection in most cases, and radioiodine therapy was administered as needed. The median follow-up period was 6.7 years. A total of 2,482 patients were included in this study, including 178 micro-pT3 patients, 533 macro-pT3 patients, and 1,771 low-risk PTC patients. Recurrence was documented in 14 (7.9 %) micro-pT3 patients, 124 (23.3 %) macro-pT3 patients, and 36 (2 %) low-risk PTC patients. The micro-pT3 patients with LN metastases (N1) demonstrated a higher recurrence rate than the N0-x patients (14.8 vs. 4.8 %; p < 0.01), whereas the risk of recurrence among the T2 N0-x (5 %) and micro-pT3 N0-x (4.8 %) patients was similar (p = 0.95). Micro-pT3 N1 patients are at high risk of recurrence and should be treated aggressively. Because the outcomes of the micro-pT3 N0-x patients were similar to those of the low-risk PTC patients (pT2 N0-x), we suggest that micro-pT3 N0-x should be treated in a similar manner, with low-dose iodine-131 and recombinant human thyrotropin.

TheBRAFV600E Mutation Is an Independent, Poor Prognostic Factor for the Outcome of Patients with Low-Risk Intrathyroid Papillary Thyroid Carcinoma: Single-Institution Results from a Large Cohort Study

The BRAF(V600E) mutation, the most frequent genetic alteration in papillary thyroid carcinoma (PTC), was demonstrated to be a poor prognostic factor. The aim of this study was to evaluate its prognostic significance in a large cohort of low-risk intrathyroid PTC. Among the 431 consecutive PTC patients, we selected 319 patients with an intrathyroid tumor and no metastases (T1-T2, N0, M0). The BRAF(V600E) mutation was analyzed by PCR-single-strand conformation polymorphism analysis and direct genomic sequencing. The correlation between the presence/absence of the mutation, the clinical-pathological features, and the outcome of the PTC patients was investigated. The BRAF(V600E) mutation was present in 106 of 319 PTC patients (33.2%). Its prevalence was also the same in subgroups identified according to the level of risk. The BRAF(V600E) mutation correlated with multifocality, aggressive variant, absence, or infiltration of the tumoral capsule. BRAF(V600E)-mutated PTC also required a higher number of radioiodine courses to obtain disease-free status. The BRAF(V600E) mutation was the only prognostic factor predicting the persistence of the disease in these patients after 5 yr of follow-up. The BRAF(V600E) mutation was demonstrated to be a poor prognostic factor for the persistence of the disease independent from other clinical-pathological features in low-risk intrathyroid PTC patients. It could be useful to search for the BRAF(V600E) mutation in the workup of low-risk PTC patients to distinguish those who require less or more aggressive treatments. In particular, the high negative predictive value of the BRAF(V600E) mutation could be useful to identify, among low-risk PTC patients, those who could avoid 131-I treatment.

Prognosis of low-risk papillary thyroid carcinoma patients: Its relationship with the size of primary tumors

It is well-known that papillary thyroid carcinoma (PTC) has a generally indolent character and shows a favorable prognosis unless it has no high-risk features such as clinical lymph node metastasis, distant metastasis, and significant extrathyroid extension. In this study, we investigated the prognosis of 3,965 patients with PTC without these features. We classified these patients into 3 groups: T-1, tumor ≤ 2 cm (n = 2,591); T-2, tumor 2.1-4 cm (n = 1,123); T-3, tumor > 4 cm (n = 251). Ten-year recurrence rates of T-1, T-2, and T-3 patients were 0.3, 1.3, and 1.9% for the thyroid (in the subset of patients who underwent limited thyroidectomy), 1.9, 4.6, and 8.1% for lymph nodes, and 0.4, 1.6, and 3.4% for distant organs, respectively. A tumor size larger than 2 cm had an independent prognostic impact on all these recurrences also on multivariate analysis. These findings suggest that PTC larger than 2 cm exhibited more aggressive biological characteristics than that measuring 2 cm or less, even though it had no other high-risk features. However, the incidences of distant recurrence and carcinoma death were still low and it remains unclear whether extensive surgery is mandatory for otherwise low-risk PTC patients with large tumor.

Clinical Relevance of Thyroglobulin Doubling Time in the Management of Patients with Differentiated Thyroid Cancer

ThyroidVol. 21, No. 7 Editorials and CommentaryClinical Relevance of Thyroglobulin Doubling Time in the Management of Patients with Differentiated Thyroid CancerFurio Pacini, Mona M. Sabra, and R. Michael TuttleFurio PaciniDepartment of Internal Medicine, Endocrinology & Metabolism, and Biochemistry, Section of Endocrinology and Metabolism, University of Siena, Siena, Italy.Search for more papers by this author, Mona M. SabraDepartment of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York.Search for more papers by this author, and R. Michael TuttleDepartment of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York.Search for more papers by this authorPublished Online:27 Jun 2011https://doi.org/10.1089/thy.2011.2107.ed1AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Clinical Relevance of Thyroglobulin Doubling Time in the Management of Patients with Differentiated Thyroid Cancer." , 21(7), pp. 691–692FiguresReferencesRelatedDetailsCited byMolecular testing in thyroid cancer diagnosis and managementBest Practice & Research Clinical Endocrinology & Metabolism, Vol. 37, No. 1Metformin Decreases Serum Thyroglobulin Concentration in Nonmedullary Thyroid Carcinoma13 September 2022 | Journal of the Endocrine Society, Vol. 6, No. 11Thyroglobulin and thyroid cancerRole of Thyroglobulin Doubling Time in Differentiated Thyroid Cancer and Its Relationship with Demographic-Histopathologic Risk Factors and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters Mine Araz, Çiğdem Soydal, Elgin Özkan, Pınar Akkuş, Demet Nak, N. 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A TUTHYREF® network reviewBulletin du Cancer, Vol. 106, No. 9Surgical options for thyroid cancer and post-surgical management20 April 2018 | Expert Review of Endocrinology & Metabolism, Vol. 13, No. 3Thyroglobulin measurement in the management of patients with differentiated thyroid cancer16 March 2018 | Critical Reviews in Clinical Laboratory Sciences, Vol. 55, No. 3Thyroglobulin18 September 2018Analysis of radioiodine therapy and prognostic factors of differentiated thyroid cancer patients with pulmonary metastasisMedicine, Vol. 96, No. 19Neoplasms of the Thyroid26 February 2017Surveillance Strategies After Initial Treatment of Differentiated Thyroid Cancer25 June 20172015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer Bryan R. Haugen, Erik K. Alexander, Keith C. Bible, Gerard M. Doherty, Susan J. Mandel, Yuri E. Nikiforov, Furio Pacini, Gregory W. Randolph, Anna M. Sawka, Martin Schlumberger, Kathryn G. Schuff, Steven I. Sherman, Julie Ann Sosa, David L. Steward, R. Michael Tuttle, and Leonard Wartofsky12 January 2016 | Thyroid, Vol. 26, No. 1Staging of Thyroid Cancer20 September 20162016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid CancerInternational Journal of Thyroidology, Vol. 9, No. 2Fluorodeoxyglucose positron emission tomography/computerized tomography in differentiated thyroid cancer management: Importance of clinical justification and value in predicting survival11 February 2015 | Journal of Medical Imaging and Radiation Oncology, Vol. 59, No. 3Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: A multifactorial decision-making guide for the thyroid cancer care collaborative3 April 2014 | Head & Neck, Vol. 37, No. 4Thyroglobulin measurement by highly sensitive assays: focus on laboratory challengesClinical Chemistry and Laboratory Medicine (CCLM), Vol. 53, No. 9How sensitive (second-generation) thyroglobulin measurement is changing paradigms for monitoring patients with differentiated thyroid cancer, in the absence or presence of thyroglobulin autoantibodiesCurrent Opinion in Endocrinology, Diabetes & Obesity, Vol. 21, No. 5In Search of an Unstimulated Thyroglobulin Baseline Value in Low-Risk Papillary Thyroid Carcinoma Patients Not Receiving Radioactive Iodine Ablation Trevor E. Angell, Carole A. Spencer, Barbara D. Rubino, John T. Nicoloff, and Jonathan S. LoPresti3 July 2014 | Thyroid, Vol. 24, No. 7How to Manage Patients with Differentiated Thyroid Cancer and a Rising Serum Thyroglobulin LevelEndocrinology and Metabolism Clinics of North America, Vol. 43, No. 2Advances in the follow-up of differentiated or medullary thyroid cancer3 April 2012 | Nature Reviews Endocrinology, Vol. 8, No. 8Particularités méthodologiques et interprétation du dosage de thyroglobuline sériqueMédecine Nucléaire, Vol. 36, No. 1 Volume 21Issue 7Jul 2011 InformationCopyright 2011, Mary Ann Liebert, Inc.To cite this article:Furio Pacini, Mona M. Sabra, and R. Michael Tuttle.Clinical Relevance of Thyroglobulin Doubling Time in the Management of Patients with Differentiated Thyroid Cancer.Thyroid.Jul 2011.691-692.http://doi.org/10.1089/thy.2011.2107.ed1Published in Volume: 21 Issue 7: June 27, 2011PDF download

Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma

Functional lateral neck dissection requires a large incision providing adequate exposure of the surgical field. We evaluated the feasibility of minimally invasive video-assisted functional lateral neck dissection (VALNED) in patients with papillary thyroid carcinoma (PTC). Low-risk PTC patients with lateral neck metastases <2 cm, in absence of any evidence of great vessels involvement, were considered eligible. After accomplishing total thyroidectomy and central neck clearance, dissection was performed under endoscopic vision by using a technique very similar to conventional surgery through the single 4-cm skin incision used for thyroidectomy. Two patients were selected: 1 underwent bilateral and 1 unilateral VALNED. The mean number of the removed nodes was 25 per side. Both patients experienced transient postoperative hypocalcemia. No other complication occurred. No evidence of residual or recurrent disease was found at follow-up. VALNED is feasible, and the results are encouraging. For definitive conclusions, larger series and comparative studies are necessary.

The BRAF mutation is useful for prediction of clinical recurrence in low‐risk patients with conventional papillary thyroid carcinoma

The activating BRAF(V600E) mutation is the most common genetic alteration reported in papillary thyroid carcinoma (PTC). While some reports suggest the BRAF(V600E) mutation is associated with factors predicting a poor prognosis and recurrence, this remains a controversial issue. To determine whether the presence of the BRAF(V600E) mutation is a prognostic indicator for clinical recurrence in low-risk patients with conventional PTC. The study involved 203 conventional PTC patients who underwent total or near-total thyroidectomy followed by immediate 131I ablation of the remnants. Patients with antithyroglobulin antibodies and those with extracervical metastases at presentation were excluded. DNA was extracted from paraffin-embedded tumour specimens, and the presence of the BRAF(V600E) mutation was evaluated using PCR amplification and direct sequencing. The BRAF(V600E) mutation was found to be present in 149 (73.4%) of 203 patients. The BRAF(V600E) mutation was correlated with male gender (P = 0.006) and with tumour size (P = 0.005). While there appeared to be an association between the BRAF(V600E) mutation and extrathyroid extension, this did not reach statistical significance (P = 0.062). During follow-up of the 203 patients (median 7.3 years; range 0.7-10.0 years), 36 (18%) patients experienced recurrence. While univariate analysis showed the BRAF(V600E) mutation was associated with tumour recurrence (21% with mutation vs 7% without mutation; P = 0.037), this association was not shown following multivariate analyses adjusting for the clinicopathological prognostic factors of age, gender, tumour size, extrathyroid extension, multifocality and lymph node metastasis. Although the BRAF(V600E) mutation was found to be associated with a higher clinical recurrence of disease in low-risk conventional PTC patients, it was not an independent predictor.

Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients.

It is uncertain whether more extensive primary surgery and increasing use of radioiodine remnant ablation (RRA) for papillary thyroid carcinoma (PTC) have resulted in improved rates of cause-specific mortality (CSM) and tumor recurrence (TR). Details of the initial presentation, therapy, and outcome of 2444 PTC patients consecutively treated during 1940-1999 were recorded in a computerized database. Patients were followed for more than 43,000 patient-years. The 25-year rates for CSM and TR were 5% and 14%, respectively. Temporal trends were analyzed for six decades. During the six decades, the proportion with initial MACIS (distant Metastasis, patient Age, Completeness of resection, local Invasion, and tumor Size) scores <6 were 77%, 82%, 84%, 86%, 85%, and 82%, respectively (p = 0.06). Lobectomy accounted for 70% of initial procedures during 1940-1949 and 22% during 1950-1959; during 1960-1999 bilateral lobar resection (BLR) accounted for 91% of surgeries (p <0.001). RRA after BLR was performed during 1950-1969 in 3% but increased to 18%, 57%, and 46% in successive decades (p <0.001). The 40-year rates for CSM and TR during 1940-1949 were significantly higher (p = 0.002) than during 1950-1999. During the last 50 years the 10-year CSM and TR rates for the 2286 cases did not significantly change with successive decades. Moreover, the 10-year rates for CSM and TR were not significantly improved during the last five decades of the study, either for the 1917 MACIS <6 patients or the 369 MACIS < 6 patients. Increasing use of RRA has not apparently improved the already excellent outcome, achieved before 1970, in low risk (MACIS <6) PTC patients managed by near-total thyroidectomy and conservative nodal excision.