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Prevalence of Postoperatively Detected High-risk Features in 2-to 4-cm Papillary Thyroid Cancers

Cited 3 time in Web of Science Cited 0 time in Scopus
Authors

Choi, Jee-Hye; Lee, Ja Kyung; Kim, Woochul; Yu, Hyeong Won; Kim, Su-jin; Chai, Young Jun; Choi, June Young; Lee, Kyu Eun

Issue Date
2022-09
Publisher
The Endocrine Society
Citation
Journal of Clinical Endocrinology and Metabolism, Vol.107 No.10, pp.E4124-E4131
Abstract
Context The 2015 American Thyroid Association guidelines proposed thyroid lobectomy as an acceptable option for 1- to 4-cm papillary thyroid cancers (PTC) without extrathyroidal extension (ETE) or lymph node (LN) metastasis. However, high-risk features are often detected postoperatively, even in tumors that are considered low risk on preoperative workup. A continued evaluation is necessary to determine the optimal treatment strategies. Objective We examined the frequency of preoperatively and postoperatively detected high-risk features in 2- to 4-cm PTCs to assess the appropriate surgical extent. Methods All patients who underwent a thyroid surgery between 2015 and 2020 with a final diagnosis of 2- to 4-cm PTC were selected. Demographics, preoperative findings, perioperative course, and surgical pathology were retrospectively analyzed. Results Of the entire study cohort (N = 424), 244 (57.5%) patients had at least 1 of the following high-risk features: gross ETE (18.6%), distant metastasis (1.2%), >3 LN involvement with extranodal extension (24.8%), any LN > 3 cm (0.5%), positive margin (13.2%), TERT mutation (2.6%), vascular invasion (10.8%), cN1 disease (28.5%), and > 5 LN involvement (30.4%). Two hundred patients had neither ETE nor LN metastasis on preoperative imaging, but 62/200 (31.0%) were found to have at least 1 of the aforementioned high-risk features on final pathology. Preoperative imaging had sensitivities of 75.9% and 44.4% for detecting gross ETE and LN metastasis, respectively. Conclusion A significant portion of patients with 2- to 4-cm PTCs, including those who preoperatively met the criteria for lobectomy, were found to have high-risk features on final pathology. Careful patient selection and appropriate counseling are necessary when considering lobectomy for tumors greater than 2 cm.
ISSN
0021-972X
URI
https://hdl.handle.net/10371/186483
DOI
https://doi.org/10.1210/clinem/dgac457
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