Impact of nodal status evaluation on therapeutic strategy for clinically unifocal T1b/small T2 node negative papillary thyroid carcinoma.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Pub Date : 2024-11-18 DOI:10.1007/s12020-024-04101-x

Antonio Laurino, Francesco Pennestrì, Priscilla Francesca Procopio, Annamaria Martullo, Gloria Santoro, Pierpaolo Gallucci, Francesca Prioli, Luca Sessa, Esther Diana Rossi, Alfredo Pontecorvi, Carmela De Crea, Marco Raffaelli

{"title":"Impact of nodal status evaluation on therapeutic strategy for clinically unifocal T1b/small T2 node negative papillary thyroid carcinoma.","authors":"Antonio Laurino, Francesco Pennestrì, Priscilla Francesca Procopio, Annamaria Martullo, Gloria Santoro, Pierpaolo Gallucci, Francesca Prioli, Luca Sessa, Esther Diana Rossi, Alfredo Pontecorvi, Carmela De Crea, Marco Raffaelli","doi":"10.1007/s12020-024-04101-x","DOIUrl":null,"url":null,"abstract":"Purpose: In absence of nodal metastases or aggressive features, thyroid lobectomy (TL) should be preferred over total thyroidectomy (TT) for 1-4 cm unifocal, papillary thyroid carcinoma (PTC). However, occult, despite non-microscopic (≥2 mm), nodal metastases may be present in clinically node-negative (cN0) PTC.Methods: Among 4216 thyroidectomies for malignancy (2014-2023), 110 TL plus ipsilateral central neck dissection (I-CND) were scheduled for unifocal cT1b/small cT2 (≤3 cm) cN0 PTCs. Frozen section examination (FSE) of removed nodes was performed: when positive, completion thyroidectomy (CT) was accomplished during the same procedure. In presence of aggressive pathologic features, CT was suggested within 6 months from index operation.Results: FSE was positive for occult not-microscopic nodal metastases in 33 cases (30%), underwent synchronous CT. Among the remaining 77 patients, 24 (31.2%) were scheduled for CT, after multidisciplinary tumor board discussion, due to at least 2 high-risk factors. The median number of removed and metastatic nodes was 8 (5-11) and 2 (1-5), respectively, at definitive histopathology. Furthermore, multifocality was present in 53 (48.2%) cases, lymphovascular invasion in 66 (60%) cases, aggressive subtypes in 20 (18.2%) cases and extracapsular invasion in 5 (4.5%) cases. Overall, 57 (51.8%) patients underwent immediate or delayed CT.Conclusion: More than 50% of patients with unifocal cT1b/small cT2 cN0 PTC scheduled for TL may be eligible for CT because of aggressive tumor features. An intraoperative decision-making approach based on I-CND and nodes FSE may ensure accurate staging and risk stratification, thus reducing the risk of recurrence and the need for reoperation.","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12020-024-04101-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: In absence of nodal metastases or aggressive features, thyroid lobectomy (TL) should be preferred over total thyroidectomy (TT) for 1-4 cm unifocal, papillary thyroid carcinoma (PTC). However, occult, despite non-microscopic (≥2 mm), nodal metastases may be present in clinically node-negative (cN0) PTC.

Methods: Among 4216 thyroidectomies for malignancy (2014-2023), 110 TL plus ipsilateral central neck dissection (I-CND) were scheduled for unifocal cT1b/small cT2 (≤3 cm) cN0 PTCs. Frozen section examination (FSE) of removed nodes was performed: when positive, completion thyroidectomy (CT) was accomplished during the same procedure. In presence of aggressive pathologic features, CT was suggested within 6 months from index operation.

Results: FSE was positive for occult not-microscopic nodal metastases in 33 cases (30%), underwent synchronous CT. Among the remaining 77 patients, 24 (31.2%) were scheduled for CT, after multidisciplinary tumor board discussion, due to at least 2 high-risk factors. The median number of removed and metastatic nodes was 8 (5-11) and 2 (1-5), respectively, at definitive histopathology. Furthermore, multifocality was present in 53 (48.2%) cases, lymphovascular invasion in 66 (60%) cases, aggressive subtypes in 20 (18.2%) cases and extracapsular invasion in 5 (4.5%) cases. Overall, 57 (51.8%) patients underwent immediate or delayed CT.

Conclusion: More than 50% of patients with unifocal cT1b/small cT2 cN0 PTC scheduled for TL may be eligible for CT because of aggressive tumor features. An intraoperative decision-making approach based on I-CND and nodes FSE may ensure accurate staging and risk stratification, thus reducing the risk of recurrence and the need for reoperation.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

结节状态评估对临床单灶T1b/小T2结节阴性甲状腺乳头状癌治疗策略的影响。

目的：对于1-4厘米单灶甲状腺乳头状癌（PTC），如果没有结节转移或侵袭性特征，甲状腺叶切除术（TL）应优于甲状腺全切除术（TT）。然而，临床结节阴性（cN0）的PTC可能存在隐匿性结节转移，尽管不显微（≥2 mm）：在4216例恶性肿瘤甲状腺切除术（2014-2023年）中，110例TL加同侧颈部中央切除术（I-CND）是针对单灶cT1b/小cT2（≤3厘米）cN0 PTC而安排的。对切除的结节进行冷冻切片检查（FSE）：如果结果呈阳性，则在同一手术过程中完成甲状腺切除术（CT）。如果出现侵袭性病理特征，建议在手术后 6 个月内进行 CT 检查：结果：33 例（30%）FSE 阳性的隐匿性非显微结节转移患者接受了同步 CT 检查。在剩余的 77 例患者中，有 24 例（31.2%）因至少两个高危因素而在多学科肿瘤委员会讨论后被安排接受 CT 检查。最终组织病理学结果显示，切除结节和转移结节的中位数分别为 8 个（5-11）和 2 个（1-5）。此外，53 例（48.2%）存在多灶性，66 例（60%）存在淋巴管侵犯，20 例（18.2%）存在侵袭性亚型，5 例（4.5%）存在囊外侵犯。总体而言，57 例（51.8%）患者接受了即时或延迟 CT 检查：结论：50%以上计划接受TL手术的单灶cT1b/小cT2 cN0 PTC患者可能因肿瘤侵袭性特征而符合CT检查条件。基于 I-CND 和结节 FSE 的术中决策方法可确保准确的分期和风险分层，从而降低复发风险和再次手术的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.