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

Autor: Laurino A; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Pennestrì F; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. francesco.pennestri@policlinicogemelli.it.; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy. francesco.pennestri@policlinicogemelli.it., Procopio PF; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy., Martullo A; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy., Santoro G; Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino-Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Gallucci P; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Prioli F; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Sessa L; Fondazione Istituto G. Giglio Cefalù, Palermo, Italy.; UniCamillus, Saint Camillus International University of Health and Medical Sciences, Rome, Italy., Rossi ED; UOC Anatomia Patologica della Testa e Collo, del Polmone e dell'Apparato Endocrino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Dipartimento di Scienza della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy., Pontecorvi A; UOC Medicina Interna, Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy., De Crea C; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy., Raffaelli M; UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
Jazyk: angličtina
Zdroj: Endocrine [Endocrine] 2024 Nov 18. Date of Electronic Publication: 2024 Nov 18.
DOI: 10.1007/s12020-024-04101-x
Abstrakt: 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.
Competing Interests: Compliance with ethical standards Conflict of interest A.L., P.F.P., A.M., G.S., F.P., L.S., and E.D.R., A.P., and C.D.C. declare they have no conflict of interest. F.P. and P.G. and M.R. are advisor consultants for Medtronic (Minneapolis, Minnesota, USA). M.R. is advisor consultant for Intuitive Surgical (Sunnyvale, California, USA) and AbMedica (Cerro Maggiore, Milano, Italy). All the authors declare that have received no funding for this study.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: