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Fields TD, Underwood HJ, Pitt SC. Management of Small Papillary Thyroid Cancers. Surg Clin North Am 2024; 104:725-740. [PMID: 38944494 DOI: 10.1016/j.suc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Thyroid cancer is the most common endocrine malignancy. With increasing imaging utilization, there has been an increase in the recognition of small, indolent cancers that would otherwise go undiagnosed. Historically, the surgical recommendation for all patients with thyroid cancer was a total thyroidectomy. However, over the last 20 years, there have been numerous studies evaluating the de-escalation of interventions for low-risk thyroid cancers, transitioning from total thyroidectomy to thyroid lobectomy or active surveillance when indicated. Here, we review the current literature and recommendations with each of these treatment options.
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Affiliation(s)
- Tyler D Fields
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Hunter J Underwood
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/HJUnderwoodMD
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/susieQP8
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Campagnoli M, Dell'Era V, Rosa MS, Negri F, Malgrati E, Garzaro M, Valletti PA. Patient's Scar Satisfaction after Conventional Thyroidectomy for Differentiated Thyroid Cancer. J Pers Med 2023; 13:1066. [PMID: 37511679 PMCID: PMC10381783 DOI: 10.3390/jpm13071066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Differentiated thyroid carcinoma (DTC) is the most frequent endocrine neoplasm. Its treatment is based on surgery with consequent impact on patients' quality of life (QoL) and aesthetic implication. The aim of the present study is to assess scar satisfaction in patients affected by DTC who underwent total or partial thyroidectomy. A comparison was also made between scar satisfaction with different subcuticular suture. Validated questionnaires have been employed during a 3-month follow-up: Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ). Eventually, the impact of thyroid cancer on QoL of patients was performed in the studied population employing the Thyroid-related patient-reported outcome questionnaire (ThyPRO) and European Organisation for Research Additionally, Treatment of Cancer-Quality of Life questionnaire-C30 (EORTC QLQ-C30). It was conducted in a single center observational study considering 74 patients respecting inclusion criteria. Overall scar satisfaction was found to improve during follow-up, reaching the best scores at 3 months from surgery. Subcuticular suture does not seem to influence the scar satisfaction. In our study male patients seem to be more satisfied, on the other hand age does not seem to influence satisfaction. Overall, the ThyPRO questionnaire and EORTC QLQ-C30 scores did not statistically differ between preoperative and postoperative suggesting a small impact of DTC in QoL.
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Affiliation(s)
| | - Valeria Dell'Era
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
| | | | - Fabiola Negri
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Eric Malgrati
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
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Choi JH, Lee JK, Kim W, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. Prevalence of Postoperatively Detected High-risk Features in 2- to 4-cm Papillary Thyroid Cancers. J Clin Endocrinol Metab 2022; 107:e4124-e4131. [PMID: 35914522 DOI: 10.1210/clinem/dgac457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Department of Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY 10029, USA
| | - Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
- Department of Surgery, Seoul National University Boramae Medical Center, Dongjak-gu, Seoul 07061, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
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Elzahaby IA, Shetiwy M, Hossam A, Elafy A. Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique. Surg Innov 2021; 29:723-729. [PMID: 34823394 DOI: 10.1177/15533506211057633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). METHODS From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). RESULTS The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170 minutes, with 10-50 mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. CONCLUSION Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients.
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Affiliation(s)
- Islam A Elzahaby
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
| | - Mosab Shetiwy
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
| | - Amr Hossam
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
| | - Amr Elafy
- Lecturer of Surgical Oncology, RinggoldID:243489Mansoura University, Mansoura, Daqahlia, Egypt
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Elbalka SS, Metwally IH, Shetiwy M, Awny S, Hamdy O, Kotb SZ, Shoman AM, Shahda E, Elzahaby IA. Prevalence and predictors of thyroid cancer among thyroid nodules: a retrospective cohort study of 1,000 patients. Ann R Coll Surg Engl 2021; 103:683-689. [PMID: 34448415 DOI: 10.1308/rcsann.2021.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Thyroid cancer is increasing in incidence globally due either to early detection (overestimation) or true increment. A recent debate concerns multinodular goitre (MNG) or toxic goitres which have classically been considered at a lower risk for cancer. METHODS In this study, we enrolled retrospectively all patients with nodular goitre treated at our tertiary hospital and analysed their data with the aim of detecting the rate of cancer among different types of nodular goitre. We also studied predictors of incidental malignancy among thyroidectomies. RESULTS A predilection for solitary thyroid nodules (STNs) was found in women of younger age, with STNs tending to be larger in comparison with MNG in the same age group. However, both types of nodules were at equal risk of harbouring malignancy. Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda scores were the only dependent predictors of malignancy within thyroid nodules. CONCLUSION The authors recommend management of both STNs and MNG using the same algorithm.
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Affiliation(s)
- S S Elbalka
- Oncology Center Mansoura University, Mansoura, Egypt
| | - I H Metwally
- Oncology Center Mansoura University, Mansoura, Egypt
| | - M Shetiwy
- Oncology Center Mansoura University, Mansoura, Egypt
| | - S Awny
- Oncology Center Mansoura University, Mansoura, Egypt
| | - O Hamdy
- Oncology Center Mansoura University, Mansoura, Egypt
| | - S Z Kotb
- Oncology Center Mansoura University, Mansoura, Egypt
| | - A M Shoman
- Mansoura University Hospitals, Mansoura, Egypt
| | - E Shahda
- Mansoura University Hospitals, Mansoura, Egypt
| | - I A Elzahaby
- Oncology Center Mansoura University, Mansoura, Egypt
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Nabhan F, Dedhia PH, Ringel MD. Thyroid cancer, recent advances in diagnosis and therapy. Int J Cancer 2021; 149:984-992. [PMID: 34013533 DOI: 10.1002/ijc.33690] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022]
Abstract
Over the past several decades, the approach to the diagnosis and management of patients with follicular cell-derived thyroid cancer has evolved based on improved classification of patients better matching clinical outcomes, as well as advances in imaging, laboratory, molecular technologies and knowledge. While thyroid surgery, radioactive iodine therapy and TSH suppression remain the mainstays of treatment, this expansion of knowledge has enabled de-escalation of therapy for individuals diagnosed with low-risk well-differentiated thyroid cancer; better definition of treatment choices for patients with more aggressive disease; and improved ability to optimize treatments for patients with persistent and/or progressive disease. Most recently, the advancement of knowledge regarding the molecular aspects of thyroid cancer has improved thyroid cancer diagnosis and has enabled individualized therapeutic options for selected patients with the most aggressive forms of the disease. Guidelines from multiple societies across the world reflect these changes, which focus on taking a more individualized approach to clinical management. In this review, we discuss the current more personalized approach to patients with follicular cell-derived thyroid cancer and point toward areas of future research still needed in the field.
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Affiliation(s)
- Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Cancer Biology Program, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Priya H Dedhia
- Cancer Biology Program, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA.,Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Cancer Biology Program, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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Uçan B, Şahin M, Özbek M, Kızılgül M, Sayki Arslan M, Çalışkan M, Saylam G, Çakal E. Lobectomy may not be suitable for patients with follicular neoplasm cytology. Turk J Med Sci 2020; 50:8-11. [PMID: 31340635 PMCID: PMC7080349 DOI: 10.3906/sag-1610-125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/25/2017] [Indexed: 11/04/2022] Open
Abstract
Background/aim The most appropriate surgical management of follicular neoplasm/suspicious for follicular neoplasm (FN) lesions is still contradictory. We aimed to evaluate the data of our patients with follicular neoplasm treated with thyroidectomy. Materials and methods We retrospectively analyzed the data of 74 patients who were diagnosed with follicular neoplasm cytology (FN cytology) by fine needle aspiration biopsy (FNAB) and had undergone total thyroidectomy or lobectomy with isthmectomy (LwI). Results We examined a total of 74 patients, of which 64 (83.7%) were female and 10 (16.3%) were male. The malignancy rate in the pathological examinations of these patients was 31/74 (41.9%). The most common cancer among the patients with malignancy was papillary thyroid carcinomas (PTC) (20/31, 65%). Among the subtypes of PTCs, 11 were classical PTC, 5 were a follicular variant of PTC, 2 were the oncocytic variant of PTC, 1 was the diffuse sclerosing variant, and 1 was a columnar cell variant of PTC. Conclusion Since most FN cytology has been pathologically diagnosed with papillary cancer and some papillary cancer subtypes have been unfavorable pathologically, total thyroidectomy should be the most suitable treatment option in this group. Lobectomy with LwI is not suitable for patients with FNAB-proven FN cytology.
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Affiliation(s)
- Bekir Uçan
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey
| | - Mustafa Özbek
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Muhammed Kızılgül
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Müyesser Sayki Arslan
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mustafa Çalışkan
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology and Head & Neck Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Erman Çakal
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Grisales J, Sanabria A. Utility of Routine Frozen Section of Thyroid Nodules Classified as Follicular Neoplasm. Am J Clin Pathol 2020; 153:210-220. [PMID: 31732728 DOI: 10.1093/ajcp/aqz152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic performance of frozen section in thyroid nodules classified as follicular neoplasm. METHODS A diagnostic test meta-analysis was designed. Studies that assessed frozen section in patients with thyroid nodules and a fine-needle aspiration biopsy result of Bethesda IV were selected. The outcomes measured were the number of false- and true-positive and -negative results. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) instrument for methodological quality assessment and a bivariate mixed-effects regression framework and a likelihood-based estimation of the exact binomial approach. RESULTS Forty-six studies from 1991 to 2018 were included. Most studies had moderate methodological quality. The overall sensitivity and specificity were 43% (95% confidence internal [CI], 0.34-0.53) and 100% (95% CI, 0.99-1.00), respectively. The hierarchic summary receiver operating characteristic curve showed an area under the curve of 0.91 (95% CI, 0.80-0.97). CONCLUSIONS Frozen section demonstrates moderate diagnostic performance in patients with follicular neoplasm, and its utility for making intraoperative decisions is limited. Its routine use should be discouraged.
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Affiliation(s)
- Jhorman Grisales
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Cirugia de Cabeza y Cuello, CEXCA, Medellín, Colombia
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Abstract
Although the incidence of thyroid cancer is increasing, survival remains unchanged. Due to concern for overtreatment, surgical management of thyroid cancer has evolved. Papillary thyroid microcarcinoma measuring 1 cm or smaller are considered very low risk and can be managed with either thyroid lobectomy or active surveillance. Total thyroidectomy is no longer recommended for these cancers unless there is evidence of metastasis, local invasion, or aggressive disease. Recommendations for low-risk differentiated thyroid cancer measuring 1 cm to 4 cm remain controversial. This article explores the controversies over the extent of surgery for patients with very low-risk and low-risk differentiated thyroid cancer.
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Sarfati-Lebreton M, Toqué L, Philippe JB, Finel JB, Hamy A, Mucci S. Does hemithyroidectomy still provide any benefit? ANNALES D'ENDOCRINOLOGIE 2019; 80:101-109. [DOI: 10.1016/j.ando.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/20/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023]
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Maksimovic S, Jakovljevic B, Gojkovic Z. Lymph Node Metastases Papillary Thyroid Carcinoma and their Importance in Recurrence of Disease. ACTA ACUST UNITED AC 2018; 72:108-111. [PMID: 29736098 PMCID: PMC5911164 DOI: 10.5455/medarh.2018.72.108-111] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The purpose of this study is to establish whether the lymph node metastases of the papillary thyroid carcinoma are a significant factor in recurrence of the disease by analyzing the time until recurrence of the disease and frequency of recurrence of the disease. Methods From 1 January 1995 until 30 June 2017, 102 patients were treated at the Public Health Institute Hospital “Sveti Vracevi” in Bijeljina for PTC. In all patients, surgery of the thyroid gland and/or lymph nodes of the neck was performed. Total thyroidectomy (TT) was performed in 20 patients and near-total thyroidectomy leaving <1 g thyroid tissue adjacent to the recurrent laryngeal nerve in 7 patients. TT and lymph nodes dissection were performed in 71 patients. Palliative surgery and biopsy due to locally advanced disease were performed in 3 patients. Results In our study, 102 patients with PTC were analyzed. 82 patients experienced pure PTC (80.4%), the other 20 patients (19.6%) experienced other variants of PTC. 24 patients (23.5%) experienced multi centric or bilateral tumors. 71 patients (69.6%) experienced histologically verified metastases in the lymph nodes of the neck. 7 patients (6.8%) experienced distant metastases. 20 patients underwent total thyroidectomy (TT), and 7 near-total thyroidectomy. Total thyroidectomy + dissection of central and lower jugular lymph nodes with frozen section histopathology verification was performed in 71 patients (69.6%). Out of these 71 patients, in 50 patients (70.4%) metastases were verified in the lower jugular lymph nodes. A modified lymph node dissection (MRND) was also performed in these patients. Conclusion Lymph node metastases of the papillary thyroid carcinoma are a plausible prognostic factor. They are important for recurrence of the disease, but not for survival.
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Affiliation(s)
- Sinisa Maksimovic
- Public Health Institution Hospital "Sveti Vracevi" in Bijeljina, University of Banja Luka, Faculty of Medicine, Bosnia and Herzegovina
| | | | - Zdenka Gojkovic
- Faculty of Medicine, University Clinical Centre of the Republic of Srpska, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Rusinek D, Chmielik E, Krajewska J, Jarzab M, Oczko-Wojciechowska M, Czarniecka A, Jarzab B. Current Advances in Thyroid Cancer Management. Are We Ready for the Epidemic Rise of Diagnoses? Int J Mol Sci 2017; 18:E1817. [PMID: 28829399 PMCID: PMC5578203 DOI: 10.3390/ijms18081817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023] Open
Abstract
A rising incidence of thyroid cancers (TCs) mainly small tumors, observed during recent years, lead to many controversies regarding treatment strategies. TCs represent a distinct molecular background and clinical outcome. Although in most cases TCs are characterized by a good prognosis, there are some aggressive forms, which do not respond to standard treatment. There are still some questions, which have to be resolved to avoid dangerous simplifications in the clinical management. In this article, we focused on the current advantages in preoperative molecular diagnostic tests and histopathological examination including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). We discussed the controversies regarding the extent of thyroid surgery and adjuvant radioiodine therapy, as well as new treatment modalities for radioiodine-refractory differentiated thyroid cancer (RR-DTC). Considering medullary thyroid cancer (MTC), we analyzed a clinical management based on histopathology and RET (ret proto-oncogene) mutation genotype, disease follow-up with a special attention to serum calcitonin doubling time as an important prognostic marker, and targeted therapy applied in advanced MTC. In addition, we provided some data regarding anaplastic thyroid cancer (ATC), a highly lethal neoplasm, which lead to death in nearly 100% of patients due to the lack of effective treatment options.
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Affiliation(s)
- Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Michal Jarzab
- 3rd Department of Radiotherapy and Chemotherapy, Breast Unit, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Malgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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Miccoli P, Bakkar S. Surgical management of papillary thyroid carcinoma: an overview. Updates Surg 2017; 69:145-150. [DOI: 10.1007/s13304-017-0449-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/09/2017] [Indexed: 01/07/2023]
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Nabhan F, Ringel MD. Thyroid nodules and cancer management guidelines: comparisons and controversies. Endocr Relat Cancer 2017; 24:R13-R26. [PMID: 27965276 PMCID: PMC5241202 DOI: 10.1530/erc-16-0432] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 12/23/2022]
Abstract
Thyroid cancer is an increasingly prevalent malignancy throughout the world. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. All of these guidelines recognize this increasing incidence, particularly of small papillary thyroid cancers, due in part to improved technology enabling early or even 'over' diagnosis. Recent advances in molecular imaging and molecular methods have been developed to better characterize thyroid nodules, and a number of studies that have clarified risk stratification systems that can be modified over time allow for individualization of diagnosis, initial treatment, and subsequent follow-up strategies. Advances in surgical approaches and new treatments for patients with the most aggressive forms of thyroid cancer have all influenced management guidelines. Despite substantial similarities, there also are important differences between recent guidelines for some of the common clinical scenarios encountered by physicians in clinical practice. In the present manuscript, we will highlight similarities and differences between several of the most recently published guidelines focused on key areas of importance to clinical care and controversy. These are key areas for future research to strengthen the data to support future guideline recommendations.
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Affiliation(s)
- Fadi Nabhan
- Division of EndocrinologyDiabetes and Metabolism, The Ohio State University College of Medicine, Wexner Medical Center, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Matthew D Ringel
- Division of EndocrinologyDiabetes and Metabolism, The Ohio State University College of Medicine, Wexner Medical Center, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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