Surgical Guidelines for Low-Risk Differentiated Thyroid Cancer by Tumor Size
Posted: Friday, January 15, 2021
The first choice of treatment for patients with differentiated thyroid cancer is surgery. Optimal surgical modalities exist for patients with tumors smaller than 1 cm and larger than 4 cm. To date, however, there are no clear guidelines for surgical recommendations for patients with tumor diameters between 1 and 4 cm. Yang et al, of the Second Hospital of Anhui Medical University, China, analyzed data on patients with low-risk differentiated thyroid cancer with tumor diameters between 1 and 4 cm to determine the selection criteria between total thyroidectomy and thyroid lobectomy. Their results were published in Cancer Management and Research.
A total of 103 patients with low-risk malignant thyroid cancer were included in this retrospective study. All patients had primary surgical treatment of a thyroid nodule at the Second Hospital of Anhui Medical University, available complete clinical and pathologic data, and a tumor diameter between 1 and 4 cm.
The American Thyroid Association currently recommends total thyroidectomy when tumor metastases are found in a patient’s postoperative pathology report. If no metastasis is found, thyroid lobectomy is advised. Patients in this study were divided into six groups corresponding to tumor diameter. Group A comprised patients with tumors between 1.0 and 1.5 cm; group B, 1.6–2.0 cm; group C, 2.1–2.5 cm; group D, 2.6–3.0 cm; and group E, 3.1–3.5 cm. Among patients in this study, the metastatic rate was 41.8%, which is similar to literature review results, the authors noted.
The investigators found that as tumor diameter increased, the percentage of total thyroidectomy recommended in each group showed an overall upward trend, whereas the percentage of thyroid lobectomy recommended in each group showed an overall downward trend. For patients with a tumor diameter less than 2.15 cm or a single focus, thyroid lobectomy was appropriate, whereas for patients with a tumor diameter of at least 2.15 cm or multiple foci were more likely to have total thyroidectomy.
Disclosure: The study authors reported no conflicts of interest.