Impact of the 2009 American Thyroid Association guidelines on the choice of operation for well-differentiated thyroid microcarcinomas.
BACKGROUND
The 2009 ATA Guidelines state "lobectomy alone may be sufficient treatment for small (< 1 cm), low risk, unifocal, intrathyroidal papillary carcinomas in the absence of . . . nodal metastases." We determined how often these criteria are satisfied, and whether tumor size alone can dictate operative management.


METHODS
Medical records of 346 patients with well-differentiated thyroid cancer (WDTC) who underwent thyroidectomy from January 1, 2007 to November 10, 2009, were reviewed. There were 130 patients with tumors ≤ 1 cm and negative lateral nodes. Pathology reports were reviewed to identify adverse features including multifocality, extrathyroidal extension, vascular invasion, and central node metastases.


RESULTS
Eighty-four percent underwent total thyroidectomy and 16% central node dissection. All but 2 patients had papillary cancer. Sixty-one percent with cancers 6-10 mm (group 1) had adverse pathologic features compared with 32% with cancers < 6 mm (group 2). Multifocality was most common: 55% in group 1 versus 32% in group 2 (P = .004). Positive central nodes were identified in 23% of group 1 versus 4% of group 2 (P = .004). Of patients in group 1, 88% had positive or suspicious fine-needle aspiration biopsy (FNAB) preoperatively.


CONCLUSIONS
We recommend that total thyroidectomy be considered as the initial operation for thyroid tumors 6-10 mm in size in which the preoperative FNAB is diagnostic or suspicious for WDTC.
Department of Surgery, Division of Endocrine Surgery, New York University Langone Medical Center, New York, NY, USA.
Jennifer B
JB
Ogilvie
Kepal N
KN
Patel
Keith S
KS
Heller
D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D017410:Practice Guidelines as Topic; D057234:Preoperative Period; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods* / Q000592:standards