title: Surgical treatment of thyroid follicular neoplasms: results of a retrospective analysis of a large clinical series.
abstract: The most appropriate surgical management of "follicular neoplasm/suspicious for follicular neoplasm" lesions (FN), considering their low definitive malignancy rate and the limited predictive power of preoperative clinic-diagnostic factors, is still controversial. On behalf of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB), we collected and analyzed the experience of 26 endocrine centers by computerized questionnaire. 1379 patients, surgically treated after a FN diagnosis from January 2012 and December 2103, were evaluated. Histological features, surgical complications, and medium-term outcomes were reported. Total thyroidectomy (TT) was performed in 1055/1379 patients (76.5 %), while hemithyroidectomy (HT) was carried out in 324/1379 cases (23.5 %). Malignancy rate was higher in TT than in HT groups (36.4 vs. 26.2 %), whereas the rates of transient and definitive hypoparathyroidism following TT were higher than after HT. Consensual thyroiditis (16.8 vs. 9.9 %) and patient age (50.9 vs. 47.9 %) also differed between groups. A cytological FN diagnosis was associated to a not negligible malignancy rate (469/1379 patients; 34 %), that was higher in TT than in HT groups. However, a lower morbidity rate was observed in HT, which should be considered the standard of care in solitary lesions in absence of specific risk factors. Malignancy could not be preoperatively assessed and clinical decision-making is still controversial. Further efforts should be spent to more accurately preoperatively classify FN thyroid nodules.
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy. giovanni.conzo@hotmail.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.|Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: Dipartimento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, Cattedra di Chirurgia Generale, Università degli Studi di Genova, Genoa, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Ansaldo
authors.affiliation: Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Monserrato, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Calò
authors.affiliation: General Surgery and Endocrine Surgical Unit, AORN A. Cardarelli, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Palma
authors.affiliation: UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100, Trieste, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Dobrinja
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: General Surgery and Endocrine Surgical Unit, AORN A. Cardarelli, Naples, Italy.
authors.forename: Marica
authors.initials: M
authors.lastname: Grasso
authors.affiliation: Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
authors.affiliation: Clinica Chirurgica 2, University School of Padova, Padova University, Padua, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Pelizzo
authors.affiliation: Department of Emergency and Oral Transplantation-DETO, Bari University Hospital Policlinico, Bari, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Pezzolla
authors.affiliation: Thyroid and Parathyroid Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Pezzullo
authors.affiliation: Chirurgia Generale d'Urgenza e Nuove Tecnologie - NOCSAE di Modena, Modena, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
authors.affiliation: Department of General Surgery, Ivrea Hospital, Ivrea, Italy.
authors.forename: Lodovico
authors.initials: L
authors.lastname: Rosato
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Siciliano
authors.affiliation: Ultrasound Guided and Neck Pathologies Surgery Operative Unit, Department of Surgery, S. Maria del Popolo degli Incurabili ASLNA1 Hospital, Naples, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Spiezia
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tartaglia
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
authors.affiliation: Department of Biomorphologic and Functional Sciences, "Federico II" University of Naples, Naples, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Troncone
authors.affiliation: Department of Mental Health and Preventive Medicine, Second University of Naples, Caserta, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Signoriello
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Fine needle cytology; Follicular neoplasm; Hemithyroidectomy; Thyroid cancer; Total thyroidectomy