Does the ATA Risk Stratification Apply to Patients with Papillary Thyroid Microcarcinoma?

TitleDoes the ATA Risk Stratification Apply to Patients with Papillary Thyroid Microcarcinoma?
Publication TypeJournal Article
Year of Publication2020
AuthorsStefanova DI, Bose A, Ullmann TM, Limberg JN, Finnerty BM, Zarnegar R, Fahey TJ, Beninato T
JournalWorld J Surg
Volume44
Issue2
Pagination452-460
Date Published2020 Feb
ISSN1432-2323
KeywordsAdult, Aged, Carcinoma, Papillary, Female, Humans, Incidence, Male, Middle Aged, Neoplasm Recurrence, Local, Retrospective Studies, Thyroid Neoplasms, Thyroidectomy
Abstract

BACKGROUND: The incidence of papillary thyroid microcarcinoma (PTMC) has increased over the past decade. The American Thyroid Association (ATA) suggests that these patients may undergo either thyroid lobectomy or active surveillance. It remains unclear whether there exists a subgroup of PTMC patients who may benefit from more aggressive treatment due to increased risk of recurrence.

METHODS: We retrospectively reviewed 357 patients with PTMC who underwent surgery at a single institution from 2004 to 2016. Patients were classified according to 2015 ATA risk stratification for structural disease recurrence. Demographic, oncologic, and clinicopathologic data were compared between groups.

RESULTS: Out of 357 patients, 246 were classified as low-risk PTMC, 93 were intermediate-risk, and 18 were high-risk. There were more male patients in the high-risk group (38.9%) than the intermediate- (31.2%) or low-risk groups (15.4%) (p < 0.001). Patients with low-risk microcarcinomas were more likely to have an incidental PTMC when compared to intermediate- or high-risk groups (98[39.8%], 15[16.1%], 1[5.6%], respectively, p < 0.001). Patients with high-risk PTMCs, compared to those with intermediate- and low-risk PTMCs, were more likely to have rising postoperative thyroglobulin levels after total thyroidectomy (6[40.0%], 4[5.1%], 9[5.7%], respectively, p = 0.001) and structural recurrence after lobectomy or total thyroidectomy (3[16.7%], 0[0%], 0[0%], respectively, p < 0.001). The median follow-up time was 17.5 (IQR 3-55) months.

CONCLUSIONS: Patients with high-risk PTMC have an increased risk of recurrence when compared to low- and intermediate-risk microcarcinomas, whereas intermediate-risk PTMC may behave similarly to low-risk tumors. ATA risk stratification may inform clinical decision making for patients with PTMC.

DOI10.1007/s00268-019-05215-4
Alternate JournalWorld J Surg
PubMed ID31605172