The Midwest Surgical Association
Contralateral papillary thyroid cancer: does size matter?

https://doi.org/10.1016/j.amjsurg.2008.09.011Get rights and content

Abstract

Background

The optimal extent of thyroidectomy for papillary thyroid cancer (PTC) <1 cm is controversial. Our aim was to identify the rate and factors predictive of contralateral PTC in these patients.

Methods

We examined 228 patients with PTC who underwent either completion or total thyroidectomy and analyzed the predictive value of tumor size, histology, margin status, capsular invasion, extrathyroid extension, multifocality, and node metastases.

Results

We observed no differences in the rate of contralateral disease in patients with primary PTC ≥1 cm compared with those having disease <1 cm, 30% versus 24%, respectively (P = .43). Multifocality was the only factor predictive of contralateral PTC in patients with tumors <1 cm (P = .02). Patients with tumors <.5 cm also had a comparable rate of contralateral disease (27%).

Conclusions

The presence of contralateral PTC appears to be unrelated to the size of the primary tumor. Furthermore, in patients with PTC <1 cm, multifocality is a risk factor for PTC in the contralateral lobe.

Section snippets

Methods

We reviewed the prospective University of Wisconsin Endocrine Surgery database to identify all patients with PTC who underwent either TT or CT from May 1994 to January 2007. Patients who did not have information on the size of their primary tumor were excluded. The following data were retrospectively reviewed and analyzed: patient demographics, extent of surgery, recurrence, tumor pathology, and histologic parameters, including tumor size, follicular variant, multifocality, capsular invasion,

Results

We identified 243 patients with PTC who were treated by TT or CT at the University of Wisconsin. Of these 243 patients, 228 (94%) had available information on the size of their primary tumor and were included in this investigation. The average age at diagnosis of the entire cohort was 45 years, and the majority (170 [75%]) were female (Table 1). The proportion of patients with follicular variants of PTC was 20% (46 of 228). In addition, one quarter of all patients (57 of 228) had cervical lymph

Comments

The optimal extent of surgical resection for PTC remains a topic of debate. Although consensus guidelines recommend TT for PTC ≥1 cm, the treatment of papillary microcarcinoma (PMC) is still controversial.12 Furthermore, the role of CT for tumors <1 cm is undefined. In this study, we examined a cohort of 228 patients who underwent TT or CT at the University of Wisconsin from May 1994 to January 2007. We report a similar rate of contralateral PTC for patients with primary tumors ≥1, <1, and <.5

Acknowledgments

This work was supported by the American College of Surgeons Resident Research Scholarship and NIH Grant T32 CA009614 Physician Scientist Training in Cancer Medicine.

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