Prevalence of Contralateral Tumors in Patients with Follicular Variant of Papillary Thyroid Cancer.

Prevalence of Contralateral Tumors in Patients with Follicular Variant of Papillary Thyroid Cancer.

J Am Coll Surg. 2016 Dec 22;:

Authors: Sullivan M, Graham PH, Alexander EK, Ruan DT, Nehs MA, Gawande AA, Moore FD, Howitt BE, Strickland KC, Krane JF, Barletta JA, Cho NL

Abstract
BACKGROUND: Thyroid lobectomy alone is increasingly being performed for patients with encapsulated follicular variant of papillary thyroid carcinoma (fvPTC). However, the prevalence of contralateral disease in these patients is unknown. Here, we investigated the presence of synchronous disease in fvPTC to improve decision making regarding the extent of surgical resection and need for surveillance.
STUDY DESIGN: We performed a retrospective review of patients who underwent thyroid surgery from October 2009 to February 2013 with a diagnosis of fvPTC as their primary lesion. We collected information regarding patient demographics, nodule size, multifocality, fine needle aspiration (FNA) results, lymphovascular invasion (LVI), extrathyroidal extension (ETE), and lymph node metastasis. Tumors were divided into noninvasive and invasive/infiltrative fvPTC categories. Characteristics of solitary and bilateral fvPTC were compared.
RESULTS: We identified 124 patients with final pathology demonstrating fvPTC. The most common FNA diagnosis was "suspicious for malignancy" (n=53). Sixty-five contralateral tumors were identified in 44/124 patients (35.5%) and included fvPTC (n=40), classical PTC (n=22), tall cell PTC (n=2), and follicular carcinoma (n=1). Fifty contralateral tumors were 1-5 mm, 10 measured 6-9 mm, and 5 were > 10 mm. Contralateral disease correlated significantly with LVI (p=0.037) and larger primary lesions (p=0.020). There was no significant difference noted in ETE or lymph node metastasis. Both noninvasive and invasive/infiltrative fvPTC demonstrated similar rates of contralateral disease.
CONCLUSIONS: Bilateral disease is common in fvPTC, primarily in the form of papillary microcarcinomas. Future monitoring of the contralateral lobe should be discussed with fvPTC patients who do not undergo completion thyroidectomy.

PMID: 28017809 [PubMed - as supplied by publisher]

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