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Is it time to reconsider lobectomy in low‐risk paediatric thyroid cancer?
Author(s) -
Kluijfhout Wouter P.,
Pasternak Jesse D.,
Kaay Danielle,
Vriens Menno R.,
Propst Evan J.,
Wasserman Jonathan D.
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13287
Subject(s) - medicine , thyroid cancer , thyroidectomy , histopathology , population , thyroid , retrospective cohort study , lymph node , surgery , pathology , environmental health
Summary Objective Current guidelines recommend total thyroidectomy for nearly all children with well‐differentiated thyroid cancer ( WDTC ). These guidelines, however, derive from older data accrued prior to current high‐resolution imaging. We speculate that there is a subpopulation of children who may be adequately treated with lobectomy. Design Retrospective analysis of prospectively maintained database. Patients Seventy‐three children with WDTC treated between 2004 and 2015. Measurements We applied two different risk‐stratification criteria to this population. First, we determined the number of patients meeting American Thyroid Association ( ATA ) ‘low‐risk’ criteria, defined as disease grossly confined to the thyroid with either N0/Nx or incidental microscopic N1a disease. Second, we defined a set of ‘very‐low‐risk’ histopathological criteria, comprising unifocal tumours ≤4 cm without predefined high‐risk factors, and determined the proportion of patients that met these criteria. Results Twenty‐seven (37%) males and 46 (63%) females were included in this study, with a mean age of 13·4 years. Ipsilateral‐ and contralateral multifocality were identified in 27 (37·0%) and 19 (26·0%) of specimens. Thirty‐seven (51%) patients had lymph node metastasis (N1a = 18/N1b = 19). Pre‐operative ultrasound identified all cases with clinically significant nodal disease. Of the 73 patients, 39 (53·4%) met ATA low‐risk criteria and 16 (21·9%) met ‘very‐low‐risk’ criteria. All ‘very‐low‐risk’ patients demonstrated excellent response to initial therapy without persistence/recurrence after a mean follow‐up of 36·4 months. Conclusions Ultrasound and histopathology identify a substantial population that may be candidates for lobectomy, avoiding the risks and potential medical and psychosocial morbidity associated with total thyroidectomy. We propose a clinical framework to stimulate discussion of lobectomy as an option for low‐risk patients.