Large (>4 cm) intrathyroidal encapsulated well-differentiated follicular cell-derived carcinoma without vascular invasion may have negligible risk of recurrence even when treated with lobectomy alone Journal Article
| Authors: | Ghossein, R.; Ganly, I.; Tuttle, R. M.; Xu, B. |
| Article Title: | Large (>4 cm) intrathyroidal encapsulated well-differentiated follicular cell-derived carcinoma without vascular invasion may have negligible risk of recurrence even when treated with lobectomy alone |
| Abstract: | Background: Thyroid carcinoma >4 cm in size is staged as T3a. The current American Thyroid Association guidelines recommend subtotal/total thyroidectomy and consideration for postoperative radioactive iodine (RAI) treatment for these tumors. In this retrospective cohort study, we aimed to explore the clinical course of large encapsulated thyroid carcinoma without other risk factors. Methods: Eighty-eight patients with large (>4 cm) encapsulated well-differentiated thyroid carcinoma resected between 1995 and 2021 were included in this retrospective cohort study. Exclusion criteria were tall cell variant, any extent of vascular invasion, extrathyroidal extension (microscopic or gross), high-grade histology, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), infiltrative tumors, positive resection margin, and cases with follow-up <1 year. The primary outcomes are risk of nodal metastasis at the initial resection, disease-free survival (DFS), and disease-specific survival (DSS). Results: The tumor histotype was follicular carcinoma (n = 18, 21%), oncocytic (Hurthle cell) carcinoma (n = 8, 9%), and papillary thyroid carcinoma (PTC; n = 62, 70%). Among PTC, 38 were encapsulated follicular variant, 20 classic type, and 4 solid variant. Four cases had extensive capsular invasion (CI), 61 (69%) had focal CI, whereas 23 did not have CI. Thirty-two cases (36%) were treated with lobectomy/hemithyroidectomy alone, and 55 patients (62%) did not receive RAI. Five patients had nodal metastasis at the time of primary resection, all of whom had classic-type PTC. The median follow-up period was 4.8 years (interquartile range: 3.2-9.7 years). No recurrence, being local, regional, or distant, was observed in the entire cohort, including those patients treated with lobectomy alone without RAI. The 10-year DFS and DSS were 100%, respectively. Conclusion: Large intrathyroidal encapsulated well-differentiated thyroid carcinoma without vascular invasion follow an extremely indolent clinical course with negligible risk of recurrence. Lobectomy alone without RAI may be the appropriate treatment strategy for this selected group of patients. Copyright © 2023 Mary Ann Liebert, Inc. |
| Keywords: | adult; controlled study; human tissue; middle aged; retrospective studies; major clinical study; disease course; cancer recurrence; disease free survival; recurrence risk; follow up; lymph node metastasis; cohort analysis; pathology; retrospective study; histology; radioactive iodine; iodine radioisotopes; disease progression; cancer size; carcinoma; thyroidectomy; thyroid neoplasms; thyroid papillary carcinoma; thyroid tumor; adenocarcinoma, follicular; minimally invasive; disease specific survival; disease exacerbation; follicular carcinoma; surgical margin; thyroid follicular carcinoma; goiter; hürthle cell carcinoma; tumor invasion; papillary thyroid carcinoma; capsular invasion; hemithyroidectomy; humans; human; male; female; article; well-differentiated follicular cell-derived carcinoma |
| Journal Title: | Thyroid |
| Volume: | 33 |
| Issue: | 5 |
| ISSN: | 1050-7256 |
| Publisher: | Mary Ann Liebert, Inc |
| Date Published: | 2023-05-01 |
| Start Page: | 586 |
| End Page: | 592 |
| Language: | English |
| DOI: | 10.1089/thy.2023.0032 |
| PUBMED: | 36884299 |
| PROVIDER: | scopus |
| PMCID: | PMC10171951 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Ronald Ghossein -- Export Date: 1 June 2023 -- Source: Scopus |
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