One-year experience after adapting to the 2015 American

One-year experience after adapting to the 2015 American

One-year experience after adapting to the 2015 American Thyroid Association
guidelines for differentiated thyroid cancer at the Jewish General Hospital

Hua G, Hier M, Forest VI, Mlynarek A, Payne R.
Otolaryngology Head & Neck Surgery
Faculty of Medicine, McGill University, Montreal, QC, Canada

Introduction
In the 2015 American Thyroid
Association (ATA) guidelines for
differentiated thyroid carcinoma,
several
new
recommendations
pertaining to the indications for
biopsy of a thyroid nodule were
suggested.
The guidelines now recommend
abstaining from performing a biopsy
in thyroid nodules <1.5cm unless the ultrasound examination identifies suspicious characteristics whereas the previous 2009 guidelines recommended a biopsy for all nodules 1cm. Conclusions Results Table 1. Patient and Nodule Characteristics of the Study Cohort Variable All Nodules 1.5cm Nodules <1.5cm p-value Total (%) Mean age (range), years Sex (%) Male Female Mean nodule size on U/S (range), cm Bethesda Classification (%) I (Non-diagnostic) II (Benign) III (AUS/FLUS) IV (FN/SFN) V (Suspicious for malignancy) VI (Malignant) Extent of Surgery (%) Hemi-/Subtotal Thyroidectomy Total Thyroidectomy Final Pathology (%) Benign Malignant Single nodule Multifocal disease Aggressive Features 313 50.419 (20-89) 258 (82.43) 50.919 (20-89) 55 (17.57) 48.073 (24-75) 0.1761 72 (23.00) 241 (77.00) 2.836 (0.5-9.4) 60 (23.26) 198 (76.74) 3.203 (1.5-9.4) 12 (21.82) 43 (78.18) 1.115 (0.5-1.4) 1.0000 <0.0001 8 (2.56) 33 (10.54) 74 (23.64) 34 (10.86) 67 (21.41) 97 (30.99) 8 (3.10) 31 (12.02) 67 (25.97) 32 (12.40) 58 (22.48) 62 (24.03) 0 (0) 2 (3.64) 7 (12.73) 2 (3.64) 9 (16.36) 35 (63.64) 0.3588 0.0880 0.0366 0.0589 0.3688 <0.0001 147 (46.96) 166 (53.04) 133 (51.55) 125 (48.45) 22 (40.00) 33 (60.00) 0.1382 85 (27.16) 228 (72.84) 137 (43.77) 176 (56.23) 65 (20.77) 79 (30.62) 179 (69.38) 113 (43.79) 145 (56.20) 47 (18.22) 6 (10.91) 49 (89.09) 24 (43.64) 31 (56.36) 18 (32.73) 0.0024 1.0000 0.0266 AUS/FLUS: atypia of undetermined significance/follicular lesion of undetermined significance; FN/SFN: follicular neoplasm/suspicious for follicular neoplasm. Aggressive Features denote the presence lymph node metastasis and/or extra-thyroidal extension. Table 2. Nodule Characteristics Stratified by Size and Bethesda Classification n Fig. 1 Algorithm for evaluation and management of patients with thyroid nodules based on US pattern and FNA cytology; Thyroid Nodule/DTC The aimATA of this study was toGuidelines present 2015. Aim the experience at the Jewish General Hospital since the guidelines implementation. Methods A retrospective study of 313 consecutive patients undergoing thyroidectomy from 2015 to 2016 was performed. Patients final pathology was compared to their thyroid nodule size on pre-operative ultrasound, biopsy result, age, sex, and extent of surgery. RESEARCH POSTER PRESENTATION DESIGN 2012 www.PosterPresentations.com Malignant (%) Aggressive Features (%) Nodules >1.5cm

p-value

Nodules
<1.5cm Nodules >1.5cm

p-value

4 (50.00)
5 (16.13)
39 (58.21)
21 (65.63)
48 (82.76)
62 (100)
179
(69.38)

1.0000
0.4570
1.0000
0.3353
1.0000

0 (-)
0 (0)
0 (0)
0 (0)
3 (33.33)
15 (42.86)

0 (0)
0 (0)
3 (4.48)
0 (0)
12 (20.69)
32 (51.61)

1.0000
1.0000
1.0000
0.4075
0.5261

0.0024

18 (32.73)

47 (18.22)

0.0266

Nodules
Bethesda
<1.5cm Nodules >1.5cm

p-value

Nodules
<1.5cm I II III IV V VI 0 2 7 2 9 35 8 31 67 32 58 62 0.3588 0.0880 0.0366 0.589 0.3688 <0.0001 0 (-) 0 (0) 3 (42.86) 2 (100) 9 (100) 35 (100) Total 55 258 - 49 (89.09) Of 313 patients, 228 (72.8%) were malignant on final pathology. 55 of 313 (17.6%) had a nodule <1.5cm. Nodules <1.5cm were more likely to be malignant on biopsy (63.6% vs. 24.0%; p<0.0001) and on final pathology (89.1% vs. 69.4%; p=0.0024), compared to nodules 1.5cm. Fig. 2 Artists Rendition of a Thyroid Gland; verymom.co m. These smaller nodules were also more likely to present aggressive features than larger ones (32.7% vs. 18.2%; p=0.0266). 46 of 46 (100%; 95% CI [0.908, 1.000]) nodules <1.5cm with Bethesda IV-VI were malignant on final pathology, compared to 131 of 152 (86.2%) of nodules 1.5cm with Bethesda IV-VI (p=0.0047). This study suggests that, at our institution, patients with nodules <1.5cm who are selected for thyroidectomy are at a higher risk for malignancy and more aggressive disease when compared to patients with larger nodules. These findings may be a result of adapting to the 2015 ATA guidelines for differentiated thyroid carcinoma. Contact: Richard J. Payne, MD, MSc, FRCSC Jewish General Hospital and McGill University 3755 Cte Ste Catherine, Suite E903 Montreal, QC H3T 1E2 Canada [email protected] References Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid : official journal of the American Thyroid Association. 2016;26(1):1-133. 2. Roti E, degli Uberti EC, Bondanelli M, Braverman LE. Thyroid papillary microcarcinoma: a descriptive and metaanalysis study. European journal of endocrinology. 2008;159(6):659-73. 3. Roh JL, Kim JM, Park CI. Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Annals of surgical oncology. 2008;15(9):2482-6. 4. Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World journal of surgery. 2010;34(1):28-35. 5. Giordano D, Gradoni P, Oretti G, Molina E, Ferri T. Treatment and prognostic factors of papillary thyroid microcarcinoma. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for OtoRhino-Laryngology & Cervico-Facial Surgery. 2010;35(2):118-24. 6. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroidPrognostic significance of lymph node 1.

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