Jaroslaw, Swirta1; Marcin, Barczynski1
1 Third Chair of General Surgery, Jagiellonian University, Medical Collage, Krakow, Poland
Background/Purpose: Despite progress in preoperative work-up incidentally diagnosed thyroid cancer remains a clinical problem. The aim of this study was to estimate prevalence of incidentally diagnosed papillary thyroid cancer (PTC) in patients with benign or indeterminate unilateral thyroid nodule/s.
Methods: This was a retrospective cohort study. Medical record of 3597 patients with benign thyroid disease operated in 2010-2016 were reviewed. Inclusion criterion was unilateral thyroid lobectomy for benign (Bethesda 2) or indeterminate (Bethesda 1 or 3) unilateral thyroid disease. Primary outcome
was prevalence of PTC diagnosed incidentally in the postoperative histopathological report.
Results: A group of 458 patients were eligible for the study (mean age 40.2 ± 13.4 years, F:M ratio (9:1). There were: 214 (46.7%) patients classified as Bethesda 1, 132 (28.8%) patients classified as Bethesda 2, and 112 (24.5%) patients classified as Bethesda 3. PTC was diagnosed in 36/458 (7.9%) patients. Prevalence of PTC was: 25/214 (11.7%) vs. 3/132 (2.3%) vs. 8/112 (7.1%) among Bethesda 1 vs. Bethesda 2 vs. Bethesda 3 lesions, respectively. PTC staged as pT1a was predominant and identified in 22/36 (61.1%) patients, followed by pT1b diagnosed in 6/36 (16.7%) patients, pT2 in 4/36 (11.1%), and pT3 in 4 (11.1%) patients. Completion thyroidectomy was offered to 14/36 (38.9%) patients.
Discussion & Conclusion: PTC is diagnosed on incidental basis in 1 out of 14 patients with unilateral thyroid lesion/s classified preoperatively as Bethesda 1 or 3. Completion thyroidectomy may be considered in one-third of these patients with tumors staged as pT1b or higher.