Interpreting Microscopic Positive Margins in Differentiated Thyroid Cancer

Introduction. Differentiated thyroid cancer (DTC) has an overall excellent prognosis. Patients who develop recurrent disease have a more unfavorable disease course than those with no recurrence. Higher recurrence rates are seen with incomplete surgical resection and gross positive margins. It is unclear whether microscopic positive margin affects disease recurrence rates as much as grossly positive margin. Aim of the Study. To assess whether microscopic positive margin is an independent predictor of disease recurrence in patients with overall low-risk DTC. Patients and Methods. We conducted a retrospective single-center institutional review of 1,583 consecutive patients’ charts from 1995–2013 using the Canadian Thyroid Cancer Consortium Registry. We included adult patients with nonmetastasizing T1 and T2 DTC with a minimum of three years follow-up. Univariate and multivariate analyses were used to study factors that may influence the risk of persistent/recurrent disease. Strict definitions of persistent versus recurrent disease were applied. Results. 963 patients (152 men and 811 women) were included in the study with a mean age of 46 years. Microscopic positive margins were present in 12% of the specimens and were associated with an increased rate of persistent disease (8% versus 2% in the controls) but not with an increased risk of recurrent disease (1% in both groups). T2 tumors had a significantly higher incidence of positive margins than T1 tumors (48% versus 36%) and significantly higher nodal staging. Conclusions. Microscopic positive margin in the histopathology report in patients with low-risk DTC was associated with a higher rate of persistent disease but did not increase the risk of disease recurrence. A close follow-up of biomarkers and occult residual cancerous lesions is needed, especially in the first year. Further studies are needed to determine whether additional therapeutic measures to prevent recurrence are indicated in T1 and T2 DTC with positive microscopic surgical margins.

Download Full-text

Microscopic Positive Margins in Differentiated Thyroid Cancer Is Not an Independent Predictor of Local Failure

Thyroid ◽

10.1089/thy.2015.0141 ◽

2015 ◽

Vol 25 (9) ◽

pp. 993-998 ◽

Cited By ~ 31

Author(s):

Laura Y. Wang ◽

Ronald Ghossein ◽

Frank L. Palmer ◽

Iain J. Nixon ◽

R. Michael Tuttle ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Independent Predictor ◽

Local Failure ◽

Positive Margins

Download Full-text

Abstract #805414: Poorly-Differentiated Thyroid Cancer in a Family With Multiple Members with a Novel Dicer1 Mutation, C.3675C > A (P.TYR1225*)

Endocrine Practice ◽

10.1016/s1530-891x(20)39625-7 ◽

2020 ◽

Vol 26 ◽

pp. 276

Author(s):

Diana Chang

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Poorly Differentiated

Download Full-text

No Reason for Hypothyroidism. Five year follow-up results after combined thyroidectomy and Radio Ablation Therapy for differentiated thyroid cancer

Zeitschrift für Gastroenterologie ◽

10.1055/s-0031-1285752 ◽

2011 ◽

Vol 49 (08) ◽

Author(s):

N Emmanouilidis ◽

WH Knapp ◽

J Klempnauer ◽

GFW Scheumann

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Ablation Therapy

Download Full-text

Radioiodide Treatment of Pulmonary Metastases of Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0037-1620881 ◽

1979 ◽

Vol 18 (02) ◽

pp. 86-90 ◽

Cited By ~ 26

Author(s):

V. Zamrazil ◽

D. Pohunková ◽

S. Röhling ◽

J. Němec

Keyword(s):

Thyroid Cancer ◽

Bone Metastases ◽

Differentiated Thyroid Cancer ◽

Pulmonary Metastases ◽

Survival Rates ◽

Younger Patients ◽

131I Uptake ◽

Young Subjects ◽

Radioiodide Therapy ◽

Diagnosis Of Thyroid Cancer

Pulmonary metastases were found in 123 out of 840 patients with thyroid cancer between 1955-1977. 87 patients with pulmonary metastases of differentiated cancer were studied in detail, including an evaluation of prognostically important factors. In 66 of them, the induction of 131I uptake in metastases was attempted, in half of them successfully. Uptake was achieved more frequently in younger subjects, in papillary cancers and in patients with fine pulmonary metastases on chest films. Survival (not corrected for age) was evaluated 10 and 15 years following the diagnosis of thyroid cancer and was found to be 29,1 % and 12,2%, respectively. Significantly higher survival rates were seen in younger patients, in patients with the fine type of pulmonary metastases, in the absence of bone metastases and, particularly, in patients with induced 131I uptake in metastases. Papillary cancers were found to have higher survival rates in males and in young subjects only, in the whole group the survival rates were independent of either microscopic type or sex. It is believed that biologic behaviour of distant (pulmonary) metastases may be influenced by radioiodide therapy.

Download Full-text

Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

Nuklearmedizin ◽

10.1055/s-0038-1625203 ◽

2005 ◽

Vol 44 (05) ◽

pp. 185-191 ◽

Cited By ~ 4

Author(s):

H. Wieler ◽

S. Birtel ◽

E. Ostwald-Lenz ◽

K. P. Kaiser ◽

H. P. Becker ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Survival Rates ◽

Perioperative Morbidity ◽

Referral Hospitals ◽

Principles Of Treatment ◽

Current Guidelines ◽

Papillary Microcarcinomas ◽

Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

Download Full-text

Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

Nuklearmedizin ◽

10.1055/s-0038-1632238 ◽

2000 ◽

Vol 39 (01) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

S. P. Müller ◽

Ch. Reiners ◽

A. Bockisch ◽

Katja Brandt-Mainz

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Roc Analysis ◽

Tsh Suppression ◽

Significant Difference ◽

Test Specificity ◽

The Relationship ◽

Tumor Scintigraphy ◽

Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

Download Full-text