Laurino Antonio, Pennestrì Francesco, Procopio Priscilla Francesca, Martullo Annamaria, Santoro Gloria, Gallucci Pierpaolo, Prioli Francesca, Sessa Luca, Rossi Esther Diana, Pontecorvi Alfredo, De Crea Carmela, Raffaelli Marco
UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
Endocrine. 2025 Mar;87(3):1070-1079. doi: 10.1007/s12020-024-04101-x. Epub 2024 Nov 18.
In absence of nodal metastases or aggressive features, thyroid lobectomy (TL) should be preferred over total thyroidectomy (TT) for 1-4 cm unifocal, papillary thyroid carcinoma (PTC). However, occult, despite non-microscopic (≥2 mm), nodal metastases may be present in clinically node-negative (cN0) PTC.
Among 4216 thyroidectomies for malignancy (2014-2023), 110 TL plus ipsilateral central neck dissection (I-CND) were scheduled for unifocal cT1b/small cT2 (≤3 cm) cN0 PTCs. Frozen section examination (FSE) of removed nodes was performed: when positive, completion thyroidectomy (CT) was accomplished during the same procedure. In presence of aggressive pathologic features, CT was suggested within 6 months from index operation.
FSE was positive for occult not-microscopic nodal metastases in 33 cases (30%), underwent synchronous CT. Among the remaining 77 patients, 24 (31.2%) were scheduled for CT, after multidisciplinary tumor board discussion, due to at least 2 high-risk factors. The median number of removed and metastatic nodes was 8 (5-11) and 2 (1-5), respectively, at definitive histopathology. Furthermore, multifocality was present in 53 (48.2%) cases, lymphovascular invasion in 66 (60%) cases, aggressive subtypes in 20 (18.2%) cases and extracapsular invasion in 5 (4.5%) cases. Overall, 57 (51.8%) patients underwent immediate or delayed CT.
More than 50% of patients with unifocal cT1b/small cT2 cN0 PTC scheduled for TL may be eligible for CT because of aggressive tumor features. An intraoperative decision-making approach based on I-CND and nodes FSE may ensure accurate staging and risk stratification, thus reducing the risk of recurrence and the need for reoperation.
对于1 - 4厘米的单灶性乳头状甲状腺癌（PTC），在没有淋巴结转移或侵袭性特征的情况下，甲状腺叶切除术（TL）应优先于全甲状腺切除术（TT）。然而，在临床淋巴结阴性（cN0）的PTC中，可能存在隐匿性（尽管不是微小的，≥2毫米）淋巴结转移。
在2014年至2023年期间进行的4216例恶性甲状腺切除术患者中，110例计划对单灶性cT1b/小cT2（≤3厘米）cN0 PTC行TL加同侧中央区淋巴结清扫（I - CND）。对切除的淋巴结进行冰冻切片检查（FSE）：若结果为阳性，则在同一手术过程中完成甲状腺全切术（CT）。若存在侵袭性病理特征，则建议在初次手术6个月内进行CT。
FSE显示33例（30%）存在隐匿性非微小淋巴结转移，这些患者同期接受了CT。在其余77例患者中，经过多学科肿瘤委员会讨论，24例（31.2%）因至少2个高危因素而计划进行CT。在最终病理检查中，切除的淋巴结和转移淋巴结的中位数分别为8（5 - 11）个和2（1 - 5）个。此外，53例（48.2%）为多灶性，66例（60%）有脉管侵犯，20例（18.2%）为侵袭性亚型，5例（4.5%）有包膜外侵犯。总体而言，57例（51.8%）患者接受了即刻或延迟CT。
计划行TL的单灶性cT1b/小cT2 cN0 PTC患者中，超过50%可能因肿瘤侵袭性特征而适合CT。基于I - CND和淋巴结FSE的术中决策方法可确保准确分期和风险分层，从而降低复发风险和再次手术的必要性。
