A complete thyroidectomy is currently recommended for pediatric patients with papillary thyroid carcinoma (PTC). This advice is applicable to all phases of PTC, including papillary thyroid microcarcinoma (1 cm, T1a) tumours.
The results of a recent research show that in patients with unifocal T1a PTC and no clinically visible nodal illness on preoperative ultrasonography, a thyroid lobectomy and central neck dissection should be considered. Close observation may be recommended if there is no indication of unilateral multifocality or if there are fewer than four positive lymph nodes in postoperative pathology.
This study was conducted by Chad K. Sudoko and team, with the idea of assessing the features of American Joint Committee on Cancer T1 PTC tumours in a large pediatric population and to identify a subset of patients who may benefit from a thyroid lobectomy rather than a complete thyroidectomy. The findings of this study was published in The Journal of American Medical Association, on 23rd September, 2021.
This retrospective cohort research was carried out between January 1, 2009, and May 31, 2020. The study was conducted at a tertiary care medical facility and included 102 individuals who had T1 PTC surgically treated: 52 with stage T1a (1 cm) tumours and 50 with stage T1b (>1 cm but less than 2 cm) tumours. The existence of bilateral illness and lymph node metastases were the primary outcomes.
When comparing this cohort research of 102 children patients with American Joint Committee on Cancer T1 PTC to prior published data, there was a 20% reduction in the likelihood of bilateral illness. There was a substantial correlation between nodal metastasis and bilateral illness in T1a PTC, and there was a 95% incidence of unilateral disease when no nodal metastases were found on pathological examination. Unilateral multifocality was likewise linked with bilateral disease in patients with T1b malignancies. When compared to T1a tumours, patients with T1b tumours had a higher probability of lateral (N1b) neck lymph node metastasis.
In Conclusion, these findings imply that in patients with unifocal T1a PTC without evidence of nodal disease, an initial thyroid lobectomy and ipsilateral central neck dissection may be considered. These findings also have significant clinical implications and may result in practice changes regarding the extent of thyroid surgery on low-stage pediatric PTC.
Reference:
Sudoko CK, Jenks CM, Bauer AJ, et al. Thyroid Lobectomy for T1 Papillary Thyroid Carcinoma in Pediatric Patients. JAMA Otolaryngol Head Neck Surg. Published online September 23, 2021. doi:10.1001/jamaoto.2021.2359