The Sonographic Subcentimeter Malignant Thyroid Nodule: What Does It Stand for?

• Published in: The American surgeon Vol. 84; no. 1; p. 137
• Main Authors: Marrero, Annette Pascual, Gracia, Alvaro, Méndez, William
• Format: Journal Article
• Language: English
• Published: United States 01-01-2018
• Subjects: Adult; Aged; Biopsy, Fine-Needle; Carcinoma, Papillary - diagnostic imaging; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Female; Hospitals, University; Humans; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Thyroid Cancer, Papillary; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - pathology; Thyroid Nodule - surgery; Thyroidectomy; Treatment Outcome; Ultrasonography - methods
• ISSN: 1555-9823
• DOI: 10.1177/000313481808400135

Thyroid cancer management has moved to less extensive surgery in lesions with favorable criteria. Our study evaluated if the sonographic (US) size of thyroid nodules is a reliable criterion to determine the extent of surgery in patients with papillary thyroid carcinoma (PTC). A retrospective study was performed to evaluate thyroid nodules measuring <10 mm in the preop sonogram with a permanent pathology of PTC. Patients were subdivided into two groups based on the US size: A (1-5 mm) and B (6-10 mm). Statistical correlations were made for the presence of the following unfavorable criteria: multifocality, capsular invasion, angio/lymphatic invasion, extrathyroidal invasion, and presence of metastases. A total of 1901 thyroidectomies were performed: 722 (38%) for PTC. 182 (25%) patients met the inclusion criteria. There were 30 patients in Group A (1-5 mm) and 152 patients in Group B (6-10 mm). Five (17%) patients in Group A and 53 (35%) patients in Group B presented unfavorable criteria (P < 0.005). Malignant thyroid nodules with the US size of <5 mm can in theory be candidates for partial thyroidectomy, but 17 per cent of them might still need further surgical intervention. Lesions with the US size of 6 to 10 mm still have a moderate risk of presenting unfavorable pathological criteria.