Multicenter Study

. 2022 Feb 1;148(2):99-106.

doi: 10.1001/jamaoto.2021.3277.

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Lisa Caulley^{1

2

3

4}, Antoine Eskander^{5

6}, Weining Yang⁷, Edel Auh⁸, Lydia Cairncross⁹, Nancy L Cho¹⁰, Bahar Golbon¹¹, Subramania Iyer¹², Jeffrey C Liu^{13

14}, Paul J Lee¹⁵, Brenessa Lindeman¹⁶, Charles Meltzer¹⁷, Nicole Molin¹⁴, Alessandra Moore¹⁰, Julia Noel¹⁸, Halie Nozolino¹⁶, Jesse Pasternak¹¹, Brendon Price¹⁹, Tim Ramsay³, Lars Rolighed²⁰, Mirabelle Sajisevi²¹, Arun Sharma²², Catherine Sinclair²³, Meredith Sorensen²⁴, Kyung Tae²⁵, Alice L Tang²⁶, Gabriel Tsao¹⁷, Michelle Williams²⁷, Sean Wrenn¹⁰, Monica H Xing²⁸, Mark Zafereo²⁹, Brendan C Stack Jr²³, Greg Randolph³⁰, Louise Davies^{31

32}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁵ Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁸ Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
⁹ Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁰ Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
¹¹ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
¹² Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India.
¹³ Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
¹⁵ Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
¹⁶ Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham.
¹⁷ The Permanente Medical Group, Santa Rosa, California.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California.
¹⁹ Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa.
²⁰ Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
²¹ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington.
²² Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield.
²³ Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York.
²⁴ Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
²⁵ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
²⁶ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
²⁷ Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston.
²⁸ The Thyroid, Head, and Neck Cancer Foundation, New York, New York.
²⁹ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
³⁰ Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.
³¹ VA Outcomes Group, White River Junction, Vermont.
³² Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

PMID: 34817546
PMCID: PMC8613696
DOI: 10.1001/jamaoto.2021.3277

Multicenter Study

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Lisa Caulley et al. JAMA Otolaryngol Head Neck Surg. 2022.

. 2022 Feb 1;148(2):99-106.

doi: 10.1001/jamaoto.2021.3277.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁵ Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁸ Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
⁹ Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁰ Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
¹¹ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
¹² Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India.
¹³ Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
¹⁵ Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
¹⁶ Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham.
¹⁷ The Permanente Medical Group, Santa Rosa, California.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California.
¹⁹ Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa.
²⁰ Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
²¹ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington.
²² Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield.
²³ Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York.
²⁴ Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
²⁵ Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
²⁶ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
²⁷ Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston.
²⁸ The Thyroid, Head, and Neck Cancer Foundation, New York, New York.
²⁹ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
³⁰ Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.
³¹ VA Outcomes Group, White River Junction, Vermont.
³² Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

PMID: 34817546
PMCID: PMC8613696
DOI: 10.1001/jamaoto.2021.3277

Abstract

Importance: Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment.

Objective: To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size.

Design, setting, and participants: This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed.

Main outcomes and measures: Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period.

Results: Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]).

Conclusions and relevance: Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Caulley reported grants from the Canadian Institutes of Health Research and the PSI Foundation outside the submitted work. Dr Eskander reported grants from Merck and personal fees from Bristol Myers Squibb outside the submitted work. Dr Williams reported serving as a member of the Bayer scientific advisory board. Dr Zafereo reported grants from Eli Lilly, Merck, and GenePro Diagnostics outside the submitted work. No other disclosures were reported.

Figures

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References

1. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164-2167. doi:10.1001/jama.295.18.2164 - DOI - PubMed
1. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605-613. doi:10.1093/jnci/djq099 - DOI - PubMed
1. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140(4):317-322. doi:10.1001/jamaoto.2014.1 - DOI - PubMed
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Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Affiliations

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical