What has been the result of 2 recent efforts to prevent overtreatment of papillary thyroid carcinomas (PTCs): the new diagnostic category, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and the change in guideline support for hemithyroidectomy for selected PTCs up to 4 cm in size?
In this cohort study of 3368 pathology records from 18 hospitals in 6 countries during 2015 and 2019, 4.8% of papillary thyroid neoplasms were diagnosed as NIFTP in 2019. The proportion of eligible PTCs treated with hemithyroidectomy increased between 2015 and 2019.
Overtreatment prevention strategies have had mixed success: NIFTP diagnosis has only been applied to a small proportion of cancers, but more patients received hemithyroidectomy when eligible.
Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment.
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.
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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Caulley L, Eskander A, Yang W, et al. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg. Published online November 24, 2021. doi:10.1001/jamaoto.2021.3277
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