Journal of surgical oncology · 2026
Preoperative and Intraoperative Assessment of Extrathyroidal Extension in Unilateral Papillary Thyroid Carcinoma: Does It Necessitate Total Thyroidectomy?
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Fei Kuangyu, Bin Zhang, Song Yuntao
Аннотация
BACKGROUND: The optimal surgical extent for papillary thyroid carcinoma (PTC) with extrathyroidal extension (ETE) suspected on ultrasound or intraoperative exploration remains debated. This study evaluated the diagnostic accuracy of clinical ETE (cETE) assessment and compared oncologic outcomes after lobectomy between cETE-positive and cETE-negative patients.
METHODS: This single-center retrospective study enrolled 213 patients with PTC who underwent lobectomy. cETE was defined as tumor extension beyond the thyroid capsule on preoperative ultrasound or intraoperative exploration. Pathologically confirmed ETE served as the gold standard for determining the sensitivity, specificity, and accuracy of both ultrasound and intraoperative ETE assessments. Recurrence-free survival was compared between groups by different ETE features.
RESULTS: Preoperative/intraoperative ETE assessments exhibited limited sensitivity (12.3% and 33.6%), limited accuracy (49.3% and 55.9%), and high specificity (98.9% and 85.7%). With a mean follow-up duration of 63.5 ± 11.7 months, the recurrence rates were recorded at 1.6% (1/61) in Group cETE+ in comparison to 2.0% (3/152) in Group cETE- (p = 0.871).
CONCLUSION: Clinical ETE assessment has limited accuracy but high specificity. Lobectomy offers comparable oncologic outcomes regardless of cETE status, supporting its feasibility in selected PTC patients without mandating total thyroidectomy.
METHODS: This single-center retrospective study enrolled 213 patients with PTC who underwent lobectomy. cETE was defined as tumor extension beyond the thyroid capsule on preoperative ultrasound or intraoperative exploration. Pathologically confirmed ETE served as the gold standard for determining the sensitivity, specificity, and accuracy of both ultrasound and intraoperative ETE assessments. Recurrence-free survival was compared between groups by different ETE features.
RESULTS: Preoperative/intraoperative ETE assessments exhibited limited sensitivity (12.3% and 33.6%), limited accuracy (49.3% and 55.9%), and high specificity (98.9% and 85.7%). With a mean follow-up duration of 63.5 ± 11.7 months, the recurrence rates were recorded at 1.6% (1/61) in Group cETE+ in comparison to 2.0% (3/152) in Group cETE- (p = 0.871).
CONCLUSION: Clinical ETE assessment has limited accuracy but high specificity. Lobectomy offers comparable oncologic outcomes regardless of cETE status, supporting its feasibility in selected PTC patients without mandating total thyroidectomy.