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Surgical treatment of thyroid follicular neoplasms: results of a retrospective analysis of a large clinical series

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Abstract

The most appropriate surgical management of “follicular neoplasm/suspicious for follicular neoplasm” lesions (FN), considering their low definitive malignancy rate and the limited predictive power of preoperative clinic-diagnostic factors, is still controversial. On behalf of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB), we collected and analyzed the experience of 26 endocrine centers by computerized questionnaire. 1379 patients, surgically treated after a FN diagnosis from January 2012 and December 2103, were evaluated. Histological features, surgical complications, and medium-term outcomes were reported. Total thyroidectomy (TT) was performed in 1055/1379 patients (76.5 %), while hemithyroidectomy (HT) was carried out in 324/1379 cases (23.5 %). Malignancy rate was higher in TT than in HT groups (36.4 vs. 26.2 %), whereas the rates of transient and definitive hypoparathyroidism following TT were higher than after HT. Consensual thyroiditis (16.8 vs. 9.9 %) and patient age (50.9 vs. 47.9 %) also differed between groups. A cytological FN diagnosis was associated to a not negligible malignancy rate (469/1379 patients; 34 %), that was higher in TT than in HT groups. However, a lower morbidity rate was observed in HT, which should be considered the standard of care in solitary lesions in absence of specific risk factors. Malignancy could not be preoperatively assessed and clinical decision-making is still controversial. Further efforts should be spent to more accurately preoperatively classify FN thyroid nodules.

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Acknowledgments

We thank all the individuals who contributed samples and the physicians and nursing staff who helped with recruitment worldwide. We thank Laura Falvo (Osp. San Giovanni Evangelista UOC Chirurgia Generale), Silvia Trombetta (AO San Camillo Forlanini UOC Chirurgia Generele I), Giuliano Perigli (AOU Careggi Chirurgia Gen. e End.), Paolo Del Rio (Un.Parma UO Chirurgia Gen. e Tr.Org.), Gian Luca Ansaldo (IRCCS AOU San Martino Genova UOS Chirurgia Endocrina), Angela Gurrado (Un. A. Moro Bari Uo Chirurgia Endocrina Digestive e d’Urgenza), Loredana De Pasquale (AOU Careggi Chirurgia Gen. e End. San Paolo Milano Sez. Chirurgia Endocrina e Senologica), Roberto Panconesi (Chirurgia Generale e d’Urgenza Careggi), Micaela Piccoli (Nuovo Osp. S.Agostino Modena UOS Endocrinochirurgia), Cesario Villano (AORN S.Anna e S.Sebastiano Caserta), Maria Rosa Pelizzo (AOU Padova Clinica Chirurgica II Ref. Torresan F.), Ennio Leopaldi (Resp. UOS Chir. Endocrina Chirurgia Generale II Az. Osp Polo Universitario L.Sacco Milano), Antonio De Carlo (Osp. S.Paolo Civitavecchia UOC Chir. Gen. e Mininv.), Luigi La Manna (IRCCS Fondazione Salvatore Maugeri UO Chir. Gen.), Andrea Polistena (Azienda Osp.S.Maria Terni Un.Perugia UO Chirurgia Generale e Specialità Chirurgiche), Anselmo Arlandini (Centro Tiroide UOC Chirurgia Generale ed Epatobiliopancreatica EO Ospedali Galliera), Nadia Innaro (UOC Endocrinochirurgia Pol.Un.Mater Domini Catanzaro), Francesco Tartaglia (PRGM Dipartimento Sc.Chirur. Un. La Spezia), Michele D’Ajello (Az.Osp. Santa Maria Terni UOSD Chirurgia Tiroide e Paratiroidea), Francesco Caruso (Humanitas Centro Catanese di Oncologia ORL), Tommaso Marzano (Divisione di Chirurgia Generale, Ospedale di Fossano Cuneo), Roberto Ruggiero (AOU SUN XI Chirurgia Generale e dell’Obesità Napoli), Luca Cozzaglio (IRCCS Humanitas Rozzano Chirurgia Oncologica), Ilia Pisano (Patologia Chirurgica Un. Sassari), Milena Freddi (Osp. Le Molinette Torino), Pasquale Sperlongano (AOU SUN X Chirurgia Generale Napoli), Serenella Ristagno (U.O. di Chirurgia Generale a indirizzo Oncologico “A.Gemelli”-O.C. “S. Vincenzo”—Taormina, Sicilia), and Marco Boniardi (Divisione Chirurgia Generale A. Ponti, Ospedale Niguarda Cà Granda, Milano) for their contributions in this study.

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Authors and Affiliations

  1. Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, Second University of Naples, Via Gen.G.Orsini 42, 80132, Naples, Italy

    Giovanni Conzo, Giovanni Docimo, Claudio Gambardella, Giuseppe Siciliano & Ernesto Tartaglia

  2. Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy

    Nicola Avenia

  3. Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy

    Nicola Avenia

  4. Dipartimento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, Cattedra di Chirurgia Generale, Università degli Studi di Genova, Genoa, Italy

    Gian Luca Ansaldo

  5. Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Monserrato, Italy

    Piergiorgio Calò

  6. General Surgery and Endocrine Surgical Unit, AORN A. Cardarelli, Naples, Italy

    Maurizio De Palma & Marica Grasso

  7. UCO Chirurgia Generale, Cattinara Teaching Hospital, Strada di Fiume, 34100, Trieste, Italy

    Chiara Dobrinja

  8. Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Celestino Pio Lombardi

  9. Clinica Chirurgica 2, University School of Padova, Padova University, Padua, Italy

    Maria Rosa Pelizzo

  10. Department of Emergency and Oral Transplantation-DETO, Bari University Hospital Policlinico, Bari, Italy

    Angela Pezzolla

  11. Thyroid and Parathyroid Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, Naples, Italy

    Luciano Pezzullo

  12. Chirurgia Generale d’Urgenza e Nuove Tecnologie - NOCSAE di Modena, Modena, Italy

    Micaela Piccoli

  13. Department of General Surgery, Ivrea Hospital, Ivrea, Italy

    Lodovico Rosato

  14. Ultrasound Guided and Neck Pathologies Surgery Operative Unit, Department of Surgery, S. Maria del Popolo degli Incurabili ASLNA1 Hospital, Naples, Italy

    Stefano Spiezia

  15. Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy

    Francesco Tartaglia

  16. Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari, Italy

    Mario Testini

  17. Department of Biomorphologic and Functional Sciences, “Federico II” University of Naples, Naples, Italy

    Giancarlo Troncone

  18. Department of Mental Health and Preventive Medicine, Second University of Naples, Caserta, Italy

    Giuseppe Signoriello

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  1. Giovanni Conzo
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  2. Nicola Avenia
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  3. Gian Luca Ansaldo
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  4. Piergiorgio Calò
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  5. Maurizio De Palma
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  6. Chiara Dobrinja
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  7. Giovanni Docimo
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  8. Claudio Gambardella
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  9. Marica Grasso
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  10. Celestino Pio Lombardi
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  11. Maria Rosa Pelizzo
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  12. Angela Pezzolla
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  13. Luciano Pezzullo
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  14. Micaela Piccoli
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  15. Lodovico Rosato
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  16. Giuseppe Siciliano
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  17. Stefano Spiezia
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Corresponding author

Correspondence to Giovanni Conzo.

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Informed consent was obtained from all individual participants included in this study.

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Conzo, G., Avenia, N., Ansaldo, G.L. et al. Surgical treatment of thyroid follicular neoplasms: results of a retrospective analysis of a large clinical series. Endocrine 55, 530–538 (2017). https://doi.org/10.1007/s12020-016-0953-2

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  • DOI: https://doi.org/10.1007/s12020-016-0953-2

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