Surgical Management of Indeterminate Thyroid Nodules across Different World Regions: Results from a Retrospective Multicentric (the MAIN-NODE) Study
Author:
Canu Gian Luigi1, Cappellacci Federico1ORCID, Abdallah Ahmed2ORCID, Elzahaby Islam2, Figueroa-Bohorquez David3ORCID, Lori Eleonora4ORCID, Miller Julie A.5, Pavia Sergio Zúñiga3, Pinillos Pilar3, Pongtippan Atcharaporn6, Saleh Saleh Saleh2, Sorrenti Salvatore4ORCID, Sriphrapradang Chutintorn7ORCID, Calò Pietro Giorgio1ORCID, Medas Fabio1ORCID
Affiliation:
1. Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy 2. Surgical Oncology, Mansoura University, Mansoura 35516, Egypt 3. Head and Neck Surgery, Hospital Universitario Nacional de Colombia, Bogotá 250247, Colombia 4. Department of Surgery, “Sapienza” University of Rome, 00185 Rome, Italy 5. The Royal Melbourne Hospital and Epworth Hospital, Melbourne, VIC 3121, Australia 6. Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand 7. Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Abstract
Indeterminate thyroid nodules (ITNs) are characterized by an expected malignancy ranging from 5% to 30%, with most patients undergoing a diagnostic, rather than therapeutic, operation. The aim of our study was to compare the approach to ITNs across different regions of the world. In this retrospective, multicentric, international study, according to the WHO classification, we identified the South East Asian Region (SEAR), the Americas Region (AMR), the Eastern Mediterranean Region (EMR), the Europe Region (EUR), and the Western Pacific Region (WPR). One high-volume thyroid centre was included for each region. Demographic, preoperative, and pathologic data were compared among the different regions. Overall, 5737 patients from five high-volume thyroid centres were included in this study. We found that the proportion of ITNs over the global activity for thyroid disease was higher in the EUR (37.6%) than in the other regions (21.1–23.6%). In the EMR, the patients were significantly younger (with a mean of 43.1 years) than in the other regions (range, 48.8–57.4 years). The proportion of lobectomy was significantly higher in the WPR, where 83.2% (114/137) of patients received this treatment, than in the other regions, where lobectomies were performed in 44.1–58.1% of patients. The pathological diagnosis of malignancy was significantly higher in the SEAR centre, being over 60%, than in centres of the other regions, where it ranged from 26.3% to 41.3%. The occurrence of lymph node metastases was higher in the WPR (27.8%), AMR (26.9%), and EMR (20%) centres than in the EUR and SEAR centres, where it was lower than 10%. In summary, we found in our study different approaches and outcomes in the diagnosis and treatment of ITNs among countries. Overall, almost 60% of patients with ITNs who underwent surgery actually presented a benign disease, potentially undergoing an unnecessary operation.
Subject
Cancer Research,Oncology
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