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Prevalence of Contralateral Tumors in Patients with Follicular Variant of Papillary Thyroid Cancer
*Michael C Sullivan1, *Paul H Graham2, *Erik K Alexander1, *Daniel T Ruan1, Matthew Nehs1, Atul A Gawande1, Francis D Moore, Jr1, *Brooke Howitt1, *Kyle C Strickland1, *Jeffrey F Krane1, *Justine A Barletta1, *Nancy L Cho1
1Brigham and Women's Hospital, Boston, MA;2MD Anderson Cancer Center, Houston, TX

Objective: Growing evidence suggests that follicular variant of papillary thyroid cancer (fvPTC) represents a heterogeneous population of cancers ranging from indolent tumors to those with aggressive malignant potential. We sought to define the incidence of multifocal disease in fvPTC to improve decision making regarding the extent of surgical resection.
Design: Retrospective case series.
Setting: A single, urban, tertiary care center.
Patients: All patients who underwent thyroid surgery between October 2009 and February 2013 with final pathology demonstrating fvPTC as their primary lesion.
Main Outcome Measures: We collected information regarding patient demographics, nodule size, multifocality, fine needle aspiration (FNA) results, and histopathologic features including lymphovascular invasion (LVI), capsular invasion, extrathyroidal extension, and lymph node metastasis. Tumors were divided into noninvasive and invasive fvPTC categories. Characteristics of solitary and bilateral fvPTC were compared.
Results: We identified 124 patients with final pathology demonstrating fvPTC. The most common FNA diagnosis was “suspicious for malignancy” (n=53), followed by “malignant” (n=20), and “atypia/follicular lesion of undetermined significance” (n=19). Sixty-five contralateral tumors were identified in 44 patients (35.5%) and included fvPTC (n=40), classical PTC (n=22), tall cell PTC (n=2), and follicular cancer (n=1). Patients with contralateral disease were more likely to have LVI (p=0.037) and larger primary lesions (p=0.020). There was no significant difference noted in extrathyroidal extension, invasive histology, or lymph node metastasis. Both noninvasive and invasive fvPTC demonstrated similar rates of contralateral disease.
Conclusions: Bilateral disease is prevalent in noninvasive and invasive fvPTC. Larger tumor size and LVI correlate significantly with the presence of contralateral tumors. Completion thyroidectomy should be considered for patients with fvPTC and careful monitoring of the contralateral lobe performed for the development of potentially malignant nodules.


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