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Open access

Krishna Vikneson, Tariq Haniff, May Thwin, Ahmad Aniss, Alex Papachristos, Mark Sywak, and Anthony Glover


For small thyroid cancers (≤2 cm), tumour volume may better predict aggressive disease, defined by lymphovascular invasion (LVI) than a traditional single measurement of diameter. We aimed to investigate the relationship between tumour diameter, volume and associated LVI.


Differentiated thyroid cancers (DTC) ≤ 2 cm surgically resected between 2007 and 2016 were analysed. Volume was calculated using the formula for an ellipsoid shape from pathological dimensions. A ‘larger volume’ cut-off was established by receiver operating characteristic (ROC) analysis using the presence of lateral cervical lymph node metastasis (N1b). Logistic regression was performed to compare the ‘larger volume’ cut-off to traditional measurements of diameter in the prediction.


During the study period, 2405 DTCs were surgically treated and 523 met the inclusion criteria. The variance of tumour volume relative to diameter increased exponentially with increasing tumour size; the interquartile ranges for the volumes of 10, 15 and 20 mm diameter tumours were 126, 491 and 1225 mm3, respectively. ROC analysis using volume to predict N1b disease established an optimal volume cut-off of 350 mm3 (area under curve = 0.59, P = 0.02) as ‘larger volume’. ’Larger volume’ DTC was an independent predictor for LVI in multivariate analysis (odds ratio (OR) = 1.7, P = 0.02), whereas tumour diameter > 1 cm was not (OR = 1.5, P = 0.13). Both the volume > 350 mm3 and dimension > 1 cm were associated with greater than five lymph node metastasis and extrathyroidal extension.


In this study for small DTCs ≤ 2 cm, the volume of >350 mm3 was a better predictor of LVI than greatest dimension > 1 cm.

Open access

Benjamin J. Worrall, Alexander Papachristos, Ahmad Aniss, Anthony Glover, Stan B Sidhu, Roderick J. Clifton-Bligh, Diana Learoyd, Venessa Hm Tsang, Matti Gild, Bruce G Robinson, and Mark Sywak

Background: The 2015 American Thyroid Association Guidelines(Guidelines) permit thyroid lobectomy(TL) or total thyroidectomy(TT) in the management of low-risk papillary thyroid cancer(PTC). As definitive risk-stratification is only possible post-operatively, some patients may require completion thyroidectomy(CT) after final histopathological analysis.

Methods: A retrospective cohort study of patients undergoing surgery for low-risk PTC in a tertiary referral centre was undertaken. Consecutive adult patients treated from January 2013–March 2021 were divided into two groups (pre- and post-publication of Guidelines on 01/01/2016). Only those eligible for lobectomy under rule 35(B) of the Guidelines were included: Bethesda V/VI cytology, 1–4cm post-operative size, and without pre-operative evidence of extrathyroidal extension or nodal metastases. We examined rates of TL, CT, local recurrence and surgical complications.

Results: There were 1488 primary surgical procedures performed for PTC on consecutive adult patients during the study period, of which 461 were eligible for TL. Mean tumour size (p=0.20) and mean age(p=0.78) were similar between time-periods. The TL rate increased significantly from 4.5% to 18% in the post-publication period(p<0.001). The proportion of TL patients requiring CT(43% vs 38%) was similar between groups. The overall proportion of patients requiring CT increased significantly from 1.9% to 6.9% in the post-publication period(p=0.023). There was no significant change in complications(p=0.55) or local recurrence rates(p=0.24).

Conclusion: The introduction of the 2015 ATA guidelines resulted in a modest but significant increase in the rate of lobectomy for eligible PTC patients. In the post-publication period, 38% of patients who underwent TL ultimately required CT after complete pathological analysis.