ATA risk stratification in papillary thyroid microcarcinoma has low positive predictive value when identifying recurrence - 26/02/24
Abstract |
Background |
Rising incidence of papillary thyroid microcarcinomas (PTMC) has raised concerns for overdiagnosis. Utility of the American Thyroid Association Risk Stratification System (ATA-RSS) 2015 in predicting risk of disease recurrence in patients with PTMC was assessed.
Methods |
Electronic health records of patients who underwent total thyroidectomy were queried. ATA-RSS 2015 risk stratification was performed on those with PTMC, and validity for predicting disease recurrence was calculated.
Results |
With 10-year median follow up, recurrence was higher in PTMC patients with high/intermediate vs low ATA risk (33 % vs 4 %, p = 0.002). Sensitivity of ATA-RSS for detecting recurrence was 60 %, specificity 90 %, PPV 33.3 %, NPV 96.6 %, and accuracy 88 %. When microscopic extrathyroidal extension (ETE) was excluded as an intermediate risk criterion, PPV improved to 50 % and accuracy improved to 92.5 %
Conclusions |
ATA-RSS 2015 predicts recurrence in PTMC with high NPV but low PPV. Exclusion of microscopic ETE improved PPV, which may help prevent overtreatment.
Le texte complet de cet article est disponible en PDF.Highlights |
• | High/intermediate ATA risk in PTMC had higher incidence of recurrence vs low risk. |
• | ATA-RSS 2015 had high negative predictive value, but low positive predictive value. |
• | Omission of microscopic ETE as intermediate risk criteria improved PPV of ATA-RSS. |
Keywords : Papillary thyroid microcarcinoma, ATA risk stratification, Recurrence
Plan
Vol 229
P. 106-110 - mars 2024 Retour au numéro
Article précédent
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