ATA risk stratification in papillary thyroid microcarcinoma has low positive predictive value when identifying recurrence

Am J Surg. 2024 Mar:229:106-110. doi: 10.1016/j.amjsurg.2023.11.003. Epub 2023 Nov 2.

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.

Keywords: ATA risk stratification; Papillary thyroid microcarcinoma; Recurrence.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Carcinoma, Papillary*
  • Humans
  • Neoplasm Recurrence, Local* / epidemiology
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Thyroid Neoplasms* / diagnosis
  • Thyroid Neoplasms* / pathology
  • Thyroid Neoplasms* / surgery
  • Thyroidectomy

Supplementary concepts

  • Papillary Thyroid Microcarcinoma