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

Area of Science:

• Endocrinology
• Oncology
• Surgical Pathology

Background:

• Papillary thyroid microcarcinomas (PTMC) incidence is rising, raising concerns about overdiagnosis.
• The American Thyroid Association Risk Stratification System (ATA-RSS) 2015 is a tool used in thyroid cancer management.

Purpose of the Study:

• To assess the utility of the ATA-RSS 2015 in predicting disease recurrence in patients diagnosed with PTMC.
• To evaluate the performance of the ATA-RSS 2015 in identifying patients at risk for PTMC recurrence.

Main Methods:

• A retrospective analysis of electronic health records from patients who underwent total thyroidectomy.
• Application of the ATA-RSS 2015 criteria to patients with PTMC for risk stratification.
• Calculation of the validity of the ATA-RSS 2015 in predicting disease recurrence over a 10-year median follow-up period.

Main Results:

• Patients with high/intermediate ATA risk had significantly higher recurrence rates (33%) compared to low-risk patients (4%) (p=0.002).
• The ATA-RSS 2015 demonstrated high negative predictive value (96.6%) but low positive predictive value (33.3%) for recurrence detection.
• Excluding microscopic extrathyroidal extension (ETE) as an intermediate risk criterion improved the positive predictive value to 50% and accuracy to 92.5%.

Conclusions:

• The ATA-RSS 2015 is effective in predicting PTMC recurrence, particularly in ruling out recurrence (high NPV).
• Modifying the ATA-RSS 2015 by excluding microscopic ETE may enhance its positive predictive value, potentially aiding in the prevention of overtreatment for PTMC.