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Positive Surgical Margins in Favorable-Stage Differentiated Thyroid Cancer

Mercado, Catherine E., MD*; Drew, Peter A., MD; Morris, Christopher G., MS*; Dziegielewski, Peter T., MD, FRCS(C); Mendenhall, William M., MD*; Amdur, Robert J., MD*

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1168–1171
doi: 10.1097/COC.0000000000000444
Original Articles: Endocrine

Objective: The significance of positive margin in favorable-stage well-differentiated thyroid cancer is controversial. We report outcomes of positive-margin patients with a matched-pair comparison to a negative-margin group.

Materials and Methods: A total of 25 patients with classic-histology papillary or follicular carcinoma, total thyroidectomy +/− node dissection, stage T1-3N0-1bM0, positive surgical margin at primary site, adjuvant radioactive iodine (I-131), and age older than 18 years were treated between 2003 and 2013. Endpoints were clinical and biochemical (thyroglobulin-only) recurrence-free survival. Matched-pair analysis involved a 1:1 match with negative-margin cases matched for overall stage and I-131 dose.

Results: Recurrence-free survival in positive-margin patients was 71% at 10 years. No patient was successfully salvaged with additional treatment. Only 1 patient died of thyroid cancer. Recurrence-free survival at 10 years was worse with a positive (71%) versus negative (90%) margin (P=0.140).

Conclusions: Cure with a microscopically positive margin was suboptimal (71%) despite patients having classic-histology papillary and follicular carcinoma, favorable stage, and moderate-dose I-131 therapy.

Departments of *Radiation Oncology

Pathology

Head and Neck Surgery, University of Florida College of Medicine, Gainesville, FL

The authors declare no conflicts of interest.

Reprints: Robert J. Amdur, MD, 2000 SW Archer Road, P.O. Box 100385, Gainesville, FL 32610-0385. E-mail: amdurr@shands.ufl.edu.

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