Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board.
Preoperative Molecular Testing Helps Predict Initial Surgical Management Needs in Thyroid Nodules
Molecular testing is commonly employed in patients with thyroid nodules that display indeterminate cytology; the aim of this study was to determine whether molecular testing has value for prognostication in patients with suspicious or malignant cytology.
The authors reported a retrospective, single-institution analysis of 105 patients; the outcomes of interest were disease persistence or recurrence, frequency of distant metastasis, and recurrence-free survival. The median follow-up interval was 3.8 years. Molecular testing disclosed low or intermediate risk in 94% of patients; high-risk molecular testing patterns were identified in 6% of patients.
Disease recurrence and distant metastasis were common in the high-risk group despite routine use of total thyroidectomy and radioactive iodine treatment. Local disease recurrence was documented in six of 88 patients in the intermediate risk group; one patient developed distant metastasis.
Because of the low risk of local disease recurrence and distant metastasis in patients with low- or intermediate-risk molecular testing patterns, patients in these groups may achieve adequate oncologic control with thyroid lobectomy rather than total thyroidectomy with radioactive iodine treatment.
Targeted Axillary Dissection Is Safe and Effective for Node-Positive Breast Cancer
Kuemmel S, Heil J, Bruzas S, et al. Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients with Node-Positive Breast Cancer. JAMA Surg. 2023;158(8): 807-815.
Pichardo MS, Zhang JQ, and Fayanju OM. Will Targeted Axillary Surgery Suffice for Adjuvant Treatment Decision-Making? JAMA Surg. Published online July 19, 2023.
Increasing use of neoadjuvant systemic therapy in patients with node-positive early breast cancer has resulted in a concomitant increase in rates of pathologic complete response; complete axillary lymph node dissection may not be necessary in patients with pathologic complete response. Use of targeted axillary dissection (marking followed by excision of suspicious nodes) could potentially avoid complications of complete axillary dissection while obtaining satisfactory oncologic outcomes.
The authors of this study sought to determine 3-year outcomes in patients (n = 199) who underwent treatment for node positive breast cancer. The reported study was a prospective registry analysis conducted in 50 centers in Germany; targeted axillary dissection was employed in 119 patients who presented with at least three clinically suspicious axillary nodes, and 80 patients underwent complete axillary dissection.
Disease-free survival approached 90% in both patient groups; axillary recurrence rates were less than 2% in both groups. The authors concluded that targeted axillary dissection was a safe and effective approach in patients with a good response to systemic therapy and at least three clinically positive axillary nodes.
