CSEM2408 - CSEM General Stream Oral Abstract Presentations - Lobectomy and Completion Thyroidectomy Rates after Prospective Implementation of Thyroid Lobectomy Guidelines and ThyroSPEC Molecular Testing

Blinded Abstract: Objective
We evaluated the impact of implementing guideline-based lobectomy criteria and ThyroSPEC molecular testing on lobectomy and completion thyroidectomy rates.
Methods
Thyroid cancer patients undergoing surgery in our region from July 2017 to October 2023 were included. Patients were categorized into total thyroidectomy (TTx), diagnostic lobectomy (DxL), therapeutic lobectomy (TxL), and completion thyroidectomy (CTx) groups. Lobectomy patients were reviewed to assess compliance with guideline-based criteria, CTx rates, and the impact of ThyroSPEC testing. Post-operative surgical complications and thyroid hormone replacement were also analyzed.
Results
Of 799 patients, 231 (29%) underwent lobectomy as initial surgery, with 57% DxL and 43% TxL. CTx rate was 44% among DxL patients and 26% among TxL patients. After ThyroSPEC testing implementation, CTx rates for DxL patients decreased significantly from 57% to 38%, and upfront TTx rate increased significantly from 33% to 46%. Approximately one-third of indeterminate nodules undergoing upfront TTx were due to malignant molecular markers or high-risk mutations. The surgical complication rate was 3 and 6% for initial lobectomy and 12% for CTx. Additionally, 44% of lobectomy patients required thyroid hormone replacement, with 77% requiring replacement if preoperative TSH exceeded 2 mIU/L.
Conclusions
Molecular testing has a direct benefit in guiding appropriate surgical selection. Implementation of lobectomy recommendations and ThyroSPEC testing resulted in increased upfront TTx rates and decreased post-lobectomy CTx rates. This translates to more patients receiving appropriate upfront surgeries, minimizing subsequent operations and reducing patient anxiety and healthcare costs.