Objective: In the eighth edition of the American Joint Committee on Cancer tumor–node–metastasis staging system, gross extrathyroidal extension (ETE) into the strap muscles is classified as T3b when identified during surgery. In clinical practice, this invasion is primarily assessed intraoperatively by the surgeon and documented in the operative report, forming the basis of the final T3b staging. Because this evaluation is inherently subjective, its diagnostic accuracy remains uncertain. This study evaluated the accuracy of intraoperative gross ETE assessment and whether misclassification affects recurrence outcomes. Methods: In total, 4987 patients who underwent thyroidectomy at Seoul St. Mary’s Hospital during 2017–2022 were analyzed. Patients were categorized by concordance between intraoperative findings and final pathology: confirmed gross ETE (Group A), intraoperative overestimation (Group B), and intraoperative underestimation (Group C). Clinical characteristics, recurrence rates, and predictors of inaccurate assessment were compared. Results: Of the cohort, 179 patients (3.6%) were judged intraoperatively to have gross ETE, classified as Group A (141 patients), Group B (38), and Group C (33). Recurrence rates were not significantly different among groups (6.4%, 2.6%, and 3.0% in Groups A, B, and C, respectively). Other than lymphatic invasion and tumor size, baseline characteristics were comparable among groups. Multivariate analysis identified age (odds ratio [OR]: 0.961; 95% confidence interval [CI]: 0.932–0.990;p= 0.009), tumor location (OR: 0.182; 95% CI: 0.056–0.591;p= 0.005), and lymphatic invasion (OR: 0.292; 95% CI: 0.118–0.719;p= 0.007) as independent predictors of inaccurate intraoperative evaluation. Conclusions: Among 179 patients suspected of gross ETE intraoperatively, 21.2% showed no muscle invasion on pathology. Although recurrence rates were similar across groups, recurrence-free survival tended to be lower in Group A relative to Group B, indicating the potential prognostic relevance of accurate intraoperative T3b identification. Long-term follow-up is needed to confirm this trend.
目的：在美国癌症联合委员会第八版肿瘤-淋巴结-转移分期系统中，术中发现甲状腺癌肉眼可见侵犯带状肌被归类为T3b期。临床实践中，这种侵犯主要依靠外科医生术中评估并在手术记录中记载，构成最终T3b分期的依据。由于该评估具有主观性，其诊断准确性尚不明确。本研究旨在评估术中肉眼可见甲状腺外侵犯评估的准确性，以及错误分类是否影响复发结局。 方法：对2017-2022年间在首尔圣玛丽医院接受甲状腺切除术的4987例患者进行分析。根据术中发现与最终病理结果的一致性将患者分组：确诊肉眼侵犯组（A组）、术中高估组（B组）和术中低估组（C组）。比较各组临床特征、复发率及评估不准确的预测因素。 结果：队列中179例患者（3.6%）术中判定存在肉眼侵犯，分为A组（141例）、B组（38例）和C组（33例）。各组复发率无显著差异（A、B、C组分别为6.4%、2.6%和3.0%）。除淋巴侵犯和肿瘤大小外，各组基线特征具有可比性。多变量分析显示年龄（比值比[OR]：0.961；95%置信区间[CI]：0.932-0.990；p=0.009）、肿瘤位置（OR：0.182；95% CI：0.056-0.591；p=0.005）和淋巴侵犯（OR：0.292；95% CI：0.118-0.719；p=0.007）是术中评估不准确的独立预测因素。 结论：在179例术中怀疑肉眼侵犯的患者中，21.2%病理学未显示肌肉侵犯。尽管各组复发率相似，但A组无复发生存率较B组呈降低趋势，提示准确的术中T3b分期可能具有预后意义。需长期随访以验证此趋势。
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