Documentation of the pyramidal lobe in pathology, operative, and imaging reports after thyroid surgery: a retrospective cross-sectional study of 10,871 patients
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: The pyramidal lobe is a common anatomic structure, and residual pyramidal-lobe tissue can complicate interpretation of postoperative thyroglobulin and radioactive iodine findings and can leave a thyroidectomy anatomically incomplete. How consistently the structure is named in routine clinical reports is unknown. We aimed to quantify pyramidal-lobe documentation across pathology, operative, and imaging reports and to identify factors associated with documentation. Methods: We performed a retrospective cross-sectional analysis of routinely collected records for all consecutive adults (aged ≥18 years) who underwent thyroid surgery at a single academic center between January 1, 1993, and May 31, 2025 (n=10,871), each contributing one patient-level record. Documentation was defined as an unambiguous mention of pyramidal-lobe thyroid tissue and was ascertained by electronic text search with manual confirmation of every flagged report under prespecified rules; descriptive surrogates were not accepted. Four sources were assessed: narrative pathology reports, structured pathology measurement fields, operative notes, and preoperative computed tomography (CT)/magnetic resonance imaging (MRI)/nuclear medicine reports; the denominator for every rate is stated explicitly. Routine diagnostic thyroid ultrasound was analyzed separately (6,131 patients with an available report) and was not part of the primary outcome. Pyramidal lobes not named in the record were not assumed to be absent, and cases suggesting pyramidal-lobe disease were individually adjudicated. Multivariable logistic regression with prespecified covariates estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Mean age was 51.5 years, 77.8% were female, 51.1% underwent total thyroidectomy, 36.6% had malignant histology, and 5.3% had Graves disease. The pyramidal lobe was documented in 959 of 10,871 patients (8.8%): narrative pathology reports 884 (8.1%), structured pathology fields 193 (1.8%), operative notes 46 (0.4%), and preoperative CT/MRI/nuclear medicine reports 40 (0.4%). Sources rarely overlapped, and no patient was documented in all four. Among 6,131 routine ultrasound reports, the pyramidal lobe was named in 8 (0.13%) and never measured, whereas the isthmus was named in 58.3%. Adjudication confirmed pyramidal-lobe disease in 21 patients (0.19%; 6 carcinoma, 15 focal benign). In adjusted analysis, documentation was more likely with total thyroidectomy (OR 3.31; 95% CI: 2.77-3.96), Graves disease (OR 1.86; 95% CI: 1.42-2.43), and papillary (OR 3.05; 95% CI: 2.57-3.61), follicular (OR 2.61; 95% CI: 1.87-3.63), medullary (OR 3.22; 95% CI: 2.08-4.99), and poorly differentiated or high-grade carcinoma (OR 4.13; 95% CI: 1.88-9.10) relative to benign disease. Malignant histology was not associated with structured measurement documentation. Conclusions: In this cross-sectional analysis, pyramidal-lobe documentation was uncommon and depended on which report source was examined. These findings identify a documentation gap; they do not establish that increasing documentation changes postoperative outcomes. Standardized reporting fields, local audit, and multidisciplinary agreement on when documentation is clinically relevant are candidate interventions for prospective evaluation.
Source: Gland Surgery
Institution: Emory University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221796528