Skip to main content

Advertisement

SpringerLink
Log in

Clinical impact of microscopic extrathyroidal extension in patients with papillary thyroid microcarcinoma treated with hemithyroidectomy

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Background

Pathologically confirmed microscopic extrathyroidal extension (ETE) is often identified after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). Without the presence of microscopic ETE, these patients would be optimal candidates for hemithyroidectomy.

Aim

The present study aimed at evaluating the clinical impact of microscopic ETE on the recurrence of PTMC treated with hemithyroidectomy.

Subjects and methods

We compared the clinicopathological characteristics and 5-year outcomes for 262 PTMC patients without ETE and 86 with microscopic ETE who were treated with hemithyroidectomy between January 2004 and December 2010.

Results

The mean tumour size was larger (0.67 vs. 0.54 cm, p < 0.001) and the proportion of tumours measuring ≥0.5 cm was higher (84.9 vs. 66.8 %, p = 0.001) in patients with microscopic ETE as compared with patients without ETE. Occult multifocal disease was more frequent in patients with microscopic ETE than in those without ETE (14.0 vs. 6.5 %, p = 0.030). However, the recurrence rate was not different between the two groups during the mean 55.8-month follow-up period. In addition, univariate and multivariate analyses revealed no meaningful association between recurrence and microscopic ETE in patients with PTMC treated with hemithyroidectomy.

Conclusions

Although microscopic ETE was associated with large tumour size and multifocal disease, its clinical impact on disease recurrence was not significant in PTMC patients treated with hemithyroidectomy. Therefore, microscopic ETE identified after hemithyroidectomy would not be an absolute indication for completion thyroidectomy in patients with PTMC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP (1995) Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg 170:467–470

    Article  CAS  PubMed  Google Scholar 

  2. Ortiz S, Rodriguez JM, Soria T et al (2001) Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg 124:261–265

    Article  CAS  PubMed  Google Scholar 

  3. Jung SP, Kim M, Choe JH, Kim JS, Nam SJ, Kim JH (2013) Clinical implication of cancer adhesion in papillary thyroid carcinoma: clinicopathologic characteristics and prognosis analyzed with degree of extrathyroidal extension. World J Surg 37:1606–1613

    Article  PubMed  Google Scholar 

  4. Arora N, Turbendian HK, Scognamiglio T et al (2008) Extrathyroidal extension is not all equal: Implications of macroscopic versus microscopic extent in papillary thyroid carcinoma. Surgery 144:942–947 (discussion 947–948)

    Article  PubMed  Google Scholar 

  5. Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY (2011) Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol 18:1916–1923

    Article  PubMed  Google Scholar 

  6. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474

    Article  PubMed  Google Scholar 

  7. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

  8. Kim E, Park JS, Son KR, Kim JH, Jeon SJ, Na DG (2008) Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid 18:411–418

    Article  CAS  PubMed  Google Scholar 

  9. Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878

    Article  PubMed  Google Scholar 

  10. Besic N, Pilko G, Petric R, Hocevar M, Zgajnar J (2008) Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol 97:221–225

    Article  PubMed  Google Scholar 

  11. Lim DJ, Baek KH, Lee YS et al (2007) Clinical, histopathological, and molecular characteristics of papillary thyroid microcarcinoma. Thyroid 17:883–888

    Article  CAS  PubMed  Google Scholar 

  12. Mercante G, Frasoldati A, Pedroni C et al (2009) Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid 19:707–716

    Article  CAS  PubMed  Google Scholar 

  13. Li X, Zhao C, Hu D et al (2013) Hemithyroidectomy increases the risk of disease recurrence in patients with ipsilateral multifocal papillary thyroid carcinoma. Oncol Lett 5:1412–1416

    PubMed Central  PubMed  Google Scholar 

  14. Bilimoria KY, Bentrem DJ, Ko CY et al (2007) Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 246:375–381 (discussion 381–384)

    Article  PubMed  Google Scholar 

  15. Yu GP, Schantz SP (2009) Extent of surgery affects papillary thyroid cancer. Ann Surg 249:549–550 (author reply 550)

    Article  PubMed  Google Scholar 

  16. Gershinsky M, Barnett-Griness O, Stein N et al (2012) Total versus hemithyroidectomy for microscopic papillary thyroid cancer. J Endocrinol Invest 35:464–468

    CAS  PubMed  Google Scholar 

  17. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid—prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40

    Article  PubMed  Google Scholar 

  18. Ahn D, Heo SJ, Park JH et al (2011) Clinical relationship between Hashimoto’s thyroiditis and papillary thyroid cancer. Acta Oncol 50:1228–1234

    Article  PubMed  Google Scholar 

  19. Kim EY, Kim WG, Kim WB et al (2009) Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clin Endocrinol (Oxf) 71:581–586

    Article  Google Scholar 

  20. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803

    Article  CAS  PubMed  Google Scholar 

  21. McGriff NJ, Csako G, Gourgiotis L, Lori CG, Pucino F, Sarlis NJ (2002) Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med 34:554–564

    Article  CAS  PubMed  Google Scholar 

  22. Sugitani I, Fujimoto Y (2010) Does postoperative thyrotropin suppression therapy truly decrease recurrence in papillary thyroid carcinoma? A randomized controlled trial. J Clin Endocrinol Metab 95:4576–4583

    Article  CAS  PubMed  Google Scholar 

  23. Ahmadieh H, Azar ST (2012) Controversies in the management and followup of differentiated thyroid cancer: beyond the guidelines. J Thyroid Res 2012:512401

    Article  PubMed Central  PubMed  Google Scholar 

  24. Cristofanilli M, Yamamura Y, Kau SW et al (2005) Thyroid hormone and breast carcinoma. Primary hypothyroidism is associated with a reduced incidence of primary breast carcinoma. Cancer 103:1122–1128

    Article  CAS  PubMed  Google Scholar 

  25. Hercbergs AH, Ashur-Fabian O, Garfield D (2010) Thyroid hormones and cancer: clinical studies of hypothyroidism in oncology. Curr Opin Endocrinol Diabetes Obes 17:432–436

    Article  CAS  PubMed  Google Scholar 

  26. Schmidinger M, Vogl UM, Bojic M et al (2011) Hypothyroidism in patients with renal cell carcinoma: blessing or curse? Cancer 117:534–544

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors D. Ahn, J.H. Sohn, J.H. Jeon, and J.Y. Jeong declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea

    D. Ahn & J. H. Sohn

  2. Department of Endocrinology, School of Medicine, Kyungpook National University, Daegu, Korea

    J. H. Jeon

  3. Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea

    J. Y. Jeong

  4. Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University Medical Centre, 807 Hogukno, Buk-gu, Daegu, 702-210, Korea

    J. H. Sohn

Authors
  1. D. Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. H. Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. H. Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Y. Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. H. Sohn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahn, D., Sohn, J.H., Jeon, J.H. et al. Clinical impact of microscopic extrathyroidal extension in patients with papillary thyroid microcarcinoma treated with hemithyroidectomy. J Endocrinol Invest 37, 167–173 (2014). https://doi.org/10.1007/s40618-013-0025-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-013-0025-x

Keywords

Search

Navigation