Abstract
Background
Subtotal thyroidectomy or lobectomy without radioactive iodide (131I) treatment is sufficient for postoperative treatment of incidental papillary thyroid microcarcinoma (PTMC). Aggressive surgical treatment with 131I therapy is indicated for nonincidental PTMC.
Methods
This is a retrospective analysis of 335 PTMC patients who received primary thyroid surgical treatment and long-term follow-up in a single medical center. All PTMC patients were categorized as incidental (group I) or nonincidental (group II). Group II patients (209 cases) were categorized as intrathyroid (group II A), neck lymph node or local regional soft-tissue invasion (group II B) and distant metastasis (group II C) groups.
Results
In group I, 105 of 126 cases received only subtotal thyroidectomy or lobectomy. None died of thyroid cancer. Histological evaluation revealed multicentric PTMC in 12 (9.5%) and 52 (24.9%) cases (P < 0.05) in groups I and II, respectively. In group II, 55 of the 209 patients (26.3%) presented with extrathyroidal involvement. Two cases of relapse occurred in group I and 20 in group II by the end of follow-up. One patient in group II B and two patients in group II C died of thyroid cancer. Nine out of ten patients in group II C were diagnosed with distant metastases before primary thyroid surgical treatment.
Conclusion
Subtotal thyroidectomy is effective surgical treatment for incidental PTMC. For nonincidental cases, aggressive treatment is essential for reducing the risk of cancer relapse or mortality following surgery.
Similar content being viewed by others
References
Reynolds RM, Weir J, Stockton DL, et al. Changing trends in incidence and mortality of thyroid cancer in Scotland. Clin Endocrinol 2005; 62:156–62
Colonna M, Guizard AV, Schvartz C, et al. A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983–2000). Eur J Cancer 2007; 43:891–900
Roti E, Rossi R, Trasforini G, et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab 2006; 91:2171–8
Delellis RA, Lloyd RV, Heitx PU, et al. (2004) Pathology and genetics of tumors of endocrine organs. In: World Health Organization of Tumours. Lyon: IARC. pp 73–6
Sobin LH, UICC. (2002) Wittekind Ch (ed). TNM classification of malignant tumors, 6th edition. New York: Wiley-Liss. pp 52–6
Mitselou A, Vougiouklakis T, Peschos D, et al. Occult thyroid carcinoma. A study of 160 autopsy cases. The first report for the region of Epirus-Greece. Anticancer Res 2002; 22:427–32
de Matos PS, Ferreira AP, Ward LS. Prevalence of papillary microcarcinoma of the thyroid in Brazilian autopsy and surgical series. Endocr Pathol 2006; 17:165–73
Kovács GL, Gonda G, Vadász G, et al. Epidemiology of thyroid microcarcinoma found in autopsy series conducted in areas of different iodine intake. Thyroid 2005; 15:152–7
Martinez-Tello FJ, Martinez-Cabruja R, Fernandez-Martin J, et al. Occult carcinoma of the thyroid. A systematic autopsy study from Spain of two series performed with two different methods. Cancer 1993; 71:4022–9
Sakoratas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev 2005; 31:423–38
Mittendorf EA, Khiyami A, McHenry CR. When fine-needle aspiration biopsy cannot exclude papillary thyroid cancer: a therapeutic dilemma. Arch Surg 2006; 141:961–6
Pelizzo MR, Boschin IM, Toniato A, et al. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol 2006; 32:1144–8
Hay ID, Grant CS, Taylor WF, et al. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: A retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987; 102:1088–95
Lupoli G, Vitale G, Caraglia M, et al. Familial papillary thyroid microcarcinoma: a new clinical entity. Lancet 1999; 353:637–9
Yamashita H, Noguchi S, Murakami N, et al. Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer 1999; 86:842–9
Schönberger J, Marienhagen J, Agha A, et al. Papillary microcarcinoma and papillary cancer of the thyroid < or=1 cm: modified definition of the WHO and the therapeutic dilemma. Nuklearmedizin 2007; 46:115–20
Furlan JC, Bedard Y, Rosen IB. Biologic basis for the treatment of microscopic, occult well-differentiated thyroid cancer. Surgery 2001; 130:1050–4
Lin KD, Lin JD, Huang HS, et al. Skull metastasis with brain invasion from thyroid papillary microcarcinoma: report of a case. J Formos Med Assoc 1997; 96:280–2
Erdem T, Miman MC, Oncel S, et al. Metastatic spread of occult papillary carcinoma of the thyroid to the parapharyngeal space: a case report. Kulak Burun Bogaz Ihtis Derg 2003; 10:244–7
Hefer T, Joachims HZ, Hashmonai M, et al. Highly aggressive behaviour of occult papillary thyroid carcinoma. J Laryngol Otol 1995; 109:1109–12
Cappelli C, Castellano M, Braga M, et al. Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 2007; 95:555–60
Lee J, Rhee Y, Lee S, et al. Frequent, aggressive behaviors of thyroid microcarcinomas in korean patients. Endocr J 2006; 53:627–32
Hagag P, Hod N, Kummer E, et al. Follicular variant of papillary thyroid carcinoma: clinical-pathological characterization and long-term follow-up. Cancer J 2006; 12:275–82
Chang HY, Lin JD, Chou SC, et al. Clinical presentations and outcomes of surgical treatment of follicular variant of the papillary thyroid carcinomas. Jpn J Clin Oncol 2006; 36:688–93
Lupi C, Giannini R, Ugolini C, et al. Association of BRAF V600E mutation with poor clinicopathological outcomes in 500 consecutive cases of papillary thyroid carcinoma. J Clin Endocrinol Metab 2007; 92:4085–90
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lin, JD., Kuo, SF., Chao, TC. et al. Incidental and Nonincidental Papillary Thyroid Microcarcinoma. Ann Surg Oncol 15, 2287–2292 (2008). https://doi.org/10.1245/s10434-008-9958-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-008-9958-2