Skip to main content

Abstract

Papillary thyroid microcarcinomas are on the rise. Debate exists whether this is a real increase or whether it represents an increase in diagnostic scrutiny. There is significant evidence that suggests that this increase in incidence is associated with an increase in diagnostic scrutiny. Therefore, we need to examine how we manage this disease, which in most cases is indolent. Molecular markers will likely, one day, aid in the decision-making of which neoplasms need to be aggressively treated and which may be actively observed. At present, it is safe and effective to manage papillary thyroid microcarcinomas (PTMCs) conservatively, with active surveillance only, for appropriate patients, following the use of a risk-stratified, evidence-based approach. With the increased use of diagnostic modalities in the primary care setting, an in-depth understanding of the natural history of PTMC is important in the management of this now common—however, rarely deadly—clinical entity.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7.

    Article  CAS  PubMed  Google Scholar 

  2. Ahn HS, Kim HJ, Welch HG. Korea’s thyroid-cancer “epidemic”--screening and overdiagnosis. N Engl J Med. 2014;371(19):1765–7.

    Article  PubMed  Google Scholar 

  3. Colonna M, 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(5):891–900.

    Article  CAS  PubMed  Google Scholar 

  4. Rego-Iraeta A, et al. Time trends for thyroid cancer in northwestern Spain: true rise in the incidence of micro and larger forms of papillary thyroid carcinoma. Thyroid. 2009;19(4):333–40.

    Article  PubMed  Google Scholar 

  5. Black WC, Welch HG. Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy. N Engl J Med. 1993;328(17):1237–43.

    Article  CAS  PubMed  Google Scholar 

  6. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605–13.

    Article  PubMed  Google Scholar 

  7. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140(4):317–22.

    Article  PubMed  Google Scholar 

  8. Vanderlaan WP. The occurrence of carcinoma of the thyroid gland in autopsy material. N Engl J Med. 1947;237(7):221.

    Article  CAS  PubMed  Google Scholar 

  9. Bondeson L, Ljungberg O. Occult thyroid carcinoma at autopsy in Malmo. Swed Cancer. 1981;47(2):319–23.

    Article  CAS  Google Scholar 

  10. Sobrinho-Simoes MA, Sambade MC, Goncalves V. Latent thyroid carcinoma at autopsy: a study from Oporto. Port Cancer. 1979;43(5):1702–6.

    Article  CAS  Google Scholar 

  11. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531–8.

    Article  CAS  PubMed  Google Scholar 

  12. Neuhold N, et al. Incidental papillary microcarcinoma of the thyroid--further evidence of a very low malignant potential: a retrospective clinicopathological study with up to 30 years of follow-up. Ann Surg Oncol. 2011;18(12):3430–6.

    Article  PubMed  Google Scholar 

  13. Bahl M, et al. Trends in incidentally identified thyroid cancers over a decade: a retrospective analysis of 2,090 surgical patients. World J Surg. 2014;38(6):1312–7.

    Article  PubMed  Google Scholar 

  14. Ezzat S, et al. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154(16):1838–40.

    Article  CAS  PubMed  Google Scholar 

  15. Desser TS, Kamaya A. Ultrasound of thyroid nodules. Neuroimaging Clin N Am. 2008;18(3):463–78, vii.

    Article  PubMed  Google Scholar 

  16. Haugen BR, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  17. American Thyroid Association Guidelines Taskforce on Thyroid, N., et al., Revised american thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11): p. 1167–214.

    Google Scholar 

  18. Are C, et al. FDG-PET detected thyroid incidentalomas: need for further investigation? Ann Surg Oncol. 2007;14(1):239–47.

    Article  PubMed  Google Scholar 

  19. Katz SC, Shaha A. PET-associated incidental neoplasms of the thyroid. J Am Coll Surg. 2008;207(2):259–64.

    Article  PubMed  Google Scholar 

  20. Hoang JK, Nguyen XV, Davies L. Overdiagnosis of thyroid cancer: answers to five key questions. Acad Radiol. 2015;22(8):1024–9.

    Article  PubMed  Google Scholar 

  21. Niemeier LA, et al. A combined molecular-pathologic score improves risk stratification of thyroid papillary microcarcinoma. Cancer. 2012;118(8):2069–77.

    Article  CAS  PubMed  Google Scholar 

  22. Virk RK, et al. BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype-phenotype correlation. Mod Pathol. 2013;26(1):62–70.

    Article  CAS  PubMed  Google Scholar 

  23. Xing M, et al. BRAF V600E and TERT promoter mutations cooperatively identify the most aggressive papillary thyroid cancer with highest recurrence. J Clin Oncol. 2014;32(25):2718–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Nikiforov YE, et al. Highly accurate diagnosis of cancer in thyroid nodules with follicular neoplasm/suspicious for a follicular neoplasm cytology by ThyroSeq v2 next-generation sequencing assay. Cancer. 2014;120(23):3627–34.

    Article  CAS  PubMed  Google Scholar 

  25. Ito Y, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13(4):381–7.

    Article  PubMed  Google Scholar 

  26. Lee J, et al. Long-term outcomes of total thyroidectomy versus thyroid lobectomy for papillary thyroid microcarcinoma: comparative analysis after propensity score matching. Thyroid. 2013;23(11):1408–15.

    Article  PubMed  Google Scholar 

  27. Kucuk NO, et al. Treatment for microcarcinoma of the thyroid--clinical experience. Clin Nucl Med. 2007;32(4):279–81.

    Article  PubMed  Google Scholar 

  28. Hay ID, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008;144(6):980–7; discussion 987–8.

    Article  PubMed  Google Scholar 

  29. Nixon IJ, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2012;151(4):571–9.

    Article  PubMed  Google Scholar 

  30. Untch BR, et al. Oncologic outcomes after completion thyroidectomy for patients with well-differentiated thyroid carcinoma. Ann Surg Oncol. 2014;21(4):1374–8.

    Article  PubMed  Google Scholar 

  31. Leboulleux S, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab. 2007;92(9):3590–4.

    Article  CAS  PubMed  Google Scholar 

  32. Wada N, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.

    PubMed  PubMed Central  Google Scholar 

  33. Qu N, et al. Risk factors for central compartment lymph node metastasis in papillary thyroid microcarcinoma: a meta-analysis. World J Surg. 2015;39(10):2459–70.

    Article  PubMed  Google Scholar 

  34. Xiang D, et al. Papillary thyroid microcarcinomas located at the middle part of the middle third of the thyroid gland correlates with the presence of neck metastasis. Surgery. 2015;157(3):526–33.

    Article  PubMed  Google Scholar 

  35. Zeng RC, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck. 2014;36(1):101–6.

    Article  PubMed  Google Scholar 

  36. Kouvaraki MA, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946–54; discussion 954–5.

    Article  PubMed  Google Scholar 

  37. Hughes CJ, et al. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck. 1996;18(2):127–32.

    Article  CAS  PubMed  Google Scholar 

  38. Lee SH, et al. Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma. Laryngoscope. 2008;118(4):659–62.

    Article  PubMed  Google Scholar 

  39. Caliskan M, et al. Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma. Endocr J. 2012;59(4):305–11.

    Article  PubMed  Google Scholar 

  40. Ito Y, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006;30(1):91–9.

    Article  PubMed  Google Scholar 

  41. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007;245(4):604–10.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bardet S, et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur J Endocrinol. 2008;158(4):551–60.

    Article  CAS  PubMed  Google Scholar 

  43. Cavicchi O, et al. Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg. 2007;137(4):654–8.

    Article  PubMed  Google Scholar 

  44. Hay ID, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26(8):879–85.

    Article  PubMed  Google Scholar 

  45. Mazzaferri EL. Thyroid remnant 131I ablation for papillary and follicular thyroid carcinoma. Thyroid. 1997;7(2):265–71.

    Article  CAS  PubMed  Google Scholar 

  46. Ito Y, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Oda H, et al. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 2016;26(1):150–5.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Brito JP, et al. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26(1):144–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Disclosures

The authors have no conflicts of interest or financial disclosures.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer R. Cracchiolo MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cracchiolo, J.R., Shaha, A.R. (2017). Papillary Thyroid Microcarcinomas. In: Roman, S., Sosa, J., SolĂłrzano, C. (eds) Management of Thyroid Nodules and Differentiated Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43618-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43618-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43616-6

  • Online ISBN: 978-3-319-43618-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics