Abstract
Purpose
To compare the histopathological features and the outcomes of the follicular variant and classical variant of papillary thyroid carcinoma.
Material and the methods
Demographic data, histopathological features (tumor size, thyroid capsule invasion, extrathyroidal extension, vascular invasion and multicentricity), lymph node metastasis, local recurrence, distant metastasis and mortality during the follow-up of 258 C-PTC and 153 FVPTC patients who underwent total thyroidectomy were compared. The dynamic risk assessment system was used to refine postoperative risk estimates based on the assessment of response to initial treatment.
Results
The demographic data showed no significant difference between the two groups. The mean tumor size showed no significant difference between the two groups. The rate of thyroid capsule invasion, extrathyroidal extension, and lymph node metastasis was significantly higher in C-PTC than in FVPTC group, whereas multicentricity and bilobar involvement were significantly higher in FVPTC group than in C-PTC group. Central lymph node metastasis was significantly more frequent in patients with C-PTC than in those with FVPTC (p < 0.0001). Local recurrence was found in 22 (5.3 %) patients overall and was significantly more common in C-PTC group than in FVPTC group. In patients ≥45 years, the local recurrence rate was significantly higher in patients with CPTC than in those with FVPTC. The local recurrence rate in patients <45 years was not significantly different between the two groups of patients. The multicentricity rate was significantly higher in the FVPTC group for both age groups. Dynamic risk assessment showed that the rate of intermediate- and high-risk groups showed no significant difference between C-PTC and FVPTC patients but the rate of low risk patients was higher in FVPTC group than in C-PTC group (p = 0.04). The recurrence rate in low-risk group was found higher in C-PTC compared to FVPTC patients (4.7 vs. 0.7 %, p = 0.04, respectively). The recurrence rate showed no significant difference in both intermediate- and high-risk groups in C-PTC and FVPTC patients. During the follow-up, the rate of distant metastasis and disease-specific mortality was not significantly different between the two groups (p = 0.25).
Conclusion
FVPTC is a common subtype of PTC and has a higher rate of multicentricity with bilobar involvement. Although aggressive histopathologic features, such as thyroid capsule invasion, extrathyroidal extension, and lymph node metastasis, are significantly more frequent in CPTC than in FVPTC, the long-term outcome is similar in both subtypes after appropriate initial surgery and postoperative RAI ablation treatment.
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References
Jossart GH, Clark OH (1994) Well-differentiated thyroid cancer. Curr Probl Surg 31:933–1012
Carcangiu ML, Zampi G, Pupi A, Castagnoli A, Rosai J (1985) Papillary carcinoma of the thyroid: a clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer 55:805–828
Sebastian SO, Gonzalez JM, Paricio PP et al (2000) Papillary thyroid carcinoma: prognostic index for survival including the histological variety. Arch Surg 135:272–277
Zidan J, Karen D, Stein M et al (2003) Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival. Cancer 97:1181–1185
Mazzaferri EL, Kloos RT (1953) Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 138:33–38
Passler C, Prager G, Scheuba C et al (2003) Follicular variant of papillary thyroid carcinoma: a long-term follow-up. Arch Surg 138:1362–1366
LiVolsi VA, Asa SL (1994) The demise of follicular carcinoma of the thyroid gland. Thyroid. 4:233–236
Burningham AR, Krishnan J, Davidson BJ et al (2005) Papillary and follicular variant of papillary carcinoma of the thyroid: initial presentation and response to therapy. Otolaryngol Head Neck Surg 132:840–844
Tuttle RM, Tala H, Shah J et al (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to theraphy variables to modify the initial risk estimates predicted by the new American thyroid Association staging system. Thyroid 20:1341–1349
Regalbuto C, Malandrino P, Frasca F et al (2013) The tall cell variant of papillary thyroid carcinoma: clinical and pathological features and outcomes. J Endocrinol Invest 36(4):249–254
Tielens ET, Sherman SI, Hruban RH et al (1994) Follicular variant of papillary thyroid carcinoma: a clinicopathologic study. Cancer 73:424–431
Falvo L, Catanio A, D’Andrea V et al (2005) Prognostic importance of histologic vascular invasion in papillary thyroid carcinoma. Ann Surg 241:640–646
Yu XM, Schneider DF, Leverson G, Chen H, Sippel RS (2013) Follicular variant of papillary thyroid carcinoma is a unique clinical entity: a population-based study of 10,740 cases. Thyroid. 23(10):1263–1268
Lang BH, Lo CY, Chan WF, Lam AK, Wan KY (2006) Classical and follicular variant of papillary thyroid carcinoma: a comparative study on clinicopathologic features and long-term outcome. World J Surg 30(5):752–758
Hagag P, Hod N, Kummer E, Cohenpour M, Horne T, Weiss M (2006) Follicular variant of papillary thyroid carcinoma: clinical-pathological characterization and long-term followup. Cancer J 12:275–282
Gardner RE, Tuttle RM, Burman KD et al (2000) Prognostic importance of vascular invasion in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 126:309–312
Falvo L, Catania A, D’Andrea V et al (2005) Prognostic importance of histologic vascular invasion in papillary thyroid carcinoma. Annal Surg 4:640–646
Nishida T, Katayama S, Tsujimoto M (2002) The clinicopathological significance of histologic vascular invasion in differentiated thyroid carcinomas. Am J Surg 183:80–86
Mete O, Asa SL (2011) Pathological definition and clinical significance of vascular invasion in thyroid carcinomas of follicular epithelial derivation. Mod Pathol 24(12):1545–1552
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, 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(11):1167–1214
Xing M (2005) BRAF mutation in thyroid cancer. Endocr Relat Cancer 12:245–262
Fugazzola L, Puxeddu E, Avenia N et al (2006) Correlation between B-RAFV600E mutation and clinico-pathologic parameters in papillary thyroid carcinoma: data from a multicentric Italian study and review of the literature. Endocr Relat Cancer 13:455–464
Lee JH, Lee ES, Kim YS (2007) Clinicopathologic significance of BRAF V600E mutation in papillary carcinomas of the thyroid:a meta-analysis. Cancer 110:38–46
Xing M, Westra WH, Tufano RP et al (2005) BRAF mutation predicts a poorer clinical prognosis for papillary thyroid cancer. J Clin Endocrinol Metab 90:6373–6379
Lassalle S, Hofman V, Ilie M et al (2010) Clinical impact of the detection of BRAF mutations in thyroid pathology potential usefulness as diagnostic, prognostic and theragnostic applications. Curr Med Chem 17:1839–1850
Handkiewicz-Junak D, Czarniecka A, Jarzab B (2010) Molecular prognostic markers in papillary and follicular thyroid cancer: current status and future directions. Mol Cell Endocrinol 322:8–28
Xing M (2007) BRAF mutation in papillary thyroid cancer: pathogenic role, molecular bases, and clinical implications. Endocr Rev 28:742–762
Kim TH, Park YJ, Lim JA et al (2012) The association of the BRAF(V600E) mutation with prognostic factors and poor clinical outcome in papillary thyroid cancer: a meta-analysis. Cancer 118:1764–1773
Kebebew E, Weng J, Bauer J et al (2007) The prevalence and prognostic value of BRAF mutation in thyroid cancer. Ann Surg 246:466–470 discussion 470–1
Elisei R, Ugolini C, Viola D et al (2008) BRAF(V600E) mutation and outcome of patients with papillary thyroid carcinoma: a 15-year median follow-up study. J Clin Endocrinol Metab 93:3943–3949
Ito Y, Yoshida H, Maruo R et al (2009) BRAF mutation in papillary thyroid carcinoma in a Japanese population: its lack of correlation with high-risk clinicopathological features and disease-free survival of patients. Endocr J 56:89–97
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Tunca, F., Sormaz, I.C., Iscan, Y. et al. Comparison of histopathological features and prognosis of classical and follicular variant papillary thyroid carcinoma. J Endocrinol Invest 38, 1327–1334 (2015). https://doi.org/10.1007/s40618-015-0376-6
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DOI: https://doi.org/10.1007/s40618-015-0376-6