World Journal of Surgery

, Volume 34, Issue 6, pp 1214–1221 | Cite as

Papillary Thyroid Microcarcinoma: Extrathyroidal Extension, Lymph Node Metastases, and Risk Factors for Recurrence in a High Prevalence of Goiter Area

  • Celestino P. Lombardi
  • Rocco Bellantone
  • Carmela De Crea
  • Nunzia C. Paladino
  • Guido Fadda
  • Massimo Salvatori
  • Marco Raffaelli



Although papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency, the best therapeutic option and follow-up protocol have not been established yet, especially in the case of incidental diagnosis. We reviewed our series of patients with PTMC to determine risk factors for recurrence in an area where there is a high prevalence of goiter.


The medical records of all patients who underwent thyroidectomy with a final pathology report of PTMC between October 2002 and June 2007 were reviewed. PTMC was defined as a papillary thyroid carcinoma 10 mm or less in diameter. Follow-up evaluation was obtained by outpatient consultation and/or telephone interview.


In a series of 2,220 patients who underwent thyroidectomy for a thyroid carcinoma, 933 had a PTMC. Diagnosis was incidental in 704 patients (75.5%). Upon multivariate analysis, tumor size, nonincidental diagnosis, and neck node metastases at diagnosis were independent risk factors for extracapsular spread (ECS), while ECS, multifocal disease, and number of removed lymph nodes were independent risk factors for lymph node metastases at diagnosis. Follow-up evaluation was completed in 287 patients, 9 (3.1%) of whom experienced recurrence. The number of removed and metastasized nodes at first operation and the length of the follow-up were independent risk factors for recurrent disease.


Incidental diagnosis of PTMC is frequent in a high prevalence of goiter area. PTMC shows a variable degree of aggressiveness. Management protocols should be based on patient- and tumor-related prognostic factors, as for larger tumors.


Goiter Papillary Thyroid Carcinoma Multifocal Disease Remove Lymph Node Completion Thyroidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Lloyd R, De Lellis R, Heitz P et al (2004) World Health Organization Classification of Tumours: pathology and genetics of tumours of the endocrine organs. International Agency for Research on Cancer (IARC) Press, LyonGoogle Scholar
  2. 2.
    Lo CY, Chan WF, Lang BH et al (2006) Papillary microcarcinoma: is there any difference between clinically overt and occult tumors? World J Surg 30:759–766CrossRefPubMedGoogle Scholar
  3. 3.
    Grodski S, Brown T, Sidhu S et al (2008) Increasing incidence of thyroid cancer is due to increased pathologic detection. Surgery 144:1038–1043CrossRefPubMedGoogle Scholar
  4. 4.
    Leenhardt L, Grosclaude P, Chérié-Challine L (2004) Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French thyroid cancer committee. Thyroid 14:1056–1060CrossRefPubMedGoogle Scholar
  5. 5.
    Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167CrossRefPubMedGoogle Scholar
  6. 6.
    Burgess JR, Tucker P (2006) Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine-needle aspirate cytology. Thyroid 16:47–53CrossRefPubMedGoogle Scholar
  7. 7.
    Grodski S, Delbridge L (2008) An update on papillary microcarcinoma. Curr Opin Oncol 21:1–4CrossRefGoogle Scholar
  8. 8.
    Sclumberger MJ (1998) Papillary and follicular thyroid cancer. N Engl J Med 5:297–306CrossRefGoogle Scholar
  9. 9.
    Shaha AR (2000) Controversies in the management of thyroid nodule. Laryngoscope 110:183–193CrossRefPubMedGoogle Scholar
  10. 10.
    Ito Y, Uruno T, Nakano K et al (2003) An observational trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13:381–387CrossRefPubMedGoogle Scholar
  11. 11.
    British Thyroid Association (2007) Guidelines for the management of thyroid cancer.
  12. 12.
    Kucuk NO, Tari P, Tokmak E et al (2007) Treatment of microcarcinoma of the thyroid-clinical experience. Clin Nucl Med 32:181–279Google Scholar
  13. 13.
    Pelizzo MR, Boschin IM, Toniato A et al (2006) Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol 32:1144–1148CrossRefPubMedGoogle Scholar
  14. 14.
    Allo MD, Christianson W, Koivunen D (1988) Not all “occult” papillary carcinomas are “minimal”. Surgery 104:971–976PubMedGoogle Scholar
  15. 15.
    Cappelli C, Castellano M, Braga M et al (2007) Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 95:555–560CrossRefPubMedGoogle Scholar
  16. 16.
    Chow SM, Law SCK, Chan JKC et al (2003) Papillary microcarcinoma of the thyroid–prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40CrossRefPubMedGoogle Scholar
  17. 17.
    Liou MJ, Lin JD, Chung MH et al (2005) Renal metastasis from papillary thyroid microcarcinoma. Acta Otolaryngol 125:438–442CrossRefPubMedGoogle Scholar
  18. 18.
    Arora N, Turbedian HK, Kato MA et al (2009) Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid 5:473–477CrossRefGoogle Scholar
  19. 19.
    Roti E, Degli Uberti EC, Bondanelli M et al (2008) Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 159:659–673CrossRefPubMedGoogle Scholar
  20. 20.
    Ito Y, Higashiyama T, Takamura Y et al (2007) Prognosis of patients with benign thyroid diseases accompanied by incidental papillary carcinoma undetectable on preoperative imaging tests. World J Surg 31:1672–1676CrossRefPubMedGoogle Scholar
  21. 21.
    Lin JD, Kuo SF, Chao TC et al (2008) Incidental and nonincidental papillary thyroid microcarcinoma. Ann Surg Oncol 15:2287–2292CrossRefPubMedGoogle Scholar
  22. 22.
    Pellegriti G, Scollo C, Lumera G et al (2004) Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab 89:3713–3720CrossRefPubMedGoogle Scholar
  23. 23.
    Noguchi S, Yamashita H, Uchino S et al (2008) Papillary microcarcinoma. World J Surg 32:747–753CrossRefPubMedGoogle Scholar
  24. 24.
    International Union Against Cancer (UICC) (2002) Thyroid gland. In: Sobin LH, Wittekind Ch (eds) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York, pp 52–56Google Scholar
  25. 25.
    Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ et al (2006) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Taskforce. Thyroid 16:1–33CrossRefGoogle Scholar
  26. 26.
    Salvatori M, Perotti G, Rufini F et al (2004) Are there disadvantages in administering 131I ablation therapy in patients with differentiated thyroid carcinoma without a preablative diagnostic 131I whole-body scan? Clin Endocrinol 61:704–710CrossRefGoogle Scholar
  27. 27.
    Mazzaferri EL, Sipos J (2008) Should all patients with subcentimeter thyroid nodules undergo fine-needle aspiration biopsy and preoperative neck ultrasonography to define the extent of tumor invasion? Thyroid 18:597–602CrossRefPubMedGoogle Scholar
  28. 28.
    Hay ID, Hutchinson ME, Gonzales-Losada T et al (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–988CrossRefPubMedGoogle Scholar
  29. 29.
    Baudin E, Travagli JP, Ropers J et al (1998) Microcarcinoma of the thyroid gland: the Gustave Roussy Institute experience. Cancer 83:553–559CrossRefPubMedGoogle Scholar
  30. 30.
    Antonaci A, Anello A, Aucello A et al (2006) Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: clinical behavior and surgical management. Clin Ter 157:225–229PubMedGoogle Scholar
  31. 31.
    Rossi ED, Raffaelli M, Minimo C et al (2005) Immunocytochemical evaluation of thyroid neoplasms on thin-layer smears from fine-needle aspiration biopsy. Cancer Cytopathol 25:87–95Google Scholar
  32. 32.
    Bellantone R, Lombardi CP, Raffaelli M et al (2004) Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy. Thyroid 14:43–47CrossRefPubMedGoogle Scholar
  33. 33.
    Mazzaferri EL (2007) Management of low risk differentiated thyroid cancer. Endocr Pract 13:498–512PubMedGoogle Scholar
  34. 34.
    Pazaitou-Panayoutou K, Capezzone M, Pacini F (2007) Clinical features and therapeutic implication of papillary thyroid microcarcinoma. Thyroid 17:1085–1092CrossRefGoogle Scholar
  35. 35.
    Ito Y, Miyauchi A (2007) A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroid. Nat Clin Pract Endocrinol Metab 3:240–248CrossRefPubMedGoogle Scholar
  36. 36.
    Russel WO, Ml Ibanez, Clark RL et al (1963) Thyroid carcinoma: classification, intraglandular dissemination and clinicopathologic study based upon whole organ sections of 80 glands. Cancer 16:1425–1460CrossRefGoogle Scholar
  37. 37.
    Roh JL, Kim JM, Park C II (2008) Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol 15:2482–2486CrossRefPubMedGoogle Scholar
  38. 38.
    Shattuck TM, Westra WH, Ladenson PW et al (2005) Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma. New Engl J Med 352:2406–2412CrossRefPubMedGoogle Scholar
  39. 39.
    Xing M (2009) BRAF mutation in papillary thyroid microcarcinoma: the promise of better risk management. Ann Surg Oncol 16:801–803CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Celestino P. Lombardi
    • 1
  • Rocco Bellantone
    • 1
  • Carmela De Crea
    • 1
  • Nunzia C. Paladino
    • 1
  • Guido Fadda
    • 2
  • Massimo Salvatori
    • 3
  • Marco Raffaelli
    • 1
  1. 1.Division of Endocrine Surgery, Department of Surgery, Istituto di Semeiotica ChirurgicaUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Institute of PathologyUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Institute of Nuclear MedicineUniversità Cattolica del Sacro CuoreRomeItaly

Personalised recommendations