Skip to main content

Small papillary thyroid carcinoma with minimal extrathyroidal extension should be managed as ATA low-risk tumor

Journal of Endocrinological Investigation volume 41, pages 1029–1035 (2018)Cite this article

Abstract

Purpose

According to American Thyroid Association (ATA) guideline, papillary thyroid cancer (PTC) with minimal extrathyroidal extension (mETE) is classified at “intermediate risk” of persistent/recurrent disease. However, the impact of mETE per se on patients’ outcome is not fully understood. The aim of our study was to evaluate the prognostic significance of mETE in patients with PTC not submitted to therapeutic or prophylactic lymph node dissection, according to tumor size and other prognostic factors.

Patients and methods

We retrospectively evaluated a total of 514 PTC patients: 127 (24.7%) had mETE (pT3Nx) and 387 (75.3%) had negative margins (pT1-2Nx). At a median follow-up of 9.1 years, patients were divided in two groups: patients with “good outcome” (no evidence of disease) and patients with “poor outcome” (persistent structural disease or recurrent disease or tumor-related death).

Results

The rate of patients with “poor outcome” was significantly higher in patients with mETE compared with patients with negative margins (11.8 versus 5.1%; OR 2.4576, 95% CI 1.2178–4.9594, p = 0.01). However, mETE was significantly associated with poor outcome only in patients with tumors larger than 1.5 cm.

Conclusions

mETE is an unfavorable prognostic factor in tumors larger than 1.5 cm, suggesting that, in the absence of other unfavorable characteristics, smaller tumors with mETE should be classified and managed as “low risk” tumors.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. 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. https://doi.org/10.1245/s10434-010-0985-4

    Article  PubMed  Google Scholar 

  2. 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  PubMed  CAS  Google Scholar 

  3. Ortiz S, Rodríguez JM, Soria T, Pérez-Flores D, Piñero A, Moreno J, Parrilla P (2001) Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg 124:261–265

    Article  PubMed  CAS  Google Scholar 

  4. Santos MJ, Bugalho MJ (2016) Papillary thyroid carcinoma: different clinical behavior among pT3 tumors. Endocrine 53:754–760. https://doi.org/10.1007/s12020-016-0927-4

    Article  PubMed  CAS  Google Scholar 

  5. 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. https://doi.org/10.1007/s00268-013-2034-5

    Article  PubMed  Google Scholar 

  6. Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA (2017) Extrathyroidal extension is associated with compromised survival in patients with thyroid cancer. Thyroid 27(5):626–631. https://doi.org/10.1089/thy.2016.0132

    Article  PubMed  CAS  Google Scholar 

  7. Radowsky JS, Howard RS, Burch HB, Stojadinovic A (2014) Impact of degree of extrathyroidal extension of disease on papillary thyroid cancer outcome. Thyroid 24:241–244. https://doi.org/10.1089/thy.2012.0567

    Article  PubMed  Google Scholar 

  8. Yin DT, Yu K, Lu RQ, Li X, Xu J, Lei M (2016) Prognostic impact of minimal extrathyroidal extension in papillary thyroid carcinoma. Medicine (Baltimore) 95(52):e5794. https://doi.org/10.1097/MD.0000000000005794

    Article  Google Scholar 

  9. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30:780–786

    Article  PubMed  Google Scholar 

  10. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A (2006) Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45 years. Surg Today 36:12–18

    Article  PubMed  Google Scholar 

  11. Arora N, Turbendian HK, Scognamiglio T, Wagner PL, Goldsmith SJ, Zarnegar R, Fahey TJ 3rd (2008) Extrathyroidal extension is not all equal: implications of macroscopic versus microscopic extent in papillary thyroid carcinoma. Surgery 144:942–947. https://doi.org/10.1016/j.surg.2008.07.023

    Article  PubMed  Google Scholar 

  12. 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. https://doi.org/10.1245/s10434-011-1556-z

    Article  PubMed  Google Scholar 

  13. Shin JH, Ha TK, Park HK, Ahn MS, Kim KH, Bae KB, Kim TH, Choi CS, Kim TK, Bae SK, Kim SH (2013) Implication of minimal extrathyroidal extension as a prognostic factor in papillary thyroid carcinoma. Int J Surg 11:944–947. https://doi.org/10.1016/j.ijsu.2013.06.015

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Jin BJ, Kim MK, Ji YB, Song CM, Park JH, Tae K (2015) Characteristics and significance of minimal and maximal extrathyroidal extension in papillary thyroid carcinoma. Oral Oncol 51:759–763. https://doi.org/10.1016/j.oraloncology.2015.05.010

    Article  PubMed  Google Scholar 

  16. Woo CG, Sung CO, Choi YM, Kim WG, Kim TY, Shong YK, Kim WB, Hong SJ, Song DE (2015) Clinicopathological significance of minimal extrathyroid extension in solitary papillary thyroid carcinomas. Ann Surg Oncol 22:S728–S733. https://doi.org/10.1245/s10434-015-4659-0

    Article  PubMed  Google Scholar 

  17. Wang LY, Ghossein R, Palmer FL, Nixon IJ, Tuttle RM, Shaha AR, Shah JP, Patel SG, Ganly I (2015) Microscopic positive margins in differentiated thyroid cancer is not an independent predictor of local failure. Thyroid 25:993–998. https://doi.org/10.1089/thy.2015.0141

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kluijfhout WP, Pasternak JD, Kwon JS, Lim J, Shen WT, Gosnell JE, Khanafshar E, Duh QY, Suh I (2016) Microscopic positive tumor margin does not increase the risk of recurrence in patients with T1–T2 well-differentiated thyroid cancer. Ann Surg Oncol 23:1446–1451. https://doi.org/10.1245/s10434-015-4998-x

    Article  PubMed  Google Scholar 

  19. Al-Qurayshi Z, Shama MA, Randolph GW, Kandil E (2017) Minimal extrathyroidal extension does not affect survival of well-differentiated thyroid cancer. Endocr Relat Cancer 24:221–226. https://doi.org/10.1530/ERC-16-0509

    Article  PubMed  Google Scholar 

  20. Haugen BR, Alexander EK, Bible KC et al (2016) 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 26:1–133. https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  21. Castagna MG, Cantara S, Pacini F (2016) Reappraisal of the indication for radioiodine thyroid ablation in differentiated thyroid cancer patients. J Endocrinol Invest 39:1087–1094. https://doi.org/10.1007/s40618-016-0503-z

    Article  PubMed  CAS  Google Scholar 

  22. Pacini F, Brianzoni E, Durante C, Elisei R, Ferdeghini M, Fugazzola L, Mariotti S, Pellegriti G (2016) Recommendations for post-surgical thyroid ablation in differentiated thyroid cancer: a 2015 position statement of the Italian Society of Endocrinology. J Endocrinol Invest 39:341–347. https://doi.org/10.1007/s40618-015-0375-7

    Article  PubMed  CAS  Google Scholar 

  23. Tuttle M, Morris LF, Haugen B, Shah J, Sosa JA, Rohren E, Subramaniam RM, Hunt JL, Perrier ND (2017) Thyroid differentiated and anaplastic carcinoma (Chapter 73). In: Amin MB, Edge SB, Greene F, Byrd D, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM et al (eds) AJCC cancer staging manual, 8th edn. Springer International Publishing, New York City

    Google Scholar 

Download references

Funding

This work was supported in part by Grants from the Italian Ministry of Health (Grant #RF-2011-02950673).

Author information

Affiliations

  1. Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy

    M. G. Castagna, R. Forleo, F. Maino, N. Fralassi, F. Barbato, T. Pilli, M. Capezzone, L. Brilli, C. Ciuoli, S. Cantara, C. Formichi & F. Pacini

  2. Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy

    P. Palmitesta

Authors
  1. M. G. Castagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Forleo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Maino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Fralassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Barbato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Palmitesta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Pilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Capezzone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Brilli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C. Ciuoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Cantara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C. Formichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. F. Pacini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. G. Castagna.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Castagna, M.G., Forleo, R., Maino, F. et al. Small papillary thyroid carcinoma with minimal extrathyroidal extension should be managed as ATA low-risk tumor. J Endocrinol Invest 41, 1029–1035 (2018). https://doi.org/10.1007/s40618-018-0854-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-018-0854-8

Keywords

  • PTC
  • Micropapillary thyroid cancer
  • Minimal extrathyroidal extension
  • Tumor diameter
  • Aggressive histology