Annals of Surgical Oncology

, 15:2287 | Cite as

Incidental and Nonincidental Papillary Thyroid Microcarcinoma

  • Jen-Der Lin
  • Sheng-Fong Kuo
  • Tzu-Chieh Chao
  • Chuen Hsueh
Endocrine Tumors



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.


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.


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.


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.


Nearly total thyroidectomy Thyroglobulin Multicentric 131I treatment Follicular variant of papillary thyroid carcinoma 


  1. 1.
    Reynolds RM, Weir J, Stockton DL, et al. Changing trends in incidence and mortality of thyroid cancer in Scotland. Clin Endocrinol 2005; 62:156–62CrossRefGoogle Scholar
  2. 2.
    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; 43:891–900PubMedCrossRefGoogle Scholar
  3. 3.
    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; 91:2171–8PubMedCrossRefGoogle Scholar
  4. 4.
    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 73–6Google Scholar
  5. 5.
    Sobin LH, UICC. (2002) Wittekind Ch (ed). TNM classification of malignant tumors, 6th edition. New York: Wiley-Liss. pp 52–6Google Scholar
  6. 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; 22:427–32PubMedGoogle Scholar
  7. 7.
    de Matos PS, Ferreira AP, Ward LS. Prevalence of papillary microcarcinoma of the thyroid in Brazilian autopsy and surgical series. Endocr Pathol 2006; 17:165–73PubMedCrossRefGoogle Scholar
  8. 8.
    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; 15:152–7PubMedCrossRefGoogle Scholar
  9. 9.
    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; 71:4022–9PubMedCrossRefGoogle Scholar
  10. 10.
    Sakoratas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev 2005; 31:423–38CrossRefGoogle Scholar
  11. 11.
    Mittendorf EA, Khiyami A, McHenry CR. When fine-needle aspiration biopsy cannot exclude papillary thyroid cancer: a therapeutic dilemma. Arch Surg 2006; 141:961–6PubMedCrossRefGoogle Scholar
  12. 12.
    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; 32:1144–8PubMedCrossRefGoogle Scholar
  13. 13.
    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; 102:1088–95PubMedGoogle Scholar
  14. 14.
    Lupoli G, Vitale G, Caraglia M, et al. Familial papillary thyroid microcarcinoma: a new clinical entity. Lancet 1999; 353:637–9PubMedCrossRefGoogle Scholar
  15. 15.
    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; 86:842–9PubMedCrossRefGoogle Scholar
  16. 16.
    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; 46:115–20PubMedGoogle Scholar
  17. 17.
    Furlan JC, Bedard Y, Rosen IB. Biologic basis for the treatment of microscopic, occult well-differentiated thyroid cancer. Surgery 2001; 130:1050–4PubMedCrossRefGoogle Scholar
  18. 18.
    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; 96:280–2PubMedGoogle Scholar
  19. 19.
    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; 10:244–7PubMedGoogle Scholar
  20. 20.
    Hefer T, Joachims HZ, Hashmonai M, et al. Highly aggressive behaviour of occult papillary thyroid carcinoma. J Laryngol Otol 1995; 109:1109–12PubMedCrossRefGoogle Scholar
  21. 21.
    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; 95:555–60PubMedCrossRefGoogle Scholar
  22. 22.
    Lee J, Rhee Y, Lee S, et al. Frequent, aggressive behaviors of thyroid microcarcinomas in korean patients. Endocr J 2006; 53:627–32PubMedCrossRefGoogle Scholar
  23. 23.
    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; 12:275–82PubMedCrossRefGoogle Scholar
  24. 24.
    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; 36:688–93PubMedCrossRefGoogle Scholar
  25. 25.
    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; 92:4085–90PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Jen-Der Lin
    • 1
  • Sheng-Fong Kuo
    • 1
  • Tzu-Chieh Chao
    • 2
  • Chuen Hsueh
    • 3
  1. 1.Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung UniversityTaoyuan HsienTaiwan, R.O.C.
  2. 2.Department of General Surgery, Chang Gung Memorial HospitalChang Gung UniversityTaoyuan HsienTaiwan, R.O.C.
  3. 3.Department of Pathology, Chang Gung Memorial HospitalChang Gung UniversityTaoyuan HsienTaiwan, R.O.C.

Personalised recommendations