Papillary Microcarcinoma of the Thyroid: Clinical Characteristics and BRAFV600E Mutational Status of 977 Cases
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Papillary thyroid carcinoma (PTC) is one of the most common endocrine malignancies. It is estimated that papillary thyroid microcarcinoma (PTMC) accounts for up to 30 % of all PTCs. The clinical significance of PTMC is still unclear, although it may be related to recurrence, distant metastasis, and mortality. The purpose of this study was to analyze the clinical characteristics and BRAFV600E mutational status of PTMCs in a Chinese population and to determine risk factors for poor prognosis.
We performed a retrospective review of 977 PTMC cases that underwent surgical resection from January 2001 to January 2010 at Tianjin Medical University Cancer Institute and Hospital.
The mean size of 977 PTMCs was 5.2 (range, 2–10) mm. Multifocal tumors were seen in 323 patients. The majority of patients (692) had a T1 lesion, whereas 279 had T3 and 6 had T4a; 40.1 % patients had BRAFV600E mutation. The frequencies of extrathyroidal extension and lymph node metastasis were 29.2 and 23.4 %, respectively. Distant metastasis was present in 15 patients. Half of the patients (50.8 %) received a total thyroidectomy and others had a lobectomy.
The present study suggests that highly aggressive PTMCs may arise in a subset of patients with BRAFV600E mutation and tumors greater than 5 mm. Extrathyroidal invasion, lymph node metastases, and the type of surgical procedures were significantly associated with tumor recurrence. Although multivariate analysis showed that tumor recurrence was not associated with BRAFV600E mutation, it has not been shown that treating these patients more aggressively changes outcomes.
KeywordsThyroid Cancer Papillary Thyroid Carcinoma Papillary Thyroid Papillary Thyroid Cancer Cervical Lymph Node Metastasis
The authors thank Prof. Baocun Sun in Tianjin Medical University Cancer Institute and Hospital for providing materials, the members of Dr. Gao’s department for their assistance in the discussion, and Dr. Peirong Yu, Professor, Department of Plastic Surgery at the MD Anderson Cancer Center, Houston, TX, for scientific and language editing.
Conflict of interest
The authors declare that there is no conflict of interest for this study.
This research did not receive any specific grant from any funding agencies in the public, commercial or not-for-profit sectors.
- 1.Udelsman R, Chen H. The current management of thyroid cancer. Adv Surg. 1999;33:1–27.Google Scholar
- 2.Lloyd R, De Lellis R, Heitz P, Eng C. World Health Organization classification of tumours: pathology and genetics of tumours of the endocrine organs. Lyon, France: IARC Press International Agency for Research on Cancer; 2004.Google Scholar
- 14.Adeniran AJ, Zhu Z, Gandhi M, Steward DL, Fidler JP, Giordano TJ, Biddinger PW, Nikiforov YE. Correlation between genetic alterations and microscopic features, clinical manifestations, and prognostic characteristics of thyroid papillary carcinomas. Am J Surg Pathol. 2006;30:216–22.PubMedCrossRefGoogle Scholar
- 16.Nikiforova MN, Kimura ET, Gandhi M, Biddinger PW, Knauf JA, Basolo F, Zhu Z, Giannini R, Salvatore G, Fusco A, Santoro M, Fagin JA, Nikiforov YE. BRAF mutations in thyroid tumors are restricted to papillary carcinomas and anaplastic or poorly differentiated carcinomas. J Clin Endocrinol Metab. 2003 88 5399–5404.Google Scholar
- 17.Puxeddu E, Moretti S, Elisei R, Romei C, Pascucci R, Martinelli M, Marino C, Avenia N, Rossi ED, Fadda G, Cavaliere A, Ribacchi R, Falorni A, Pontecorvi A, Pacini F, Pinchera A, Santeusanio F. BRAF(V599E) mutation is the leading genetic event in adult sporadic papillary thyroid carcinomas. J Clin Endocrinol Metab. 2004;89:2414–20.PubMedCrossRefGoogle Scholar
- 23.Rouxel A, Hejblum G, Bernier MO, Boelle PY, Menegaux F, Mansour G, Hoang C, Aurengo A, Leenhardt L. Prognostic factors associated with the survival of patients developing locoregional recurrences of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2004;89:5362–8.PubMedCrossRefGoogle Scholar
- 27.Edge SB, Compton CC, Byrd DR. AJCC cancer staging manual, 7th edition. New York: Springer; 2010.Google Scholar
- 33.Nikiforov YE. Thyroid tumors: Classification and general considerations. In: Nikiforov YE, Biddinger PW, Thompson LDR, editors. Diagnostic pathology and molecular genetics of the thyroid. Philadelphia: Lippincott Williams & Wilkins; 2009:95–102.Google Scholar
- 34.Statistik Austria. Available: http://www.statistik.at/web_de/statistiken/gesundheit/krebserkrankungen/schilddruese/021796.html. Accessed 22 Aug 2010.
- 43.Howell GM, Carty SE, Armstrong MJ. Both BRAF V600E mutation and older age (> 65 years) are associated with recurrent papillary thyroid cancer. Ann Surg Oncol. 2011;5:19.Google Scholar