Therapeutic Strategy of Papillary Microcarcinoma of the Thyroid Gland: A Nuclear Medicine Perspective

  • Otmar Schober
  • Burkhard Riemann
Part of the Medical Radiology book series (MEDRAD)


Patients with papillary thyroid microcarcinoma (PTMC) have an excellent prognosis with a normal life expectancy. According to the literature, the incidence of PTMC is increasing. To date, PMTCs account for up to 30 % of all differentiated thyroid cancers. Because of the differential definitions of the PTMC, the therapeutic approaches of the national Scientific Societies have not been standardised. The therapeutic algorithms have to be adjusted with regard to current thyroid surgery, radioiodine ablation and thyrotropin-suppressive therapy as well as follow-up. Recently, the Therapy Committee of the European Association of Nuclear Medicine (EANM) has recommended a risk-adapted therapy and follow-up. Risk factors which require a more aggressive therapeutic approach are multifocality, thyroid capsule infiltration, evidence of locoregional or distant metastasis and unfavourable histology. It was the aim to review the current therapeutic concepts in patients with PTMC from a nuclear medicine perspective.


Thyroid Carcinoma Papillary Thyroid Carcinoma Papillary Carcinoma Differentiate Thyroid Cancer Follicular Thyroid Carcinoma 
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. Adeniran AJ, Zhu Z, Gandhi M, Steward DL, Fidler JP, Giordano TJ, Biddinger PW, Nikiforov YE (2006) Correlation between genetic alterations and microscopic features, clinical manifestations, and prognostic characteristics of thyroid papillary carcinomas. Am J Surg Pathol 30:216–222PubMedCrossRefGoogle Scholar
  2. Akslen LA, Haldorsen T, Thoresen SO, Glattre E (1991) Survival and causes of death in thyroid cancer: a population-based study of 2479 cases from Norway. Cancer Res 51:1234–1241PubMedGoogle Scholar
  3. Baudin E, Travagli JP, Ropers J, Mancusi F, Bruno-Bossio G, Caillou B, Cailleux AF, Lumbroso JD, Parmentier C, Schlumberger M (1998) Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 83:553–559PubMedCrossRefGoogle Scholar
  4. Besic N, Pilko G, Petric R, Hocevar M, Zgajnar J (2008) Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol 97:221–225PubMedCrossRefGoogle Scholar
  5. Cady B (1998) Presidential address: beyond risk groups—a new look at differentiated thyroid cancer. Surgery 124:947–957PubMedCrossRefGoogle Scholar
  6. Cappelli C, Pirola I, Cumetti D, Micheletti L, Tironi A, Gandossi E, Martino E, Cherubini L, Agosti B, Castellano M, Mattanza C, Rosei EA (2005) Is the anteroposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology? Clin Endocrinol 63:689–693CrossRefGoogle Scholar
  7. Cheema Y, Olson S, Elson D, Chen H (2006) What is the biology and optimal treatment for papillary microcarcinoma of the thyroid? J Surg Res 134:160–162PubMedCrossRefGoogle Scholar
  8. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40PubMedCrossRefGoogle Scholar
  9. Cooper DS, Specker B, Ho M, Sperling M, Ladenson PW, Ross DS, Ain KB, Bigos ST, Brierley JD, Haugen BR, Klein I, Robbins J, Sherman SI, Taylor T, Maxon HR 3rd (1998) Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid 8:737–744PubMedCrossRefGoogle Scholar
  10. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM, American Thyroid Association Guidelines Taskforce (2006) Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16:109–142Google Scholar
  11. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM, American Thyroid Association Guidelines Taskforce (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214Google Scholar
  12. DeLellis RA, Lloyd RV, Heitz PU, Eng C (2004) World Health Organisation Classification of tumours. In: Pathology and genetics of tumours of endocrine organs. IARC Press, LyonGoogle Scholar
  13. Dietlein M, Dressler J, Eschner W, Grünwald F, Lassmann M, Leisner B, Luster M, Moser E, Reiners C, Schicha H, Schober O, Deutsche Gesellschaft für Nuklearmedizin; Deutsche Gesellschaft für Medizinische Physik (2007) Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3). Nuklearmedizin 46:213–219Google Scholar
  14. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322PubMedCrossRefGoogle Scholar
  15. Dralle H, Sekulla C (2005) Thyroid surgery: generalist or specialist (in German)? Zentralbl Chir 130:428–432PubMedCrossRefGoogle Scholar
  16. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  17. Fink A, Tomlinson G, Freeman JL, Rosen IB, Asa SL (1996) Occult micropapillary carcinoma associated with benign follicular thyroid disease and unrelated thyroid neoplasms. Mod Pathol 9:816–820PubMedGoogle Scholar
  18. Gospodarowicz MK, Miller D, Groome PA, Greene FL, Logan PA, Sobin LH (2004) The process for continuous improvement of the TNM classification. Cancer 100:1–5PubMedCrossRefGoogle Scholar
  19. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer, New YorkCrossRefGoogle Scholar
  20. Harach HR, Franssila KO, Wasenius VM (1985) Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer 56:531–538PubMedCrossRefGoogle Scholar
  21. Hay ID, Hutchinson ME, Gonzalez-Losada T, McIver B, Reinalda ME, Grant CS, Thompson GB, Sebo TJ, Goellner JR (2009) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–987CrossRefGoogle Scholar
  22. Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Kuma K, Miyauchi A (2004) Preoperative ultrasonographic examination for lymph node metastasis: usefulness when designing lymph node dissection for papillary microcarcinoma of the thyroid. World J Surg 28:498–501PubMedCrossRefGoogle Scholar
  23. Khoo ML, Freeman JL, Witterick IJ, Irish JC, Rotstein LE, Gullane PJ, Asa SL (2002) Underexpression of p27/Kip in thyroid papillary microcarcinomas with gross metastatic disease. Arch Otolaryngol Head Neck Surg 128:253–257PubMedCrossRefGoogle Scholar
  24. Kwak JY, Kim EK, Kim MJ, Son EJ, Chung WY, Park CS, Nam KH (2009) Papillary microcarcinoma of the thyroid: predicting factors of lateral neck node metastasis. Ann Surg Oncol 16:1348–1355PubMedCrossRefGoogle Scholar
  25. Lee J, Rhee Y, Lee S, Ahn CW, Cha BS, Kim KR, Lee HC, Kim SI, Park CS, Lim SK (2006) Frequent, aggressive behaviors of thyroid microcarcinomas in Korean patients. Endocr J 53:627–632PubMedCrossRefGoogle Scholar
  26. Lerch H, Schober O, Kuwert T, Saur HB (1997) Survival of differentiated thyroid carcinoma studied in 500 patients. J Clin Oncol 15:2067–2075PubMedGoogle Scholar
  27. Lim DJ, Baek KH, Lee YS, Park WC, Kim MK, Kang MI, Jeon HM, Lee JM, Yun-Cha B, Lee KW, Son HY, Kang SK (2007) Clinical, histopathological, and molecular characteristics of papillary thyroid microcarcinoma. Thyroid 17:883–888PubMedCrossRefGoogle Scholar
  28. Londero SC, Godballe C, Krogdahl A, Bastholt L, Specht L, Sørensen CH, Pedersen HB, Pedersen U, Christiansen P (2008) Papillary microcarcinoma of the thyroid gland: is the immunohistochemical expression of cyclin D1 or galectin-3 in primary tumour an indicator of metastatic disease? Acta Oncol 47:451–457PubMedCrossRefGoogle Scholar
  29. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, Tennvall J, Bombardieri E (2008) Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 35:1941–1959PubMedCrossRefGoogle Scholar
  30. Mazzaferri EL (2000) Long-term outcome of patients with differentiated thyroid carcinoma: effect of therapy. Endocr Pract 6:469–476PubMedCrossRefGoogle Scholar
  31. McGriff NJ, Csako G, Gourgiotis L, Lori CG, Pucino F, Sarlis NJ (2002) Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med 34:554–564PubMedCrossRefGoogle Scholar
  32. McHenry CR, Rosen IB, Walfish PG (1991) Prospective management of nodal metastases in differentiated thyroid cancer. Am J Surg 162:353–356PubMedCrossRefGoogle Scholar
  33. Nikiforov YE (2008) Thyroid carcinoma: molecular pathways and therapeutic targets. Mod Pathol 21:S37–S43PubMedCentralPubMedCrossRefGoogle Scholar
  34. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W, European Thyroid Cancer Taskforce (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803Google Scholar
  35. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, Panunzi C, Rinaldi R, Toscano V, Pacella CM (2002) Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 87:1941–1946PubMedCrossRefGoogle Scholar
  36. Pazaitou-Panayiotou K, Capezzone M, Pacini F (2007) Clinical features and therapeutic implication of papillary thyroid microcarcinoma. Thyroid 17:1085–1092PubMedCrossRefGoogle Scholar
  37. Pelizzo MR, Boschin IM, Toniato A, Pagetta C, Piotto A, Bernante P, Casara D, Pennelli G, Rubello D (2004) Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience. Nucl Med Commun 25:547–552PubMedCrossRefGoogle Scholar
  38. Pelizzo MR, Boschin IM, Toniato A, Piotto A, Bernante P, Pagetta C, Rampin L, Rubello D (2006) Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol 32:1144–1148PubMedCrossRefGoogle Scholar
  39. Pisello F, Geraci G, Sciumè C, Li Volsi F, Modica G (2007) Total thyroidectomy of choice in papillary micro carcinoma (in Italian). G Chir 28:13–19PubMedGoogle Scholar
  40. Rahbar K, Hutzenlaub V, Fischer RJ, Schober O, Riemann B (2008) Risk-profile and outcome of small papillary and follicular thyroid carcinomas. Nuklearmedizin 47:188–194PubMedGoogle Scholar
  41. Reiners C, Geling M, Luster M, Farahati J, Mäder U (2005) Epidemiologie des Schilddrüsenkarzinoms. Onkologe 11:11–19CrossRefGoogle Scholar
  42. Riemann B, Schober O (2007) Das “kleine“ Schilddrüsenkarzinom (in German). Nuklearmedizin 46:113–114Google Scholar
  43. Rosai J, LiVolsi VA, Sobrinho-Simoes M, Williams ED (2003) Renaming papillary microcarcinoma of the thyroid gland: the Porto proposal. Int J Surg Pathol 11:249–251PubMedCrossRefGoogle Scholar
  44. Ross DS, Litofsky D, Ain KB, Brierley JD, Cooper DS, Haugen BR, Jonklaas J, Ladenson PW, Magner J, Robbins J, Skarulis MC, Steward DL, Maxon HR, Sherman SI (2009) Recurrence after treatment of micropapillary thyroid cancer. Thyroid 19:1043–1048PubMedCrossRefGoogle Scholar
  45. Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, Pearce EN, Braverman LE, Degli Uberti EC (2006) Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab 91:2171–2178PubMedCrossRefGoogle Scholar
  46. Roti E, degli Uberti EC, Bondanelli M, Braverman LE (2008) Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 159:659–673Google Scholar
  47. Schlumberger M, Berg G, Cohen O, Duntas L, Jamar F, Jarzab B, Limbert E, Lind P, Pacini F, Reiners C, Sánchez Franco F, Toft A, Wiersinga WM (2004) Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 150:105–112PubMedCrossRefGoogle Scholar
  48. Schober O, Schwarzrock R (1986) The thyroid gland with low uptake lesions: evaluation by ultrasound. Radiology 158:277–278PubMedCrossRefGoogle Scholar
  49. Shaha AR (2000) Thyroid cancer: extent of thyroidectomy. Cancer Control 7:240–245PubMedGoogle Scholar
  50. Sherman SI (2003) Thyroid carcinoma. Lancet 361:501–511PubMedCrossRefGoogle Scholar
  51. Siddiqui MA, Griffith KA, Michael CW, Pu RT (2008) Nodule heterogeneity as shown by size differences between the targeted nodule and the tumor in thyroidectomy specimen: a cause for a false-negative diagnosis of papillary thyroid carcinoma on fine-needle aspiration. Cancer 114:27–33PubMedCrossRefGoogle Scholar
  52. Sobin LH, Wittekind C (2002) UICC TNM classification of malignant tumors, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  53. Sobin LH, Gospodarowicz MK, Wittekind C (2009) UICC TNM classification of malignant tumors, 7th edn. Wiley-Liss, New YorkGoogle Scholar
  54. Viglietto G, Chiappetta G, Martinez-Tello FJ, Fukunaga FH, Tallini G, Rigopoulou D, Visconti R, Mastro A, Santoro M, Fusco A (1995) RET/PTC oncogene activation is an early event in thyroid carcinogenesis. Oncogene 11:1207–1210PubMedGoogle Scholar
  55. Wittekind C, Greene FL, Henson DE, Hutter RVP, Sobin LH (2003) TNM supplement. A commentary on uniform use, 3rd edn. Wiley-Liss, New YorkGoogle Scholar
  56. Yamamoto Y, Maeda T, Izumi K, Otsuka H (1990) Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer 65:1173–1179PubMedCrossRefGoogle Scholar
  57. Yang GC, LiVolsi VA, Baloch ZW (2002) Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol 10:133–139PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2012

Authors and Affiliations

  1. 1.Department of Nuclear MedicineUniversity Hospital of MünsterMünsterGermany

Personalised recommendations