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

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Therapeutic Nuclear Medicine

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

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.

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References

  • 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 30:216–222

    Article  PubMed  Google Scholar 

  • 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 51:1234–1241

    CAS  PubMed  Google Scholar 

  • 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 83:553–559

    Article  CAS  PubMed  Google Scholar 

  • Besic N, Pilko G, Petric R, Hocevar M, Zgajnar J (2008) Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol 97:221–225

    Article  PubMed  Google Scholar 

  • Cady B (1998) Presidential address: beyond risk groups—a new look at differentiated thyroid cancer. Surgery 124:947–957

    Article  CAS  PubMed  Google Scholar 

  • 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 63:689–693

    Article  Google Scholar 

  • 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 134:160–162

    Article  PubMed  Google Scholar 

  • 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 98:31–40

    Article  PubMed  Google Scholar 

  • 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 8:737–744

    Article  CAS  PubMed  Google Scholar 

  • 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 16:109–142

    Google Scholar 

  • 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 19:1167–1214

    Google Scholar 

  • 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, Lyon

    Google Scholar 

  • 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 46:213–219

    Google Scholar 

  • 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 136:1310–1322

    Article  PubMed  Google Scholar 

  • Dralle H, Sekulla C (2005) Thyroid surgery: generalist or specialist (in German)? Zentralbl Chir 130:428–432

    Article  CAS  PubMed  Google Scholar 

  • Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  • 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 9:816–820

    CAS  PubMed  Google Scholar 

  • Gospodarowicz MK, Miller D, Groome PA, Greene FL, Logan PA, Sobin LH (2004) The process for continuous improvement of the TNM classification. Cancer 100:1–5

    Article  PubMed  Google Scholar 

  • Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Book  Google Scholar 

  • Harach HR, Franssila KO, Wasenius VM (1985) Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer 56:531–538

    Article  CAS  PubMed  Google Scholar 

  • 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 144:980–987

    Article  Google Scholar 

  • 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 28:498–501

    Article  PubMed  Google Scholar 

  • 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 128:253–257

    Article  PubMed  Google Scholar 

  • 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 16:1348–1355

    Article  PubMed  Google Scholar 

  • 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 53:627–632

    Article  PubMed  Google Scholar 

  • Lerch H, Schober O, Kuwert T, Saur HB (1997) Survival of differentiated thyroid carcinoma studied in 500 patients. J Clin Oncol 15:2067–2075

    CAS  PubMed  Google Scholar 

  • 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 17:883–888

    Article  CAS  PubMed  Google Scholar 

  • 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 47:451–457

    Article  CAS  PubMed  Google Scholar 

  • 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 35:1941–1959

    Article  CAS  PubMed  Google Scholar 

  • Mazzaferri EL (2000) Long-term outcome of patients with differentiated thyroid carcinoma: effect of therapy. Endocr Pract 6:469–476

    Article  CAS  PubMed  Google Scholar 

  • 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 34:554–564

    Article  CAS  PubMed  Google Scholar 

  • McHenry CR, Rosen IB, Walfish PG (1991) Prospective management of nodal metastases in differentiated thyroid cancer. Am J Surg 162:353–356

    Article  CAS  PubMed  Google Scholar 

  • Nikiforov YE (2008) Thyroid carcinoma: molecular pathways and therapeutic targets. Mod Pathol 21:S37–S43

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • 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 154:787–803

    Google Scholar 

  • 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 87:1941–1946

    Article  CAS  PubMed  Google Scholar 

  • Pazaitou-Panayiotou K, Capezzone M, Pacini F (2007) Clinical features and therapeutic implication of papillary thyroid microcarcinoma. Thyroid 17:1085–1092

    Article  PubMed  Google Scholar 

  • 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 25:547–552

    Article  PubMed  Google Scholar 

  • 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 32:1144–1148

    Article  CAS  PubMed  Google Scholar 

  • Pisello F, Geraci G, Sciumè C, Li Volsi F, Modica G (2007) Total thyroidectomy of choice in papillary micro carcinoma (in Italian). G Chir 28:13–19

    CAS  PubMed  Google Scholar 

  • Rahbar K, Hutzenlaub V, Fischer RJ, Schober O, Riemann B (2008) Risk-profile and outcome of small papillary and follicular thyroid carcinomas. Nuklearmedizin 47:188–194

    CAS  PubMed  Google Scholar 

  • Reiners C, Geling M, Luster M, Farahati J, Mäder U (2005) Epidemiologie des Schilddrüsenkarzinoms. Onkologe 11:11–19

    Article  Google Scholar 

  • Riemann B, Schober O (2007) Das “kleine“ Schilddrüsenkarzinom (in German). Nuklearmedizin 46:113–114

    Google Scholar 

  • Rosai J, LiVolsi VA, Sobrinho-Simoes M, Williams ED (2003) Renaming papillary microcarcinoma of the thyroid gland: the Porto proposal. Int J Surg Pathol 11:249–251

    Article  PubMed  Google Scholar 

  • 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 19:1043–1048

    Article  PubMed  Google Scholar 

  • 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 91:2171–2178

    Article  CAS  PubMed  Google Scholar 

  • Roti E, degli Uberti EC, Bondanelli M, Braverman LE (2008) Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 159:659–673

    Google Scholar 

  • 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 150:105–112

    Article  CAS  PubMed  Google Scholar 

  • Schober O, Schwarzrock R (1986) The thyroid gland with low uptake lesions: evaluation by ultrasound. Radiology 158:277–278

    Article  CAS  PubMed  Google Scholar 

  • Shaha AR (2000) Thyroid cancer: extent of thyroidectomy. Cancer Control 7:240–245

    CAS  PubMed  Google Scholar 

  • Sherman SI (2003) Thyroid carcinoma. Lancet 361:501–511

    Article  PubMed  Google Scholar 

  • 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 114:27–33

    Article  PubMed  Google Scholar 

  • Sobin LH, Wittekind C (2002) UICC TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York

    Google Scholar 

  • Sobin LH, Gospodarowicz MK, Wittekind C (2009) UICC TNM classification of malignant tumors, 7th edn. Wiley-Liss, New York

    Google Scholar 

  • 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 11:1207–1210

    CAS  PubMed  Google Scholar 

  • Wittekind C, Greene FL, Henson DE, Hutter RVP, Sobin LH (2003) TNM supplement. A commentary on uniform use, 3rd edn. Wiley-Liss, New York

    Google Scholar 

  • Yamamoto Y, Maeda T, Izumi K, Otsuka H (1990) Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer 65:1173–1179

    Article  CAS  PubMed  Google Scholar 

  • Yang GC, LiVolsi VA, Baloch ZW (2002) Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol 10:133–139

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Münster, Albert- Schweitzer-Campus 1, 48149, Münster, Germany

    Otmar Schober & Burkhard Riemann

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  1. Otmar Schober
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  2. Burkhard Riemann
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Correspondence to Otmar Schober .

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Editors and Affiliations

  1. THERANOSTICS Center for Molecular, Radiotherapy and Molecular Imaging, ENETS Center of Excellence, Bad Berka, Germany

    Richard P. Baum

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Schober, O., Riemann, B. (2012). Therapeutic Strategy of Papillary Microcarcinoma of the Thyroid Gland: A Nuclear Medicine Perspective. In: Baum, R. (eds) Therapeutic Nuclear Medicine. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_744

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  • DOI: https://doi.org/10.1007/174_2012_744

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