Abstract
Background
Although papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency, the best therapeutic option and follow-up protocol have not been established yet, especially in the case of incidental diagnosis. We reviewed our series of patients with PTMC to determine risk factors for recurrence in an area where there is a high prevalence of goiter.
Methods
The medical records of all patients who underwent thyroidectomy with a final pathology report of PTMC between October 2002 and June 2007 were reviewed. PTMC was defined as a papillary thyroid carcinoma 10 mm or less in diameter. Follow-up evaluation was obtained by outpatient consultation and/or telephone interview.
Results
In a series of 2,220 patients who underwent thyroidectomy for a thyroid carcinoma, 933 had a PTMC. Diagnosis was incidental in 704 patients (75.5%). Upon multivariate analysis, tumor size, nonincidental diagnosis, and neck node metastases at diagnosis were independent risk factors for extracapsular spread (ECS), while ECS, multifocal disease, and number of removed lymph nodes were independent risk factors for lymph node metastases at diagnosis. Follow-up evaluation was completed in 287 patients, 9 (3.1%) of whom experienced recurrence. The number of removed and metastasized nodes at first operation and the length of the follow-up were independent risk factors for recurrent disease.
Conclusions
Incidental diagnosis of PTMC is frequent in a high prevalence of goiter area. PTMC shows a variable degree of aggressiveness. Management protocols should be based on patient- and tumor-related prognostic factors, as for larger tumors.
Similar content being viewed by others
References
Lloyd R, De Lellis R, Heitz P et al (2004) World Health Organization Classification of Tumours: pathology and genetics of tumours of the endocrine organs. International Agency for Research on Cancer (IARC) Press, Lyon
Lo CY, Chan WF, Lang BH et al (2006) Papillary microcarcinoma: is there any difference between clinically overt and occult tumors? World J Surg 30:759–766
Grodski S, Brown T, Sidhu S et al (2008) Increasing incidence of thyroid cancer is due to increased pathologic detection. Surgery 144:1038–1043
Leenhardt L, Grosclaude P, Chérié-Challine L (2004) Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French thyroid cancer committee. Thyroid 14:1056–1060
Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167
Burgess JR, Tucker P (2006) Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fine-needle aspirate cytology. Thyroid 16:47–53
Grodski S, Delbridge L (2008) An update on papillary microcarcinoma. Curr Opin Oncol 21:1–4
Sclumberger MJ (1998) Papillary and follicular thyroid cancer. N Engl J Med 5:297–306
Shaha AR (2000) Controversies in the management of thyroid nodule. Laryngoscope 110:183–193
Ito Y, Uruno T, Nakano K et al (2003) An observational trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13:381–387
British Thyroid Association (2007) Guidelines for the management of thyroid cancer. http://www.british-thyroid-association.org/Thyroid_cancer_guidelines_2007.pdf
Kucuk NO, Tari P, Tokmak E et al (2007) Treatment of microcarcinoma of the thyroid-clinical experience. Clin Nucl Med 32:181–279
Pelizzo MR, Boschin IM, Toniato A et al (2006) Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol 32:1144–1148
Allo MD, Christianson W, Koivunen D (1988) Not all “occult” papillary carcinomas are “minimal”. Surgery 104:971–976
Cappelli C, Castellano M, Braga M et al (2007) Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 95:555–560
Chow SM, Law SCK, Chan JKC et al (2003) Papillary microcarcinoma of the thyroid–prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40
Liou MJ, Lin JD, Chung MH et al (2005) Renal metastasis from papillary thyroid microcarcinoma. Acta Otolaryngol 125:438–442
Arora N, Turbedian HK, Kato MA et al (2009) Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid 5:473–477
Roti E, Degli Uberti EC, Bondanelli M et al (2008) Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 159:659–673
Ito Y, Higashiyama T, Takamura Y et al (2007) Prognosis of patients with benign thyroid diseases accompanied by incidental papillary carcinoma undetectable on preoperative imaging tests. World J Surg 31:1672–1676
Lin JD, Kuo SF, Chao TC et al (2008) Incidental and nonincidental papillary thyroid microcarcinoma. Ann Surg Oncol 15:2287–2292
Pellegriti G, Scollo C, Lumera G et al (2004) Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab 89:3713–3720
Noguchi S, Yamashita H, Uchino S et al (2008) Papillary microcarcinoma. World J Surg 32:747–753
International Union Against Cancer (UICC) (2002) Thyroid gland. In: Sobin LH, Wittekind Ch (eds) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York, pp 52–56
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ et al (2006) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Taskforce. Thyroid 16:1–33
Salvatori M, Perotti G, Rufini F et al (2004) Are there disadvantages in administering 131I ablation therapy in patients with differentiated thyroid carcinoma without a preablative diagnostic 131I whole-body scan? Clin Endocrinol 61:704–710
Mazzaferri EL, Sipos J (2008) Should all patients with subcentimeter thyroid nodules undergo fine-needle aspiration biopsy and preoperative neck ultrasonography to define the extent of tumor invasion? Thyroid 18:597–602
Hay ID, Hutchinson ME, Gonzales-Losada T et al (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–988
Baudin E, Travagli JP, Ropers J et al (1998) Microcarcinoma of the thyroid gland: the Gustave Roussy Institute experience. Cancer 83:553–559
Antonaci A, Anello A, Aucello A et al (2006) Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: clinical behavior and surgical management. Clin Ter 157:225–229
Rossi ED, Raffaelli M, Minimo C et al (2005) Immunocytochemical evaluation of thyroid neoplasms on thin-layer smears from fine-needle aspiration biopsy. Cancer Cytopathol 25:87–95
Bellantone R, Lombardi CP, Raffaelli M et al (2004) Management of cystic or predominantly cystic thyroid nodules: the role of ultrasound-guided fine-needle aspiration biopsy. Thyroid 14:43–47
Mazzaferri EL (2007) Management of low risk differentiated thyroid cancer. Endocr Pract 13:498–512
Pazaitou-Panayoutou K, Capezzone M, Pacini F (2007) Clinical features and therapeutic implication of papillary thyroid microcarcinoma. Thyroid 17:1085–1092
Ito Y, Miyauchi A (2007) A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroid. Nat Clin Pract Endocrinol Metab 3:240–248
Russel WO, Ml Ibanez, Clark RL et al (1963) Thyroid carcinoma: classification, intraglandular dissemination and clinicopathologic study based upon whole organ sections of 80 glands. Cancer 16:1425–1460
Roh JL, Kim JM, Park C II (2008) Central cervical nodal metastasis from papillary thyroid microcarcinoma: pattern and factors predictive of nodal metastasis. Ann Surg Oncol 15:2482–2486
Shattuck TM, Westra WH, Ladenson PW et al (2005) Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma. New Engl J Med 352:2406–2412
Xing M (2009) BRAF mutation in papillary thyroid microcarcinoma: the promise of better risk management. Ann Surg Oncol 16:801–803
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lombardi, C.P., Bellantone, R., De Crea, C. et al. Papillary Thyroid Microcarcinoma: Extrathyroidal Extension, Lymph Node Metastases, and Risk Factors for Recurrence in a High Prevalence of Goiter Area. World J Surg 34, 1214–1221 (2010). https://doi.org/10.1007/s00268-009-0375-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-009-0375-x