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Clinical Implication of Cancer Adhesion in Papillary Thyroid Carcinoma: Clinicopathologic Characteristics and Prognosis Analyzed with Degree of Extrathyroidal Extension

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Abstract

Background

Macroscopic extrathyroidal extension (ETE) is a poor prognostic factor in papillary thyroid carcinoma (PTC). However, intraoperative inspection for ETE is often inaccurate and could lead the surgeon to misconstrue simple adhesion as gross ETE. Such confusion could result in more aggressive treatment than necessary. In the present study we investigated the frequency and clinical implication of simple adhesions.

Methods

We identified 858 patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC). Clinicopathologic features, prognosis, and stimulated serum thyroglobulin (Tg) levels were compared between four groups divided according to degree of ETE: no ETE (n = 335), simple adhesion (n = 16), microscopic ETE (n = 378), and macroscopic ETE (n = 129).

Results

In the total of 145 cases, which were recognized as gross ETE under intraoperative inspection, 16 cases (11.0 %) were diagnosed as cancer confined to the thyroid without ETE by definite histology. The simple adhesion group showed no statistical differences in postoperative stimulated Tg levels from the no ETE and microscopic ETE groups (p > 0.05). In contrast, the distribution of postoperative Tg levels in the macroscopic ETE group was significantly higher than in the other groups (p < 0.001). During the 54-month median follow-up period, the macroscopic ETE and microscopic ETE groups showed poorer relapse-free survival than the no ETE and simple adhesion groups (p < 0.05).

Conclusions

The findings of the present study indicate that the discrepancy between intraoperative inspection and definite histology is not negligible when dense adhesions are present. When no tumor is found, the patient with inflammatory or fibrotic adhesions has a favorable prognosis.

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References

  1. Schlumberger MJ (1999) Diagnostic follow-up of well-differentiated thyroid carcinoma: historical perspective and current status. J Endocrinol Invest 22:3–7

    PubMed  CAS  Google Scholar 

  2. Dean DS, Hay ID (2000) Prognostic indicators in differentiated thyroid carcinoma. Cancer Control 7:229–239

    PubMed  CAS  Google Scholar 

  3. Cady B, Rossi R (1988) An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 104:947–953

    PubMed  CAS  Google Scholar 

  4. DeGroot LJ, Kaplan EL, McCormick M et al (1990) Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 71:414–424

    Article  PubMed  CAS  Google Scholar 

  5. Hay ID (1990) Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 19:545–576

    PubMed  CAS  Google Scholar 

  6. Lin JD, Liou MJ, Chao TC et al (1999) Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases. Endocr Relat Cancer 6:109–115

    Article  PubMed  CAS  Google Scholar 

  7. Andersen PE, Kinsella J, Loree TR et al (1995) Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg 170:467–470

    Article  PubMed  CAS  Google Scholar 

  8. Ortiz S, Rodriguez JM, Soria T et al (2001) Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg 124:261–265

    Article  PubMed  CAS  Google Scholar 

  9. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474

    Article  PubMed  Google Scholar 

  10. Arora N, Turbendian HK, Scognamiglio T et al (2008) Extrathyroidal extension is not all equal: implications of macroscopic versus microscopic extent in papillary thyroid carcinoma. Surgery 144:942–947 discussion 947–948

    Article  PubMed  Google Scholar 

  11. Hu A, Clark J, Payne RJ et al (2007) Extrathyroidal extension in well-differentiated thyroid cancer: macroscopic vs microscopic as a predictor of outcome. Arch Otolaryngol Head Neck Surg 133:644–649

    Article  PubMed  Google Scholar 

  12. Rivera M, Ricarte-Filho J, Tuttle RM et al (2010) Molecular, morphologic, and outcome analysis of thyroid carcinomas according to degree of extrathyroid extension. Thyroid 20:1085–1093

    Article  PubMed  Google Scholar 

  13. Gezen C, Kement M, Altuntas YE et al (2012) Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors. World J Surg Oncol 10:39 10.1186/1477-7819-10-39

    Article  PubMed  Google Scholar 

  14. Lopez MJ, Monafo WW (1993) Role of extended resection in the initial treatment of locally advanced colorectal carcinoma. Surgery 113:365–372

    PubMed  CAS  Google Scholar 

  15. Ito Y, Tomoda C, Uruno T et al (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30:780–786. doi:10.1007/s00268-005-0270-z

    Article  PubMed  Google Scholar 

  16. Moon HJ, Kim E-K, Chung WY et al (2011) Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol 18:1916–1923

    Article  PubMed  Google Scholar 

  17. Ersoz C, Soylu L, Erkocak EU et al (1997) Histologic alterations in the thyroid gland after fine-needle aspiration. Diagn Cytopathol 16:230–232

    Article  PubMed  CAS  Google Scholar 

  18. Polyzos SA, Patsiaoura K, Zachou K (2009) Histological alterations following thyroid fine needle biopsy: a systematic review. Diagn Cytopathol 37:455–465

    Article  PubMed  Google Scholar 

  19. Nikiforov Y (2012) Diagnostic pathology and molecular genetics of the thyroid, 2nd Edition. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, p. xi, 436 p

  20. Pacini F, Lippi F, Formica N et al (1987) Therapeutic doses of iodine-131 reveal undiagnosed metastases in thyroid cancer patients with detectable serum thyroglobulin levels. J Nucl Med 28:1888–1891

    PubMed  CAS  Google Scholar 

  21. Muratet JP, Giraud P, Daver A et al (1997) Predicting the efficacy of first iodine-131 treatment in differentiated thyroid carcinoma. J Nucl Med 38:1362–1368

    PubMed  CAS  Google Scholar 

  22. Menendez Torre E, Lopez Carballo MT, Rodriguez Erdozain RM et al (2004) Prognostic value of thyroglobulin serum levels and 131I whole-body scan after initial treatment of low-risk differentiated thyroid cancer. Thyroid 14:301–306

    Article  PubMed  Google Scholar 

  23. Toubeau M, Touzery C, Arveux P et al (2004) Predictive value for disease progression of serum thyroglobulin levels measured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J Nucl Med 45:988–994

    PubMed  CAS  Google Scholar 

  24. Hall FT, Beasley NJ, Eski SJ et al (2003) Predictive value of serum thyroglobulin after surgery for thyroid carcinoma. Laryngoscope 113:77–81

    Article  PubMed  Google Scholar 

  25. Ruiz-Garcia J, Ruiz de Almodovar JM, Olea N et al (1991) Thyroglobulin level as a predictive factor of tumoral recurrence in differentiated thyroid cancer. J Nucl Med 32:395–398

    PubMed  CAS  Google Scholar 

  26. Spencer CA, Wang CC (1995) Thyroglobulin measurement. Techniques, clinical benefits, and pitfalls. Endocrinol Metab Clin North Am 24:841–863

    PubMed  CAS  Google Scholar 

  27. Black EG, Hoffenberg R (1983) Should one measure serum thyroglobulin in the presence of anti-thyroglobulin antibodies? Clin Endocrinol (Oxf) 19:597–601

    Article  CAS  Google Scholar 

  28. Vincze B, Sinkovics I, Keresztes S et al (2004) Clinical significance of serum thyroglobulin and antithyroglobulin antibody in differentiated thyroid cancer after thyroid ablation. Magy Onkol 48:27–34

    PubMed  Google Scholar 

  29. Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214

    Article  PubMed  Google Scholar 

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Conflict of interest

We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

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Author notes

  1. Seung Pil Jung

    Present address: Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, Korea

Authors and Affiliations

  1. Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Seung Pil Jung, Minkuk Kim, Jun-Ho Choe, Jee Soo Kim, Seok Jin Nam & Jung-Han Kim

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  1. Seung Pil Jung
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  2. Minkuk Kim
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Correspondence to Jung-Han Kim.

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Jung, S.P., Kim, M., Choe, JH. et al. Clinical Implication of Cancer Adhesion in Papillary Thyroid Carcinoma: Clinicopathologic Characteristics and Prognosis Analyzed with Degree of Extrathyroidal Extension. World J Surg 37, 1606–1613 (2013). https://doi.org/10.1007/s00268-013-2034-5

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