Papillary Microcarcinoma of Thyroid- A Clinicopathological Study in a Tertiary Care Hospital in South India

The incidence of papillary carcinoma of thyroid has shown an increase in the last few decades. One contributing factor is the identification of Papillary Microcarcinoma of thyroid. Papillary Microcarcinoma is defined as a papillary carcinoma which is ≤ 10 mm in size in the greatest dimension. Though it is associated with excellent prognosis, controversies still exist regarding the treatment and follow up of these patients.METHODSThis study is a retrospective study done in a tertiary care hospital in South India over a period of one year from July 2016 to June 2017. All surgically removed thyroid specimens submitted to the Pathology Department of the hospital were studied. The demographic details, clinical features, ultrasound and other imaging studies were obtained from the medical records. The FNAC findings, gross features of surgically removed thyroid and histopathological findings of these thyroid specimens were recorded and analysed. The records of the follow up of these patients were obtained from the corresponding clinical department.RESULTSAmong the 486 thyroid samples received, 59 (12.13%) were malignant tumours of the thyroid, out of which Papillary carcinoma was seen in 50 cases (84.7%) including 11 cases of Papillary Microcarcinoma constituting 18.6% of all thyroid malignancies and 2.26% of thyroidectomies during the study period. Mean age of patients with PMC was 43.9 with a female: male ratio of 10:1. 10 cases were incidental PMC, while one was suspected to be papillary carcinoma on ultrasound examination and FNAC. Only one patient showed high risk features of multifocality, extrathyroidal extension and lymph node metastases. Hence she was given RAI. All patients were followed up. No recurrence has been noted in the two year period of follow up.CONCLUSIONSPapillary Microcarcinoma is being increasingly diagnosed, most of them being incidental. Hence thorough histopathological examination is mandatory to identify these lesions. Though PMC has an excellent prognosis, aggressive treatment may be required in patients with high risk features including nonincidental, lymph node metastasis, multifocality, and extra-thyroid extension.

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

ABSTRACT The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.

Active surveillance for papillary thyroid microcarcinoma: considerations before making a decision / 中华内分泌代谢杂志

For rapidly increasing low-risk papillary thyroid micocarcinoma (PTMC), Japanese scholars have proposed that immediate surgery can be replaced by active surveillance, i.e. observation strategy. The new strategy has brought not only an important update to the management of PTMC, but also controversies from different perspectives. Here we would like to give a thorough review on the observation strategy for PTMC, including its development background, available clinical data, current recommendations/suggestions by guidelines/consensuses, common misunderstandings toward this topic, challenges, and prospective in the future.

Research progress in diagnosis and treatment of papillary thyroid microcarcinoma / 实用肿瘤学杂志

Thyroid cancer is one of the most common malignant tumors in the human endocrine system . It is one of the common diseases in head and neck ,thyroid and breast surgery .Its incidence rate is increasing year by year .With the development of ultrasonography and fine needle aspiration biopsy ,as well as the auxiliary exami-nation of gene detection technology ,the detective rate of early diagnosis of papillary thyroid microcarcinoma ( PT-MC) is getting higher and higher .Compared with conventional surgery , highlighting the advantages of minimally invasive surgery , endoscopic and ultrasound guided percutaneous ablation and other new surgical methods are gradually applied in clinical treatment .Combined with the new guideline ,the present paper reviews the progress in the diagnosis and treatment of papillary thyroid microcarcinoma .

Clinicopathological features and risk factors for central compartment nodal metastasis in papillary thyroid microcarcinoma:a study of 1 401 patients / 中国肿瘤临床

Objective:To determine the clinical features of papillary thyroid microcarcinoma (PTMC) and the risk factors for central compartment lymph node (CCLN) metastasis in PTMC. Methods:Data of 1 401 patients with PTMC who were treated in Tianjin Medi-cal University Cancer Institute and Hospital between January 2014 and December 2014 were retrospectively analyzed. Chi-square test and multivariate Logistic regression analysis were used to study the risk factors. Results:With regard to clinicopathological features, the sex ratio is 1:3.4 in patients with PTMC. CCLN metastasis affected 427 (30.5%) of the total 1 401 patients. Age (χ2=14.587, P6 mm, extracapsular spread, and tumor bilaterality were independently correlated with CCLN metastasis. Conclusion:A prophylactic neck dissection of the central compartment must be considered particularly in male PT-MC patients with age6 mm, extracapsular spread, and tumor bilaterality.

Diffuse lipomatosis of the thyroid gland with papillary microcarcinoma: Report of a rare entity.

Presence of lobules of adipose tissue either focally or diffusely is very rare in the thyroid gland. Fat accumulation can be macroscopic or microscopic. Focal infi ltrates of fat have been reported in conditions such as adenolipoma, intrathyroid lipoma, and encapsulated papillary carcinoma. Diffuse lipomatosis has been reported in conditions such as amyloid goitre, heterotopic fat nests, thyrolipoma and liposarcoma. The exact mechanism of fat accumulation is not known although there are many theories postulated. Investigations such as ultrasound, computed tomography scan, and magnetic resonance imaging can detect the presence of macroscopic fat in the thyroid gland. Accurate diagnosis of the type of fat accumulation is necessary because tumorous and nontumorous conditions fall into the differential diagnosis. Only nine cases of papillary carcinoma associated with lipomatosis of thyroid are reported so far. We report possibly the fi rst case of diffuse lipomatosis of the thyroid gland with a focus of papillary microcarcinoma.

Clinicopathological features and treatment of postsurgical incidental papillary thyroid microcarcinoma / 中华内分泌外科杂志

Objective To analyze clinicopathologic features and treatment strategy of postsurgical incidental papillary thyroid microcarcinoma(PTMC).Methods A total of 305 patients undergoing surgery for thyroid diseases from Apr.2012 to Mar.2013 were retrospectively analyzed.Results Among the 305 patients,19 patients(18 females and 1 male)showed PTMC incidentally after surgery.The mean age was (43.2 ± 12.8)years (ranging from 23 to 67 years old).All patients underwent subtotal thyroidectomy,including 17 endoscopic surgery and 2 open surgery.All frozen sections were benign during operation while pathologic results were PTMC after surgery.The average size of tumors was(2.2 ± 1.5) mm which all was unicentric with no lymph node enlargement intraoperatively.Immunohistochemistry showed that the positive rate of cytokeratin 19,galectin-3,mesothelial cell,and CD56 was 87.5％,43.8％,81.3％ and 18.8％,respectively.There were 4 cases of B-raf V600E mutation found in 6 patients.All patients discharged 1 to 3 days after surgical treatment with no complication and received levothyroxine therapy with a suppressive dose of thyrotropin(TSH).131I therapy was not given.Conclusions PTMC is found more common in female and younger age under 45 years.Tumor is usually unicentric and less than 5 mm.Lymph node metastasis is rare.Immunohistochemistry and B-raf V600E mutant test can help the diagnosis.Initial endoscopic subtotal thyroidectomy is effective.There is no need of further surgery and 131I therapy.

Analysis of Relationship between Prognostic Factors and Number of Fine-Needle Aspiration Cytology (FNAC) Prior to Surgery for Papillary Thyroid Microcarcinoma According to Size / 대한내분비외과학회지

PURPOSE: Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma 10 mm. Indication of FNAC based only on tumor size is still in debate. Some favor the criteria of a size 5 mm, n=156) and the prognostic factors and number of pre-surgical FNAC procedures were compared. RESULTS: There were no significant differences in gender, age, site, accompanying benign disease, multifocality and bilaterality. Group 2 patients displayed more advanced features than group 1 patients concerning capsular invasion, lymph node metastasis and tumor stage. The number of FNAC procedures prior to the decision of surgery was not different in the two groups. CONCLUSION: PTMC exceeding 5 mm in size showed advanced features than smaller tumors. Further study about the use of FNAC according only to the size of thyroid nodules is warranted.

A Case of Cystic Lymph Node Metastasis from Thyroid Papillary Microcarcinoma / 대한갑상선학회지

Papillary carcinoma is the most common type of thyroid cancer, usually presenting as a thyroid mass. Presentation in cervical nodes alone, with no clinical suspicion of thyroid tumor, also occurs. Lymph node metastasis from papillary carcinoma of the thyroid may undergo cystic transformation. This occurrence is seldom encountered in clinical practice and in cases of microcarcinomas the diagnosis may be difficult, resulting in a delay of the correct diagnosis and of therapy for the primary tumor. We present a rare case of solitary cystic lymph node metastasis of papillary microcarcinoma of the thyroid.

Frequência de microcarcinoma papilífero em doenças benignas da tireóide / Frequency of papillary microcarcinoma in thyroid benign diseases

Objetivo: Conhecer a frequência de microcarcinoma papilífero (MCP) em doenças benignas da tireóide. Métodos: Estudo transversal e retrospectivo, realizado no laboratório Alice de Patologia, na cidade de Criciúma, SC, no período de 1996 a 2006. Foram analisados 636 laudos anatomopatológicos de tireoidectomias totais, dos quais 409 preencheram os critérios de inclusão. Destes, estudou-se as seguintes variáveis: cidade de origem, gênero, idade, doenças benignas associadas ao MCP, tamanho dos tumores, lateralidade, focalidade, localização e invasão das bordas cirúrgicas. A análise estatística foi realizada através do programa EPIINFO versão 6.0. Resultados: Dos 636 laudos estudados, 409 preencheram os critérios de inclusão. Destes, 90,7% (371) eram mulheres e 9,3% (38) homens, sendo a média de idade 48,17 anos. A maioria (95,6%) dos pacientes estudados era de Criciúma. A frequência de MCP em doenças benignas da tireóide foi de 8,8%, sendo a doença de maior coexistência com MCP o bócio multinodular, seguido pelos adenomas foliculares. O diâmetro médio dos tumores foi de 4,7mm, sendo a maioria unilateral (88,9%) e unifocal (91,7%). A variante histológica do MCP encontrada com maior frequência foi a papilífera pura (61,11%). Não houve diferença significativa na localização dos tumores. Na maioria (88,9%) dos casos as bordas cirúrgicas estavam livres de doença. Conclusão: A frequência de MCP em doenças benignas da tireóide é alta no local de realização desta pesquisa, devendo chamar a atenção dos médicos para o seu possível diagnóstico, que na maioria das vezes acaba sendo um achado incidental na análise anatomopatológica de glândulas tireóideas retiradas por doenças aparentemente benignas.

Objective: To assess the frequency of papillary microcarcinoma in benign thyroid diseases. Methods: Retrospective cross-sectional study, conducted in the laboratory of Pathology Alice in the city of Criciúma, SC, from 1996 to 2006. We analyzed 636 reports of pathological total thyroidectomy, of which 409 met the inclusion criteria. Of these, the following variables were studied: city of origin, gender, age, benign diseases associated with papillary microcarcinoma, size of tumors, laterality, focus, location and invasion of the surgical margins. Statistical analysis was performed using the program EPIINFO version 6.0. Results: Of the 636 reports studied, 409 met the inclusion criteria. Of these, 90.7% (371) were women and 9.3% (38) men, with a mean age of 48.17 years. The majority (95.6%) of patients studied was Criciúma. The frequency of papillary microcarcinoma in benign thyroid disease was 8.8%, and the disease of greater coexistence with the papillary microcarcinoma was multinodular goiter, followed by follicular adenomas. The average diameter of tumors was 4.7 mm, the majority being unilateral (88.9%) and unifocal (91.7%). A histologic variant of papillary microcarcinoma found with more frequency was papillary pure (61.11%). There was no significant difference in the location of tumorsMost(88.9%) cases the surgical margins were free of disease. Conclusion: The frequency of MCP in benign thyroid diseases is high in the place of realization of this research, and should draw the attention of doctors for their possible diagnosis, which most often ends up being an incidental finding in the anatomopathological analysis of thyroid glands removed for apparently benign diseases.

Clinical Significance of MMP-2, MMP-9 and HIF-1alpha Expression in Thyroid Micropapillary Cancer

PURPOSE: Papillary Thyroid Microcarcinoma (PTMC) is rapidly increasing due to increased interests in the public health care system and improvements in ultrasonographic instruments and fine-needle-aspiration technique. The aim of this study is to investigate relationships between clinicopathologic features and molecular markers of PTMC and to help in developing therapeutic strategies in PTMC. METHODS: Tissue samples from patients with 38 PTMC and 21 benign thyroid tumors that were operated on from Jan. 2006 to Nov. 2008 were used to make microarrays and immunohistochemical staining for ER-alpha, E-CD, VEGF, MMP-2, MMP-9, and HIF-1alpha were performed. Clinicopathologic features of each immunohistochemical staining group were analyzed retrospectively. RESULTS: There is no immunohistochemistry staining in cases with benign thyroid lesions. The expression rate of ER-alpha, E-CD, VEGF, MMP-2, MMP-9, and HIF-1alpha in PTMC group was 66%, 58%, 82%, 66%, 71% and 63%, respectively. Bilateral tumor was statistically significant (48.0% vs 7.7%, P=0.015) related to MMP-2(+) PTMC group than in MMP-2(-) group. Bilateral tumor (44.4% vs 9.1%, P=0.060) and lymphovascular invasion (25.9% vs 0%, P=0.084) seemed to have greater relation to MMP-9(+) PTMC group than to MMP-9(-) group, but there is no statistically significant difference. Bilateral tumor (50.0% vs 7.1%, P=0.012), lymph node metastasis (45.8% vs 0%, P=0.003) and lymphovascular invasion (29.2% vs 0%, P=0.033) were significantly related to HIF-1alpha (+) PTMC group compared to HIF-1alpha(-) group. CONCLUSION: Our findings suggest that MMP-2, MMP-9 and HIF-1alpha expression could be used as a prognostic marker in PTMC. Larger studies are needed to assess its prognostic value in PTMC.

Immunohistochemical and morphological characteristics of the papillary thyroid microcarcinoma / 中国现代普通外科进展

Objctive:To investigate the immunohistochemical and morphological characteristics of the papillary thyroid microcarcinoma(PTM) ,and differential diagnosis of the related disease.Methods:The morphological characteristics of 223 patients with PTM were observed under light microscope.Seventy-four cases of PTM and 32 cases of proliferative lesion of thyroid were observed under light microscope with stains of hematoxylin and eosin and immunohistochemical staining.The antibody included CK19,MC,Galectin-3 and CD56.Results:Eighty-six cases were follicular-patterned and 31 cases nuclear features were untypical in 223 cases of PTM.The positive expression rates of CK19、MC、 Galectin-3、CD56 were 100.0%,98.6%,98.6% and 4.1% in 74 cases of PTM,and were 37.5%,12.5%,18.8%,68.8% in proliferative lesion of thyroid,respectively.Conclusion:Some cases of PTM show a follicular-patterned and the nuclear features.It is untypical compared with classical papillary thyroid carcinoma.It can be differentiated from proliferative lesion with absence of envelope,obviously various and unusually proliferated follicular cells,sclerotic stroma,neoplastic follicles among the collagen and normal follicles.The wide and intensive expression of CK19,Galectin-3,and the negative expression of CD56 are extremely useful in the diagnosis of PTM,four-marker panel with CK19,Galectin-3,MC and CD56 can improve the specificity and accuracy of the differential diagnosis of PTM.

Clinically Related Factors and Features of Central Compartment Neck Lymph Nodes in Thyroid Micropapillary Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite the overall excellent prognosis for patients with thyroid papillary microcarcinoma (PMC), PMC is associated with central compartment lymph node metastasis. The aim of this study is to evaluate the effect of clinical and pathological factors affecting the central compartment lymph node metastasis in thyroid PMC. SUBJECTS AND METHOD: We undertook a retrospective study of 161 patients treated between January, 2003 and June, 2007 for papillary thyroid microcarcinoma by total thyroidectomy and central compartment neck dissection (n=161) with or without comprehensive lateral neck dissection. Following factors were included to analyze the relationship of tumor size and central compartment lymph node metastasis; sex, age, extracapsular extension, lymphovascular tumor emboli, multifocality, bilaterality, AMES risk group, lateral cervical lymph node involvement. RESULTS: In 109 of 161 patients (67.7%), tumor size between 5-10 mm was significantly related with extracapsular extension (p=0.027) and also with the AMES high risk group (p=0.007). In 75 of 161 patients (46.6%), central compartment lymph node metastasis were found. By univariate analysis, tumor multifocality, bilaterality, and lateral lymph node involvement were related with central compartment lymph node metastasis. But on multivariate analysis, tumor bilaterality (p=0.008) and lateral lymph node involvement (p=0.018) were significantly related with central compartment lymph node metastasis. CONCLUSION: Prophylactic neck dissection of central compartment lymph nodes in PMC should be recommended as a routine procedure particularly for patients with tumor bilaterality and metastatic lymph nodes in the lateral neck.

Microcarcinomas papilares de tiroides no incidentales / Non-incidental papillary microcarcinomas of the thyroid

El significado clínico de los microcarcinomas papilares de tiroides sigue siendo controvertido. La alta prevalencia en autopsias e incidental en tiroidectomías por patología benigna indican un comportamiento clínico indolente. Sin embargo, algunos desarrollan metástasis ganglionares y recurrencia local. Nuestro objetivo fue determinar características clínicas y patológicas de microcarcinonas papilares de tiroides no incidentales (MPT-NI). Se analizaron 18 pacientes con diagnóstico de microcarcinomas (tumor < 1cm) MPTNI con expresión nodular o metastásica. Se evaluaron características clínicas, histopatológicas, pronósticas y evolutivas. De los 18 pacientes con MPT-NI, 12 manifestaron expresión ganglionar inicial. En los 6 restantes, los nódulos tiroideos fueron palpables con PAAF (punción aspiración con aguja fina) positiva. La multicentricidad e infiltración extratiroidea se asoció con metástasis ganglionares en todos los casos. De los 9 diagnósticos por PAAF de metástasis ganglionares, 7 fueron quísticas. En los estudios histológicos el 83.3% de los nódulos fueron no encapsulados, con patrón de papilar clásico predominante. En la evolución, la recurrencia se manifestó en el 46% de los pacientes N1 o con metástasis ganglionar inicial, en nódulos < 4 mm. La infiltración extratiroidea estuvo presente en el 66% de los casos con recurrencia. No manifestaron recurrencia los pacientes sin compromiso ganglionar (N0) o infiltrativo capsular o extratiroideo. En el seguimiento de 10 a 122 meses todos los pacientes se encuentran libres de enfermedad demostrable. Estos resultados sugieren dos grupos de microcarcinomas tiroideos no incidentales, aquellos sin riesgo de evolución intratiroideos -N0- y con riesgo de recurrencia extratiroideos -N1-.

The clinical significance of papillary microcarcinoma of the thyroid gland keeps being controversial. Its high prevalence in autopsies and as incidental findings in thyroidectomy specimens for benign pathology indicate an indolent clinical behavior. Nevertheless some of the microcarcinomas develop lymph node metastasis and local recurrence. To determine the clinical and pathological characteristics of non-incidental papillary microcarcinomas of the thyroid (PTM -NI). 18 patients with diagnosis of non-incidental papillary microcarcinoma (tumor < 1cm) with nodular expression in the thyroid gland or with lymph node metastasis have been studied. Initial diagnosis, prediction factors and evolution have been evaluated. Of 18 patients with PTM-NI, 12 demonstrated lymph node metastasis. 6 patients had positive fine needle aspiration (FNA) of palpable thyroid nodules. Multifocality and extraglandular extension were associated with lymph node metastasis. Seven of the nine metastatic lymph nodes diagnosed by FNA were cystic. Histologically 83.3% of the nodules in the thyroid were non-encapsulated and showed papillary growth pattern. Multifocality and extrathyroid infiltration were associated with lymph node metastasis at presentation. 46% of the patients with thyroid nodules < 4 mm and lymph node involvement (N1) showed recurrence/persistence. The non-incidental intrathyroideal papillary microcarcinoma without capsular involvement, extraglandular extension or lymph node metastasis (N0) did not demonstrate recurrence. These results suggest two groups of non- incidental papillary microcarcinoma of the thyroid (PMT-NI), one intraglandular without risk of evolution -N0- and other extraglandular at risk of recurrence -N1-.

The Prognostic Factors and Therapeutic Strategy for Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: The objectives of this study were to define the prognostic factors of papillary microcarcinoma of the thyroid (PMCT), to analyse their histopathologic and epidemiologic characteristics and to investigate the optimal therapeutic management. METHODS: Our series included 254 consecutive patents who were affected by PMCT and who were operated on by the same surgeon between 1985 and 2002 among a total of 3,100 patients who underwent thyroid surgery. All the surgical specimens were examined in the same Department of Pathology. The prognostic factors were evaluated by uniand multivariate statistical analyses. RESULTS: The histopathologic characteristics such as vascular extension, infiltration into the adjacent parenchyma, a larger primary tumor (size ≥5 mm) or tumor in the thyroid capsule were all indicative of a poor prognosis. For the patents with poor prognostic factors and who were treated by partial thyroidectomy alone, the prevalence of recurrent disease was higher than that for the patients who were with treated by total thyroidectomy and 131 iodine administration. CONCLUSION: According to the prognostic factors, different therapeutic modalities could be proposed to treat patients with pillary thyroid microcarcinoma. It is reasonable to perform total thyroidectomy and 131 iodine therapy for patients with PMCT and who have high risk factors.

Is Routine Central Neck Dissection Necessary for the Treatment of Papillary Thyroid Microcarcinoma?

OBJECTIVES: It remains unclear as to whether routine central neck dissection (CND) is necessary when performing surgery to treat patients with papillary thyroid microcarcinoma (PTMC). To determine the necessity for routine CND in PTMC patients, we reviewed the clinicopathologic and laboratory data of the patients of PTMC. METHODS: Between September 2001 and July 2005, 101 patients with PTMC and clinical N0 disease were retrospectively reviewed. The study cohort was devided into groups: the total thyroidectomy plus CND group (the CND group, N=48) and the total thyroidectomy without CND group (the no CND group, N=53). The serum stimulated thyroglobulin (Tg) levels were measured after surgery and prior to radioactive iodine ablation therapy (RAI) and at 6-12 months after RAI. Pathology, the Tg levels and recurrence data were compared between the 2 groups. RESULTS: Central nodal metastases were found in 18 of the 48 CND patients (37.5%). The incidence of Tg levels >5 ng/mL at RAI was higher in the no CND patients and in the 18 node-positive CND patients compared with the 30 node-negative CND patients (22-24% vs. 3%, respectively, P=0.020-0.058). The difference when performing a similar comparison using a >2 ng/mL Tg threshold level showed no significance (10-11% vs. 4%, respectively, P>0.1). Two of the no CND patients and one node-positive CND patient had recurrences in the thyroid bed or lateral neck during a mean follow-up of 24 months. CONCLUSION: The data showed that occult metastasis to the central neck is common in PTMC patients. A CND provides pathologic information about the nodal metastases, and it potentially provides guidance for planning the postoperative RAI. However, the long-term benefit of CND on recurrence and survival remains somewhat questionable.

Clinical Characteristics of Papillary Thyroid Microcarcinoma (PTMC) / 대한내분비외과학회지

PURPOSE: PTMC is defined as a papillary thyroid cancer smaller than 10 mm in its greatest diameter. It is the most common form of differentiated thyroid cancer and its prognosis is known to be very favorable. The aim of this study is to identify its biologic behavior and to formulate a reasonable therapeutic strategy for the treatment of PTMC. METHODS: 379 patients with papillary thyroid cancer were analyzed. Each patient was diagnosed preoperatively or postoperatively and treated between Jan. 2000 and Dec. 2007. Among these patients, 143 had been identified as having PTMC (37.7%) with a mean tumor size of 0.72 cm in diameter. RESULTS: There were no significant differences of the clinical characteristics such as gender, age, the operative methods, or multicentricity between the PTMC group and the non-PTMC group, except for LN metastases. Also, there were fewer symptoms of palpable neck mass and preoperative findings such as capsular invasion and microcalcification in the PTMC group. We performed unilateral lobectomy with or without central compartment neck node dissection for the early stage diseases, but for the later stages of disease we performed near-total or total thyroidectomy with routine central compartment neck node dissection. And for the patients with lateral node enlargement, we performed ipsilateral modified radical neck dissection (MRND). CONCLUSION: This study shows that PTMC is quite similar to conventional papillary thyroid cancer in its biological behavior, and we conclude that total thyroidectomy with central compartment neck node dissection is the proper therapeutic strategy to treat PTMC. However, further study is necessary for identifying the low-risk and high-risk patients with PTMC.

Papillary Thyroid Microcarcinoma: Clinicopathologic Characteristics and Treatment Strategy

PURPOSE: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. METHODS: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 cm in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 cm in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). RESULTS: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12~86). During a mean follow-up of 32.5+/-18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P 1 cm), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.

The histological features of papillary thyroid carcinomas 1.5 cm and less in size / 대한내과학회지

BACKGROUND: A number of studies have shown that papillary microcarcinomas have a more favorable prognosis than do the larger tumors. However, some microcarcinomas may have a negative outcome. So, we investigated the histological features of small (1.5 cm) tumors. METHODS: Between January, 1996 and December, 2000, 178 patients were diagnosed and operated on for their differentiated papillary thyroid carcinoma at Pusan National University Hospital. We reviewed the charts and pathologic records of these patients and we analyzed them retrospectively. According to the tumor size 1.5cm, we divided the tumors into two groups and then compared the histological features. RESULTS: Small papillary thyroid carcinomas have a favorable outcome in most cases. However, small papillary thyroid carcinomas present with signs of aggressiveness at presentation, including lymph node metastases (33.3%), multifocality (12.5%), bilateral involvement (12.5%) and extrathyroidal extension (16.7%). Compared with larger tumors, the frequency of theses signs was similar, except for lymph node metastases, in the small papillary thyroid carcinomas. CONCLUSIONS: Approximately one third of the small papillary thyroid cancer 1.5 cm and less in size had neck lymph node metastases at presentation and the signs of aggressiveness were similarly present as compared with the larger tumors. We suggested that the standard treatment is desirable as a therapeutic strategy of small papillary thyroid carcinoma.

Clinical Characteristics of Thyroid Micropapillary Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary microcarcinoma of the thyroid gland (PMC) is defined as a papillary thyroid cancer (PTC) measuring less than 1 cm in its diameter. PMC is frequently diagnosed today, mainly as a result of the wide use of neck ultrasonography and fine needle aspiration biopsy. Despite the overall excellent prognosis for patients with PMC, the extent of thyroid resection and the necessity of lymph node dissection have become the issues of controversy. The rising incidence of the PMC among PTC necessitates the identification of prognostic factors and standardization of treatment protocols. Therefore, to evaluate the characteristics of PMC, we reviewed our experiences. SUBJECTS AND METHOD: Between 2000 and 2005, 265 patients underwent thyroid surgery and 194 patients showed PTC. Of these patients, 53 patients (27.3%) had PMC (9 male, 44 female, mean age 50.1 years). The data from these patients were retrospectively analyzed. RESULTS: The mean tumor size was 7.19 mm. The most frequently presenting symptom was thyroid mass only (77%) and the combined thyroid diseases were found in 35 patients (66%). Twelve patients (27.9%) had multifocal microcarcinomas and in 11 patients (20.8%) had extrathyroidal invasion. Lymph node metastasis was found in 18 patients (33.9%). Lymph node metastasis was significantly associated with the presence of extrathyroidal invasion (p=0.031), lymph node metastasis (p=0.008) and extrathyroidal invasion are more frequently observed in PMCs over 5 mm in size. CONCLUSION: These clinical characteristics may be considered as prognostic factors of the PMC. So the treatment modalities should be chosen taking into consideration of the various clinical factors.