Article

Thyroid papillary microcarcinoma: A descriptive and meta-analysis study

Institute of Endocrinology, University of Milan, 20133 Milan, Italy.
European Journal of Endocrinology (Impact Factor: 3.69). 09/2008; 159(6):659-73. DOI: 10.1530/EJE-07-0896
Source: PubMed

ABSTRACT The authors review anatomical, clinical characteristics and prevalence of thyroid microcarcinoma. Diagnostic procedures and risk factors of aggressiveness at diagnosis and during follow-up are also covered. The possible clinical, pathologic and therapeutic risk factors are analyzed by meta-analysis study. Treatment procedures by different authors and guidelines suggested by societies are reported.

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    • "Multifocality and extra-thyroidal extension were associated with an increased risk of lymphatic metastasis including the laterocervical area [28] [31] and a higher mortality rate and neoplastic relapse [32]. The risk of tumour recurrence varies in the case of multifocality from 1% to 2% in unicentric papillary micro carcinoma, 4e6% in multifocal papillary micro-carcinoma [33] [34], 8e10% in >4 cm intra-thyroidal PTC [35]. In our study, analysis of variance revealed that only extra-capsular extension may be considered a predictor of relapse. "
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    ABSTRACT: Aims of the study: The aim of this retrospective study was to appraise the impact of central neck dissection (CND) when treating papillary thyroid carcinoma (PTC) and identifying predictors of tumour recurrence by analysing the results and complications related to this surgical procedure. Materials and methods The study examined the histories of 347 patients with PTC, divided into two groups: group A including 284 patients who underwent total thyroidectomy (TT) only; group B including 63 patients who underwent TT and CND and possible lateral neck dissection (LND). Results The patients in the B group were younger than those in the A group (an average of 44.5 vs. 48.6; p = 0.03) and their tumours were larger (1.91 cm vs 1.27 cm, p = 0.001). Multifocality, extra-capsular extensions of the neoplastic mass and high cell histological variant were more prevalent in the B group. The incidence of permanent hyperparathyroidism was higher in group B than in group A (25.4% vs 9.5%, p = 0.0006). Recurrence of disease and the numbers requiring reoperation were also higher in group B: (24.1% in group B vs 6.6 in group A, p <0.0001). Patients classified as clinically N0 at their first operation and who were most probably clinically N1, totalled 6.6%. Conclusions Our data show that only extra-capsular extension may be considered a predictor of recurrence. The findings of our study support the idea of carrying out "therapeutic" CND only in cases of preoperative or macroscopic intraoperative clinical evidence of lymph-node involvement.
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    • "Thyroid cancer incidence is steadily increasing both in the US and Europe [1] [2], with the largest increase observed for tumors 10 mm in diameter [1]. Thyroid cancer 10 mm has been defined as thyroid microcarcinoma, usually papillary (papillary thyroid microcarcinoma, PTMC); in a review of the literature published in 1966–2008, PTMC represented 28.8% of papillary thyroid cancer, 22.9% of all thyroid cancer, and 3.8% of all thyroidectomies [3]. However, these figures are raising over time: in France, the proportion of microcarcinomas among operated cancer increased from 18.4% in 1983–1987 to 43.1% in 1998–2001 [4]. "
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    ABSTRACT: To investigate the effects of changing surgical practices on thyroid cancer incidence in the Veneto Region (North-Eastern Italy). Hospital discharge records of the period 2000-2010 were analyzed to detect trends in thyroid surgery rates by type of surgery and diagnosis. The association between surgery rates for benign and malignant diseases across the 21 Local Health Units (LHUs) was assessed by Poisson regression. In a second step, clinical and pathological charts of the year 2010 were retrieved from the larger regional surgical center. The proportions of total and incidental papillary thyroid micro carcinoma (PTMC) were compared with historical data. Factors influencing an incidental diagnosis of PTMC were analyzed by logistic regression. Among 26,000 procedures performed in the Region, there was an increase with time in the proportion of total thyroidectomies (from 67% to 78%) and surgeries with a diagnosis of thyroid cancer (from 17% to 28%). Cancer surgery rates across LHUs resulted associated to surgery rates for benign diseases (P<0.001). In the largest regional center, the proportion of PTMC increased from 35% to 56%, of whom almost 60% were incidental cases. The probability of finding an incidental PTMC was higher in total thyroidectomies than in other procedures (odds ratio=1.84, 95% confidence interval 1.08-3.14). Data from the Veneto Region suggest that the increase in PTMC is due to several factors: increased preoperative diagnosis, total gland removal, extensive histological examination. Moreover, geographical variations in cancer incidence were associated to surgery rates for benign diseases.
    Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 10/2013; DOI:10.1016/j.biopha.2013.10.001 · 2.11 Impact Factor
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    • "It is mostly diagnosed in patients who have undergone surgery for benign diseases of the thyroid gland [29] [30]. In a study, 71% of the papillary thyroid microcarcinomas were incidentally diagnosed in patients undergoing surgery for benign diseases [31]. Incidental papillary thyroid microcarcinoma rates are reported as 3.1% and 21% respectively in two other studies [32] [33]. "
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    ABSTRACT: Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thyroidectomy (STT) and neartotal thyroidectomy (NTT) are preferred surgical procedures. However, it is uncertain whether the remnant tissue contains pathological findings or not after these procedures. We aimed to evaluate and comparison the pathologic findings in remnant tissue after NTT and STT. Thyroid tissue samples of 50 patients who underwent TT for MNG disease between January 2010 and August 2011 in our clinic were evaluated. Before the dissection of the thyroid tissue subtotal and neartotal margins were marked in both right and left lobes. After the resection of the specimen, the tissue was excised from the subtotal and neartotal margin marked during the surgery. The pathologic findings of the main tissue, the residual subtotal and neartotal tissues were evaluated and compared. All patients were followed-up 1 year. 43 (86%) females and 7 (14%) males with an average age of 50.5 (23-77) were included in the study. Incidental papillary thyroid cancer was detected in 5 patients (10%). Pathologic findings were present in 31 patients (62%) of subtotal residual tissue and 28 of the patients (56%) of neartotal residual tissue. Papillary microcarcinoma was detected in 3 (9.7%) of subtotal residual tissues and 2 (7.1%) of neartotal residual tissues. There is no significant difference between subtotal and neartotal tissues in terms of existence of pathological findings (p>0.05). There is no significant difference between the neartotal and subtotal residual tissues contralateral of dominant nodule (p>0.05). 2 of the patients (4%) had temporary hypocalcemia, 1 patient (2%) had seroma and 1 patient (2%) had recurrent laryngeal nerve injury. There are high rates of microscopic pathological findings on residual tissues both after STT and NTT. The neartotal and subtotal residual tissues contralateral to the large nodule also had high levels of pathologic findings.
    International Journal of Clinical and Experimental Medicine 01/2013; 6(10):922-929. · 1.42 Impact Factor
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