Article

Papillary thyroid microcarcinoma: A study of 900 cases observed in a 60-year period

Division of Endocrinology and Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minn, USA.
Surgery (Impact Factor: 3.11). 01/2009; 144(6):980-7; discussion 987-8. DOI: 10.1016/j.surg.2008.08.035
Source: PubMed

ABSTRACT The study aims were to characterize patients with papillary thyroid microcarcinoma (PTM) and to describe post-surgical outcome.
Nine hundred PTM patients had initial treatment at Mayo Clinic during 1945-2004. Mean follow-up was 17.2 years. Recurrence and mortality details were derived from a computerized database.
Median tumor size was 7 mm; 98% were intrathyroidal. 273 patients (30%) had neck nodal involvement; 3 (0.3%) had distant metastases at diagnosis. Seven-hundred and sixty-five (85%) underwent bilateral lobar resection (BLR; total-, near-total, or bilateral subtotal thyroidectomy). Regional nodes were removed by either "node picking" (27%) or compartmental dissection (23%). Tumor resection was incomplete in 5 (0.6%). Radioiodine remnant ablation (RRA) was performed in 155 (17%). Overall survival did not differ from expected for an age and gender matched control group (P = .96); 3 patients (0.3%) died of PTM. None of the 892 patients with initial complete tumor resection developed metastatic spread during 20 postoperative years. Twenty-year and 40-year tumor recurrence rates were 6% and 8%, respectively. Higher recurrence rates were seen with multifocal tumors (P = .004) and node-positive patients (P < .001). Neither more extensive surgery nor RRA reduced recurrence rates compared to unilateral lobectomy.
More than 99% of PTM patients are not at risk of distant spread or cancer mortality. RRA after BLR did not improve postoperative outcome.

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    • "In a high percentage of cases, central or lateral lymph nodal metastases are observed without a demonstrated impact on survival, as well as the discordance between the rate of lymph node micrometastases and the low incidence of clinical recurrence, following TT without routine LD, is still subject of research. Nevertheless, it must be considered that, especially in older patients, lymphatic metastases may affect recurrence and survival rates [14]. Multifocal primary tumor, infiltration of thyroid capsule, patient age (pediatric or geriatric population), tumor size, several oncogenes (p53, BRAF), are associated with node involvement and are considered the main risk factors for recurrence [16]. "
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    International Journal of Surgery (London, England) 05/2014; 12. DOI:10.1016/j.ijsu.2014.05.010 · 1.65 Impact Factor
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    • "The high rate of micro and clinical nodal metastases is in contrast with the low incidence of clinical recurrence following TT without LD, and remains an "obscure" issue in oncology. According to recent studies, nodal metastases may affect recurrence and survival rates especially in older patients [13]. Multifocal primary tumor, infiltration of thyroid capsule, patient age (pediatric or geriatric population), tumor size greater than 3 cm, several oncogenes (p53, BRAF), nodal metastases (number and size), as demonstrated in our series, are considered the main risk factors for local recurrence [16,23]. "
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    BMC Surgery 10/2013; DOI:10.1186/1471-2482-13-S2-S3. · 1.24 Impact Factor
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    • "Despite good overall prognosis of PTMC, recurrence of the disease after initial surgical cure remains a troublesome problem.9,12,13 According to the study by Hay, et al.,14 the recurrence within cervical lymph nodes was more than 80%. They noted "nodes beget nodes". "
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