[Papillary thyroid microcarcinoma. Long-term outcome in 587 cases compared with published data].

Divisione di Patologia Speciale Chirurgica, Dipartimento di Scienze Mediche e Chirurgiche , Università di Padova, Istituto Oncologico Veneto-IRCCS, Padova, Italy.
Minerva chirurgica (Impact Factor: 0.68). 11/2007; 62(5):315-25.
Source: PubMed


Papillary thyroid microcarcinoma (PTMC), a tumor measuring =or<1 cm according to the World Health Organization (WHO) histologic classification, is the most common histologic variant of thyroid cancer. The aim of this study was to evaluate the long-term outcome of surgical treatment for PTMC at a single institution with a view to differentiate therapy options based on risk of progression of disease by comparing our results with those reported in the literature.
The study sample was a total of 587 cases of PTMC treated surgically at our institution between 1990 and 2006. PTMC was an incidental finding (PTMC-I) in 325 (55.4%) cases, diagnosed preoperatively (PTMC-D) at echography and needle-aspiration biopsy in 229 (39%), and occult with metastasis (PTMC-O) in 33 (5.6%). Patients were grouped into two classes (PTMC diameter =or>5 mm or <5 mm) and compared against prognostic factors: sex, age, type of PTMC (PTMC-I, PTMC-D, PTMC-O), extent of surgery, lymph node dissection, lymph node metastasis, iodine-131 (131-I) therapy, state of disease, relapses. These parameters were then compared against tumor size (PTMC diameter =or>5 mm or <5 mm), excluding cases of PTMC-O with metastasis.
Comparison of the two groups divided by tumor size, across the entire sample and after PTMC-O cases were excluded, revealed significant differences in the type of PTMC, frequency of partial thyroidectomy, presence of lymph node metastasis, iodine-131 therapy, life status and recurrence rate.
Published PTMC studies were analyzed for definition of the disease, incidence, therapy, prognosis, and follow-up results and compared with our data. The results of our analysis argue against use of the term ''microcarcinoma'' in the wider sense since the three PTMC categories (PTMC-I, PTMC-D, PTMC-O) present different behaviour patterns. When cases of PTMC-O with clinically manifest metastasis were excluded, none of the patients with PTMC <5 mm in diameter were reoperated for tumor recurrence and all are currently free of disease. In conclusion In PTMC <5 mm in diameter, whether PTMC-I and PTMC-D, and without evidence of lymph node involvement, partial thyroidectomy may be a viable approach to treatment. By contrast, occult PTMC with metastasis is prognostically important and should therefore be treated like tumors =or>5 mm in diameter.

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    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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    ABSTRACT: Objective. To study papillary thyroid microcarcinomas (PTMCs) detected incidentally/non-incidentally, especially those with suggestive signs for progression into clinically overt forms. Material and methods. In the first part of study 102 microcarcinomas diagnosed between 1988-2008 were investigated. In the second part we included all the 311 patients thyroidectomized for different thyroid diseases in surgical clinics from Târgu Mures in 2007. Results. During 1988-2008 the frequency of PTMCs increased progressively, achieving a peak in 2007 (46.5% of 58 PTCs). In 2007 from the 311 thyroidectomies 27 microcarcinomas were diagnosed, the majority (70.3%) being incidentalomas. In incidental and non-incidental PTMC groups the rate of microcarcinomas with potential progression into overt carcinomas was 21% and 50%, respectively. Only non-incidental forms with signs of progression were treated by total thyroidectomy in every case, while microincidentalomas just in about half of cases, although all must be treated the same way. Conclusions. After the Chernobyl nuclear accident and use of modern diagnostic methods (ultrasound and FNA) the frequency of PTCs has increased progressively and significantly, including that of microcarcinomas diagnosed mostly incidentally. We must pay attention for PTMCs, because in our casuistry 29.6% harbored suggestive signs (multifocality, extrathyroidal extension, regional lymph node metastases) for progression.
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