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: 4.07). 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.

Download full-text

Full-text

Available from: Ettore degli Uberti, Feb 18, 2014
    • "The clinical management of patients with PTMCs, however, remains variable and controversial, because these tumors generally have a clinically indolent and innocuous course with excellent clinical prognosis. Some cases of PTMC, however, do exhibit aggressive clinicopathological characteristics and poor clinical outcomes (Roti et al. 2008). Therefore, identification of markers capable of distinguishing these aggressive tumors, especially in the phase before surgery, would be very useful in guiding appropriate clinical management of PTMC. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prognostic value of the BRAFV600E mutation resulting in poor clinical outcomes of papillary thyroid carcinoma have been generally confirmed. However, the association of BRAFV600E with aggressive clinical behaviors of papillary thyroid microcarcinoma (PTMC) has not been firmly established in individual studies. We performed this meta-analysis to examine the relationship between BRAFV600E mutation and the clinicopathological features of PTMC. We conducted a systematic search in PubMed, EMBASE and the Cochrane library for relevant studies. We selected all the studies that reported clinicopathological features of PTMC patients with available information on BRAFV600E mutation status. Nineteen studies consisting of a total of 3,437 patients met these selection criteria and were included for analyses. The average prevalence of the BRAFV600E mutation was 47.48%, with no significant difference with patient sex (male vs female) and age (younger than 45 years vs 45 years or older). Compared with the wild-type BRAF gene, BRAFV600E mutation was associated with tumor multifocality (OR 1.38; 95% CI, 1.04-1.82), extrathyroidal extension (OR 3.09; 95% CI, 2.24-4.26), lymph node metastases (OR 2.43; 95% CI, 1.28-4.60), and advanced stage (OR 2.39; 95% CI, 1.38-4.15) of PTMC. Thus, our findings from this large meta-analysis definitively demonstrate that BRAFV600E mutation-positive PTMC are more likely to manifest with aggressive clinicopathological characteristics. In appropriate clinical settings, testing of BRAFV600E mutation is likely to be useful in assisting the risk stratification and management of PTMC.
    No preview · Article · Jan 2015 · Endocrine Related Cancer
  • Source
    • "We then investigated the presence of a correlation between histopathological findings and serum leptin levels. In WDTC, the size of the primary tumor, multifocality, and lymph node status are essential criteria in risk stratification into either low risk or high risk and will predict disease recurrence [27, 28]. Although trends were demonstrated between leptin levels and each of tumor size (p = 0.079), malignant lymph node involvement (p = 0.48), and multifocal disease (p = 0.064), the differences did not reach statistical significance. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background There is a proven relationship between obesity and several cancers including breast, endometrium, colorectal, and esophagus. With the increasing incidence of both obesity and thyroid cancer, we designed the present study to investigate a causal relationship between leptin, which is one of the well known adipokines, and well-differentiated thyroid cancer (WDTC). Methods Serum leptin levels were measured in 30 patients with WDTC and compared to 30 healthy control subjects before and 1 month after surgery. Other parameters studied included age, sex, body mass index, menopausal status in women, lymph node status, tumor size, and disease multifocality. Results There were no differences between the two groups regarding age and sex. Preoperative leptin levels were higher in the WDTC patients when compared to the control patients [19.25 (1.50–109.60) vs 0.90 (0.50–11.80) ng/ml, p < 0.001, group 1 vs group 2, respectively]. A significant drop in leptin levels 1 month after surgery occurred in the WDTC group, falling from 19.25 (1.50–109.60) to 0.90 (0.60–8.90) ng/ml (p < 0.001). This did not occur in the control group (p = 0.274). Lymph node involvement, tumor size, and multifocality had no effect on leptin levels, although trends were observed (p = 0.48, 0.079, and 0.064), respectively. Conclusions Serum leptin levels were significantly higher in WDTC patients when compared to control group patients, with a significant drop after surgery. Leptin may play a role in diagnosis of WDTC; however, its prognostic value is still undetermined.
    Full-text · Article · May 2014 · European Journal of Surgical Oncology
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jan 2014
Show more