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Management of incidental and non-incidental papillary thyroid microcarcinoma

Published online by Cambridge University Press:  02 April 2013

M S Elliott ,
K Gao ,
R Gupta ,
E L Chua ,
A Gargya  and
J Clark
M S Elliott*
Affiliation:
Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia Sydney Medical School, University of Sydney, New South Wales, Australia
K Gao
Affiliation:
Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia
R Gupta
Affiliation:
Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
E L Chua
Affiliation:
Sydney Medical School, University of Sydney, New South Wales, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
A Gargya
Affiliation:
Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
J Clark
Affiliation:
Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, Australia
*
Address for correspondence: Dr Michael Elliott, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, Australia 2050 E-mail: [email protected]
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Abstract

Background:

The incidence of papillary thyroid cancer is rising, with an increase in the number of microcarcinomas being discovered. There is controversy in the literature regarding the optimal management of these tumours. This study aimed to review our institution's experience with the presentation and management of papillary thyroid microcarcinoma.

Methods:

Retrospective analysis from the Sydney Head and Neck Cancer Institute, from 1987 to 2009.

Results:

A total of 228 patients were analysed. Papillary thyroid microcarcinomas were discovered incidentally in 116 (50.9 per cent) patients and non-incidentally in the remaining 112 (49.1 per cent) patients. Amongst the non-incidental group, 11.6 per cent of patients presented with lateral cervical lymph node involvement. Non-incidental microcarcinomas were significantly associated with younger age (<45 years) (p = 0.007) and larger tumours (5–10 mm) (p < 0.001). Only four patients in the incidental group suffered recurrent disease (locoregional). No patient developed distant metastatic disease or died during follow up.

Conclusion:

Papillary thyroid microcarcinomas present both incidentally and non-incidentally, with equal prevalence. Non-incidental tumours not infrequently present with cervical lymph node disease. The patient outcome is generally excellent.

Keywords

Papillary Thyroid MicrocarcinomaThyroid CancerThyroid Neoplasms
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Supplement S2 , July 2013 , pp. S17 - S23
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Hedinger, C, Williams, ED, Sobin, LH. Histological Typing of Thyroid Tumours, 2nd edn.Berlin: Springer-Verlag, 1988CrossRefGoogle Scholar
2Davies, L, Welch, HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006;295:2164–7CrossRefGoogle ScholarPubMed
3American Joint Committee on Cancer Staging. Manual for Staging of Cancer, 6th edn.Philadelphia: J B Lippincott, 2002Google Scholar
4Olen, E, Klinck, GH. Hyperthyroidism and thyroid cancer. Arch Pathol 1966;81:531–5Google ScholarPubMed
5Carlini, M, Giovannini, C, Mercadante, E, Castaldi, F, Dell'Avanzato, R, Zazza, S. Incidental thyroid microcarcinoma in benign thyroid disease: incidence in a total of 100 consecutive thyroidectomies. Chir Ital 2006;58:441–7Google Scholar
6Grodski, S, Brown, T, Sidhu, S, Gill, A, Robinson, B, Learoyd, D et al. Increasing incidence of thyroid cancer is due to pathological detection. Surgery 2008;144:1038–43CrossRefGoogle Scholar
7Cooper, DS, Doherty, GM, Haugen, BR, Kloos, RT, Lee, SL, Mandel, SJ et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214CrossRefGoogle ScholarPubMed
8Roti, E, Delgli Uberti, EC, Bondanelli, M, Braverman, LE. Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 2008;159:659–73CrossRefGoogle ScholarPubMed
9Lombardi, CP, Bellantone, R, De Crea, C, Paladino, NC, Fadda, G, Salvatori, M et al. Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 2010;34:1214–21CrossRefGoogle Scholar
10Durante, C, Attard, M, Torlontano, M, Ronga, G, Monzani, F, Costante, G et al. Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinoma. J Clin Endocrinol Metab 2010;95:4882–8CrossRefGoogle Scholar
11Bilimoria, KY, Bentrem, DJ, Ko, CY, Stewart, AK, Winchester, DP, Talamonti, MS et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 2007;246:375–84CrossRefGoogle ScholarPubMed
12Ito, Y, Uruno, T, Nakano, K, Takamura, Y, Miya, A, Kobayashi, K et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003;13:381–7CrossRefGoogle ScholarPubMed
13Mazzaferri, EL, Kloos, RT. Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447–63CrossRefGoogle ScholarPubMed
14Shattuck, TM, Westra, WH, Ladenson, PW, Arnold, A. Independent clonal origins of distinct tumor foci in multifocal papillary microcarcinoma. N Engl J Med 2005;352:2406–12CrossRefGoogle Scholar
15Noguchi, S, Yamashita, H, Uchino, A, Watanabe, S. Papillary microcarcinoma. World J Surg 2008;32:747–53CrossRefGoogle ScholarPubMed
16So, YK, Hong, SD, Seo, MY, Baek, CH, Jeong, HS, Chung, MK. Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery 2010;148:526–31CrossRefGoogle ScholarPubMed
17Machens, A, Holzhausen, HJ, Dralle, H. The prognostic value of primary tumour size in papillary and follicular thyroid carcinoma. Cancer 2005;103:2269–73CrossRefGoogle ScholarPubMed
18Chow, SM, Law, SC, Chan, JK, Au, SK, Yau, S, Lau, WH. Papillary microcarcinoma of the thyroid – prognostic significance of lymph node metastasis and multifocality. Cancer 2003;98:31–40CrossRefGoogle ScholarPubMed
19Wada, N, Duh, QY, Sugino, K, Iwasaki, H, Kameyama, K, Mimura, T et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 2003;237:399–407CrossRefGoogle ScholarPubMed
20Bonnet, S, Hartl, D, Leboulleux, S, Baudin, E, Lumbroso, JD, Al Ghuzlan, A et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 2009;94:1162–7CrossRefGoogle ScholarPubMed
21Sugitani, I, Fujimoto, Y. Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocr J 1999;46:209–16CrossRefGoogle ScholarPubMed
22Basolo, F, Torregrossa, L, Giannini, R, Miccoli, M, Lupi, C, Sensi, E et al. Correlation between the BRAF 600E mutation and tumour invasiveness in papillary thyroid carcinomas smaller than 20 millimeters: analysis of 1060 cases. J Clin Endocrinol Metab 2010;95:4197–205CrossRefGoogle Scholar
23Xing, M, Westra, WH, Tufano, RP, Cohen, Y, Rosenbaum, E, Rhoden, KJ et al. BRAF mutation predicts a poorer clinical prognosis for papillary thyroid cancer. J Clin Endocrinol Metab 2005;90:6373–9CrossRefGoogle ScholarPubMed
24Ito, Y, Miyauchi, A, Inoue, H, Fukushima, M, Kihara, M, Higashiyama, T et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg 2010;34:28–35CrossRefGoogle ScholarPubMed
25Sugitani, I, Toda, K, Yamada, K, Yamamoto, N, Ikenaga, M, Fujimoto, Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg 2010;34:1222–31CrossRefGoogle ScholarPubMed
26Yamashita, H, Noguchi, S, Murakami, N, Toda, M, Uchino, S, Watanabe, S et al. Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer 1999;86:842–93.0.CO;2-X>CrossRefGoogle ScholarPubMed