2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma

Gao, Ming; Ge, Minghua; Ji, Qinghai; Cheng, Ruochuan; Lu, Hankui; Guan, Haixia; Gao, Li; Z, Guo; Huang, Tao; Huang, Xiaoming; Li, Xiaoming; Yang, Lin; Liu, Qinjiang; Ni, Xin; Pan, Yi; Qin, Jianwu; Shan, Zhongyan; Sun, Hui; Wang, Xudong; Xu, Zhengang; Yu, Yang; Zhao, Dan; Zhang, Nai-song; Zhang, Sheng; Zheng, Ying; Zhu, Jingqiang; Li, Dapeng; Zheng, Xiangqian

doi:10.20892/j.issn.2095-3941.2017.0051

Cited by 104 publications

(98 citation statements)

References 43 publications

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“…Patients with lymph node metastasis have a high recurrence rate, and some cN0 PTMC patients are found to have lymph node metastasis after surgery [10]. In the present study, the cervical lymph node metastasis rate in the hyperechoic halo group was significantly lower than that in nonhyperechoic halo group.…”

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confidence: 47%

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Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender

Zheng

Jiang

Zhao

et al. 2020

BioMed Research International

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Purpose. To investigate the pathology and prognostic value of hyperechoic echo halo in cN0 papillary thyroid microcarcinoma (PTMC) and the relationship between age, gender, and the formation of abnormal hyperechoic echo halo and cervical lymph node metastasis. Data of 97 patients who underwent surgical treatment for the first time for single PTMC between April 2016 and March 2017 were analyzed retrospectively. The boundary status of the PTMC was determined preoperatively. Grayscale values of the nodular center, hyperechoic echo halo, and normal thyroid tissue were acquired with Adobe Photoshop CS6 software. The histopathology of the boundary and status of the cervical lymph node metastasis were analyzed. Formation of abnormal hyperechoic halo and cervical lymph node metastasis in relation to age and gender were explored. The abnormal hyperechoic halo mainly represents cancer cell infiltration with reactive hyperplasia of inflammatory cells and fibrous tissue. In the hyperechoic halo group, the grayscale values for the nodular center, hyperechoic echo halo, and normal thyroid tissue were 1552.6±578.6, 5792.0±747.6, and 3582.7±759.0, respectively (P<0.05). The cervical lymph node metastasis rate was significantly lower in patients with hyperechoic halo (15.0%) than in those without (41.6%; P<0.05) and significantly higher in those aged <45 years (53.3%) than in those aged ≥45 years (28.4%; P<0.05). There were no significant correlations between gender and cervical lymph node metastasis or between age, gender, and hyperechoic halo formation (P>0.05). cN0 PTMC patients with abnormal hyperechoic halo and age >45 years have a significantly reduced risk of cervical lymph node metastasis and relatively good prognosis.

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contrasting

confidence: 47%

“…The basic consensus on the treatment options for patients with thyroid carcinoma lymph node metastases has been clearly defined by scholars and medical workers in both China and worldwide. However, there is still much controversy over the choice of treatment for patients with clinically cervical lymph nodenegative (cN0) PTMC [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender

Zheng

Jiang

Zhao

et al. 2020

BioMed Research International

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“…All patients underwent CLND (level VI) either therapeutic or prophylactic CLND, which is routinely recommended in China. 7 Total thyroidectomy was performed for PTMC patients with bilaterality, gross ETE (gETE), bilateral cervical LNM, or other high-risk features, who would potentially require radioactive iodine ablation therapy. Lateral lymph node dissection (LLND), including neck dissection of level II-IV (level I and V were only dissected when metastatic LNs were present in these compartments), was performed in patients for whom LLNM was confirmed by preoperative FNAC and washout thyroglobulin level.…”

Section: Surgical Proceduresmentioning

confidence: 99%

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Song¹,

Yan²,

Qiu³

et al. 2020

CMAR

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To investigate the risk factors for cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). Patients and Methods: In total, 3686 patients with PTMC who underwent initial surgery in Shanghai Jiao Tong University affiliated Sixth People's Hospital from January 2010 to December 2019 were retrospectively analyzed. Univariate and multivariate analyses were conducted to identify risk factors associated with cervical LNM.

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“…According to the study of Kuma Hospital [ 11 ], the following characteristics are absent in patients diagnosed with harmless PTMC: aggressive features such as nodal or distant metastasis, macroscopic extrathyroidal extension, high-grade malignancy on cytology, evidence of progression, and attachment to the trachea or localization along the course of the recurrent laryngeal nerve. Patients with low-risk PTMC as defined by the CATO [ 12 ], for whom immediate surgery is not required, should satisfy the following conditions: nonaggressive histology, lesion diameter of ≤5 mm, lesions confined to the gland and no tumor invasion of locoregional tissues or structures, no local or distant metastases, no history of familial thyroid carcinoma history, no history of radiation exposure during childhood or adolescence, no intense mental stress, and active cooperation with the treatment (Table 6 ). Accordingly, patients who were screened out were divided into low-risk PTMC group defined by Kuma Hospital, high-risk PTMC group defined by Kuma Hospital and low-risk PTMC group defined by CATO, high-risk PTMC group defined by CATO (without considering subjective choices, mental factors, etc.).…”

Section: Methodsmentioning

confidence: 99%

“…These authors later established a detailed risk stratification for use when considering active surveillance as an alternative to immediate surgery in patients with PTMC with the goal of helping clinicians to determine the appropriateness of an observational management approach [ 10 ]. To prove the feasibility of active surveillance for low-risk PTMC and identify the characteristics of harmless lesions, we performed a retrospective study in which two such criteria were applied to our patients who had undergone surgical treatment: low-risk PTMC characteristics defined by Kuma Hospital and Chinese Association of Thyroid Oncology (CATO) consensus on PTMC management by active surveillance [ 11 , 12 ]. The aim of this study was to obtain authentic clinicopathological characteristics and identify the main indications for strict active surveillance.…”

Section: Introductionmentioning

confidence: 99%

Contrastive study of two screening criteria for active surveillance in patients with low-risk papillary thyroid microcarcinoma: a retrospective analysis of 1001 patients

et al. 2017

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Screening out patients who do not require immediate surgery is a growing trend in the field of thyroid research. In this study, we retrospectively compared the application of two surveillance selection criteria in 1001 patients who had undergone surgical treatment of papillary thyroid microcarcinoma (PTMC): low-risk PTMC characteristics defined by Kuma Hospital and CATO consensus on PTMC management of active surveillance. Treatment outcomes were compared between groups. We then analyzed the prognostic indicators of patients who could be managed by surveillance. A total of 724 patients met Kuma screening criteria and 135 met CATO screening criteria. The Kuma low-risk group had a lower incidence of multifocal lesions and CLNM than Kuma high-risk group. We also found more obvious differences in multifocal lesions, CLNM and extrathyroidal extension when evaluating the CATO low-risk criteria in the same manner. On the other hand, patients in the CATO low-risk group had a lower disease progression rate and longer disease-free survival than those in CATO high-risk group. There was no significant difference in prognosis between the Kuma low-risk group and Kuma high-risk group. Our logistic regression analysis showed that a preoperative ultrasound size of >5 mm, male sex, younger age, and malignant lesions without concurrent benign nodules could be predictors of CLNM. In conclusion, patients classified in CATO low-risk criteria had lower proportion of clinicopathological risk factors than the ones in Kuma low-risk criteria. We also found more risk factors may not be suitable for surveillance, such as tumors without concurrent benign nodules.

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2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma

Cited by 104 publications

References 43 publications

Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender

Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Contrastive study of two screening criteria for active surveillance in patients with low-risk papillary thyroid microcarcinoma: a retrospective analysis of 1001 patients

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