Extrathyroid Extension of Well-Differentiated Papillary Thyroid Microcarcinoma on US

Kwak, Jin Young; Youk, Ji Hyun; Kim, Min Jung; Son, Eun Ju; Choi, Sang‐Hoon; Oh, Ki Keun

doi:10.1089/thy.2007.0345

Cited by 132 publications

(136 citation statements)

References 19 publications

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“…5,10,12,19,25 We found microscopic extrathyroidal extension in 14% of the microcarcinomas and all but one harbored the mutation. Our study shows the incidence of extrathyroidal extension in relatively less proportion of cases compared with some of the studies in the literature.…”

Section: Discussionmentioning

confidence: 66%

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

et al. 2013

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BRAF V600E mutation has emerged as a marker of aggressive behavior in papillary thyroid carcinoma but its significance in microcarcinoma is not entirely clear. One-hundred and twenty-nine papillary thyroid microcarcinomas were tested for BRAF V600E mutation by single-strand conformation polymorphism, and their clinicopathologic features (age, sex, tumor size, multifocality, nodal metastases, histologic subtype, tumor cell morphology, architecture, tumor-associated stromal reaction, tumor interface to non-neoplastic thyroid (well circumscribed vs infiltrative), extrathyroidal extension, lymphovascular invasion, intratumoral multinucleated giant cells, and adjacent non-neoplastic thyroid pathology) were examined. Compared with tumors without the mutation (39/129, 30%), the mutated microcarcinomas (90/129, 70%) showed significantly higher prevalence of infiltrative tumor borders (78/90 vs 23/39, P ¼ 0.001), tumor-associated stromal desmoplasia/fibrosis and/or sclerosis (80/90 vs 25/39, P ¼ 0.002), classic nuclear features of papillary thyroid carcinoma (90/90 vs 35/39, P ¼ 0.008) and cystic change (43/90 vs 11/39, P ¼ 0.05). BRAF V600E mutation was more frequent in classic (75%), tall cell (91%), and other variants (470%) than in follicular variant (21%) of papillary thyroid microcarcinoma. Tumors without the mutation were significantly more likely to be solid, well circumscribed, and lacked desmoplasia/fibrosis or sclerosis. However, on multivariate analysis, only the follicular variant of papillary microcarcinoma was significantly associated with the absence of mutation (odds ratio (95% confidence interval): 0.09 (0.01-0.54)). Lymph node metastases (n ¼ 24) were more frequent in microcarcinomas with mutation than without (21/24 vs 3/24, P ¼ 0.02). All patients with lateral cervical node metastasis (n ¼ 9), and all but one tumor with extrathyroidal extension (n ¼ 17/18) showed BRAF V600E mutation. No significant differences were noted in age, sex, tumor size, multifocality, lymphovascular invasion, psammoma bodies, stromal calcification, intratumoral multinucleated osteoclastic-type giant cells, and lymphocytic infiltration between the two groups of tumors. BRAF V600E mutation is an early event in thyroid carcinogenesis, and is associated with distinctive morphology and aggressive features even in papillary thyroid microcarcinomas.

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Section: Discussionmentioning

confidence: 66%

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

et al. 2013

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“…Due to the earlier metastasizing stage, the organization structure of macroscopic metastasizing lymph node can only be detected by histopathologic examination, the echotexture of which is still normal on sonogram. However, ultrasonography of thyroid nodules presently is a useful technique for differentiating or even diagnosing thyroid pathology and may be still very effective in predicting lymph node metastasis and distinguishing between tumor stages (Shimura H et al, 2005;Tae HJ et al, 2007;Kwak JY et al, 2008;Joo JY et al, 2012;Ito Y et al, 2013;Kim KE et al, 2013). Highfrequency ultrasound can allow for the diagnosis of solid nodules smaller than 3mm and describe the sonographic features of nodules exactly.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, according the p-value and odds ratio of table 3, extrathyroid extension is the second most related to CLNM. Extrathyroid extension has been widely considered to have a high risk of CLNM (Kwak et al, 2008;Choi et al, 2012;Joo et al, 2012;Patron et al, 2012;Zhan et al, 2012;Ito et al, 2013). Closer proximity to the capsule will offer more chances for tumors to touch those lymphatic vessels, thus contributing to metastasis of cancer cells along the lymphatic tubes.…”

Section: Discussionmentioning

confidence: 99%

Shorter Distance Between the Nodule and Capsule has Greater Risk of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

Wang¹,

Cheng²,

Wen³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…It could be helpful to use the more specific set of features for diagnosing invasive thyroid microcarcinoma but an optimal definition of such a set is still being sought. In order to increase the chances of early detection of small invasive cancers, it seems reasonable to follow up small lesions revealed in the thyroid with repeated US examinations that allow detection of any significant increase in the lesion's size and analysis of the lesion's relationship with the thyroid capsule as well as evaluation of lymph nodes in the neck (30).…”

Section: Second Version (%)mentioning

confidence: 99%

“…The differences described above in epidemiological situations of examined populations result in significant differences in the reported data on FP and FN results, as well as sensitivity (from 65 to 99%) and specificity (from 72 to 100%) of thyroid FNAB (30,(35)(36)(37)(38)(39)(40).…”

Section: Second Version (%)mentioning

confidence: 99%

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

Słowińska-Klencka

Popowicz²,

Lewiński³

et al. 2008

European Journal of Endocrinology

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Objective: To evaluate the incidence of focal lesions in the thyroid in the area of recently normalized iodine supply as well as to compare the efficacy of fine-needle aspiration biopsy (FNAB) of small (infracentimetric) and large thyroid lesions in this area. Methods: The outcomes of 13 646 ultrasound (US) examinations, 13 437 US-guided FNABs of the thyroid and 1694 results of post-operative histopathological examinations were analysed. Results: Infracentimetric nodules (INs %10 mm) were revealed by US examinations in 43.5% of patients; in the majority of the cases (82.2%) INs were multiple. The percentage of revealed carcinomas by aspiration of INs is similar to that observed when large nodules (LNs O10 mm) are examined cytologically. However, the efficiency of preoperative diagnosis of INs is lower than LNs with respect to both US selection of lesions for FNAB and the percentage of false negative results of FNAB (29.8 vs 5.4%, P!0.001). In post-operative histopathological examination, extrathyroidal extension of thyroid cancers was observed in nearly 30% of microcarcinomas. Conclusions: In endemic or post-endemic areas, the efficiency of FNAB is lower in the case of small lesions than larger ones. In spite of this, the percentage of cytologically revealed carcinomas among small lesions is not lower than larger ones. Thus, it is particularly indicated to follow up small thyroid lesions with repeated US examinations in such areas.European Journal of Endocrinology 159 747-754

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Extrathyroid Extension of Well-Differentiated Papillary Thyroid Microcarcinoma on US

Abstract: This study suggests that the presence and degree of contact between a PTMC and the adjacent capsule as found on preoperative US can provide an useful predictive information about an extrathyroidal extension.

Cited by 132 publications

References 19 publications

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

Shorter Distance Between the Nodule and Capsule has Greater Risk of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply

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