Lymph Node Metastasis From 259 Papillary Thyroid Microcarcinomas

Wada, Nobuyuki; Duh, Quan Yang; Sugino, Kiminori; Iwasaki, H.; Kameyama, Kaori; Mimura, Takashi; Ito, Koichi; Takami, Hiroshi; Takanashi, Yoshinori

doi:10.1097/01.sla.0000055273.58908.19

Cited by 624 publications

(249 citation statements)

References 21 publications

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“…In contrast, however, the prevalence of clinical thyroid papillary carcinoma was 1.9-11.7 per 100,000 females of all ages [3,10], which is about 1,000 times lower than that of PMC detected on ultrasonography. The marked difference between these prevalences suggests that PMC rarely grow and become clinically apparent, prompting the question of whether immediate surgery is mandatory for all PMC detected on mass screening, although PMC is also known to show multicentricity in 15-44% of lesions and regional lymph node metastasis in 14-64% of lesions [11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

et al. 2009

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Background The recent development and spread of ultrasonography and ultrasonography-guided fine needle aspiration biopsy (FNAB) has facilitated the detection of small papillary microcarcinomas of the thyroid measuring 1 cm or less (PMC). The marked difference in prevalence between clinical thyroid carcinoma and PMC detected on mass screening prompted us to observe PMC unless the lesion shows unfavorable features, such as location adjacent to the trachea or on the dorsal surface of the thyroid possibly invading the recurrent laryngeal nerve, clinically apparent nodal metastasis, or high-grade malignancy on FNAB findings. In the present study we report comparison of the outcomes of 340 patients with PMC who underwent observation and the prognosis of 1,055 patients who underwent immediate surgery without observation. Methods Between 1993 and 2004, 340 patients underwent observation and 1,055 underwent surgical treatment without observation. These 1,395 patients were enrolled in the present study. Observation periods ranged from 18 to 187 months (average 74 months). Results The proportions of patients whose PMC showed enlargement by 3 mm or more were 6.4 and 15.9% on 5-year and 10-year follow-up, respectively. Novel nodal metastasis was detected in 1.4% at 5 years and 3.4% at 10 years. There were no factors related to patient background or clinical features linked to either tumor enlargement or the novel appearance of nodal metastasis. After observation 109 of the 340 patients underwent surgical treatment for various reasons, and none of those patients showed carcinoma recurrence. In patients who underwent immediate surgical treatment, clinically apparent lateral node metastasis (N1b) and male gender were recognized as independent prognostic factors of disease-free survival. Conclusions Papillary microcarcinomas that are not associated with unfavorable features can be candidates for observation regardless of patient background and clinical features. If there are subsequent signs of progression, such as tumor enlargement and novel nodal metastasis, it would not be too late to perform surgical treatment. Even though the primary tumor is small, careful surgical treatment including therapeutic modified neck dissection is necessary for N1b PMC patients.

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Section: Introductionmentioning

confidence: 99%

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

et al. 2009

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“…El elevado porcentaje de multifocalidad y compromiso local o regional justifica realizar una tiroidectomía total y en aquellos casos en que se detecte multifocalidad, compromiso ganglionar, invasión capsular o vascular, asociar terapia ablativa con radioyodo. Esta experiencia es semejante a la comunicada por otros autores, quienes señalan que debido a la alta proporción de pacientes con cáncer papilar multifocal, aun con tumores pequeños sería necesario realizar una tiroidectomía total, ya que existe el riesgo de dejar tejido tumoral en el lóbulo contralateral [4][5][6]11 . También existe una mayor recurrencia tumoral cuando se realiza solo lobectomía 12 , se aumenta el riesgo de crecimiento nodular benigno 13 y se complica el seguimiento mediante el uso de tiroglobulina.…”

Section: Discussionunclassified

“…En la actualidad, se han identificado como factores de riesgo de comportamiento más agresivo de los MCT la multifocalidad 4 , la presencia de linfonodos metastásicos 5,6 , compromiso de la cápsula del linfonodo 6,7 y la presencia de metás-tasis a distancia 4 . La variedad familiar del MCT también tendría un comportamiento más agresivo 8 .…”

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Características de presentación del microcarcinoma papilar del tiroides: Experiencia retrospectiva de los últimos 12 años

et al. 2005

Rev. méd. Chile

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(15 and 2.5%, respectively, p <0.001, for the former; 32.4 and 1.7%, respectively, p <0.001, for the latter). Conclusions: In this series, one third of microcarcinomas were multifocal and 10% had lymph node involvement. Therefore, the aggressiveness of these tumors is higher than what is reported in the literature and they should be treated with total thyroidectomy (Rev Méd Chile 2005; 133: 1305-10).

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“…Wada et al who did prophylactic central compartment lymphadenectomy in clinically node negative patients with microPTC who underwent thyroidectomy, reported that up to 60.9% had involved nodes [14]. Larger primary lesions, follicular variant of microPTC and the extension of the lesion beyond the thyroid capsule are identified as risk factors for lymph node metastasis [4].…”

Section: Pathologic Characteristicsmentioning

confidence: 99%

Papillary microcarcinoma of the thyroid: a review

Gunawardena

Ranasinghe

2017

Sri Lanka j Surg

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Papillary cancers of the thyroid less than 1cm in diameter are defined as microcarcinomas. Although considered as a disease with an indolent course with excellent long term prognosis a significant proportion with this condition will have lymph node metastasis at diagnosis. Clinicians need to be aware of the pathological characteristics, natural history and the internationally accepted treatment strategies when managing patients with micropapillary cancers as increasing numbers of patients are expected to be diagnosed with this condition due to widespread use of imaging modalities for numerous other indications. This brief review aims to summarize these aspects with emphasis on management.

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Lymph Node Metastasis From 259 Papillary Thyroid Microcarcinomas

Abstract: Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.

Cited by 624 publications

References 21 publications

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

Características de presentación del microcarcinoma papilar del tiroides: Experiencia retrospectiva de los últimos 12 años

Papillary microcarcinoma of the thyroid: a review

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