Outcome of papillary thyroid microcarcinoma: Study of 1,990 cases

Lu, Zhongzhi; Zhang, Yan; Wei, Songfeng; Li, Dongsheng; Zhu, Qinsheng; Sun, Shenghong; Li, Min; Li, Li

doi:10.3892/mco.2015.495

Cited by 23 publications

(22 citation statements)

References 22 publications

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“…In China, its mutation rate is up to 69%-85.3% in patients with PTC. 10,17 The BRAF V600E mutation analysis has proved valuable and accurate as an adjunctive diagnostic tool on US-FNA in providing additional information in the differential diagnosis of PTC that shows nondiagnostic or indeterminate cytology results. 8,[18][19][20] However, what role does the BRAF V600E mutation analysis play in thyroid nodules with highly suspicious US features and negative FNA findings?…”

Section: Resultsmentioning

confidence: 99%

Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results

Chen¹,

Zhou²,

Wang³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Limitations of ultrasound-guided fine-needle aspiration include nondiagnostic, indeterminate cytology and false-negative results. The BRAF V600E mutation is a specific biomarker for papillary thyroid carcinoma. This study aimed to investigate the additional diagnostic role of the BRAF V600E mutation in high-risk thyroid nodules with benign cytology results. MATERIALS AND METHODS: A total of 787 high-risk nodules in 720 patients underwent ultrasound-fine-needle aspiration. A subsequent BRAF V600E mutation test was performed on thyroid nodules with benign cytology. Final pathology confirmed thyroid nodules with benign cytology that were positive for the BRAF V600E mutation. Ultrasound was performed on thyroid nodules with benign cytology results that were negative for the BRAF V600E mutation. Fine-needle aspiration was repeated on thyroid nodules with enlarged size or changed ultrasound features. RESULTS: Among the 787 nodules, 292 thyroid nodules had benign cytology results with 256 nodules negative for the BRAF V600E mutation and 36 nodules positive for the BRAF V600E mutation. Thirty-one nodules positive for the BRAF V600E mutation were confirmed malignant, and 5 nodules were confirmed benign by pathology. Fine-needle aspiration was repeated on 11 enlarged thyroid nodules with benign cytology findings that were negative for the BRAF V600E mutation. The results of repeat fine-needle aspiration were 4 benign nodules, 2 follicular neoplasms or suspected follicular neoplasms, 3 suspected malignancies, and 2 malignant nodules. Among the 36 thyroid nodules positive for the BRAF V600E mutation, 25 (69.4%) had Ն2 suspicious ultrasound features and 11 (30.6%) nodules had 1 suspicious ultrasound feature. CONCLUSIONS: The BRAF V600E mutation test can detect papillary thyroid carcinomas that might be missed by fine-needle aspiration. We recommend that fine-needle aspiration be routinely accompanied by the BRAF V600E mutation test in high-risk thyroid nodules with Ն2 suspicious ultrasound features. ABBREVIATIONS: FNA ϭ fine-needle aspiration; PCR ϭ polymerase chain reaction; PTC ϭ papillary thyroid carcinoma; US ϭ ultrasound

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Section: Resultsmentioning

confidence: 99%

Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results

Chen¹,

Zhou²,

Wang³

et al. 2018

AJNR Am J Neuroradiol

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“…By contrast, other clinicians suggest that PCLND can reduce the recurrence and improve the survival (59,60). Previous research has revealed that CLNM of PTMC, without risk factors such as male gender, age ≥45, extrathyroid invasion, multifocality and aggressive subtype, was only 6.80–8.13% and PCLND was not recommend (20,36). On the contrary, PCLND was necessary in PTMC with these factors (13,25).…”

Section: Discussionmentioning

confidence: 98%

“…The result of Zhao et al (34) shows male gender and age ≥45 are at a higher risk of lymph node metastasis; however, certain other previous studies demonstrated that no statistically significant association existed between them (20,34,35). The research of 1,990 PTMC cases reported that the male incidence of thyroid carcinoma was associated with absence of environment protection mechanisms and emphasized that surgical intervention may possibly improve male's prognosis (36). An age ≥45 is commonly considered as a risk factor for tumor recurrence and lymph node metastasis, however, other literature has suggested that adolescents tend to develop neck lymph node metastasis (35–37).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Tao

Wang

et al. 2016

Molecular and Clinical Oncology

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Currently the surgical approach for papillary thyroid microcarcinoma (PTMC), particularly the range of lymph node dissection, remains controversial. The present study aims to evaluate the risk factors for central and lateral lymph node metastasis (CLNM and LLNM) for appropriate clinical decision of neck lymph node dissection in PTMC. A total of 66 cases of PTMC that underwent unilateral or bilateral lobectomy plus prophylactic cervical lymph node dissection were collected for clinicopathological evaluation, including age, gender, tumor size, subtypes, extrathyroidal invasion, multifocality, calcifications, loss of cellular polarity/cohesiveness (LOP/C) in the invasive front, CLNM and LLNM, and retrospectively analysis. Univariate analysis revealed that LOP/C was significantly associated with CLNM (P=0.001) and LLNM (P<0.0001). The male gender was a risk factor of CLNM (P=0.04), while the age <45 years, tumor size >0.5 cm and multifocality were high-risk factors of LLNM (P=0.022, 0.044 and 0.005, respectively). Multivariable analysis revealed that LOP/C was significantly associated with CLNM [P=0.007, odds ratio (OR)=7.765, 95% confidence interval (CI)=1.773–33.996] and LLNM [P=0.029, OR=5.717, 95% CI=1.190–27.470]. Both multivariable analysis and χ2 test revealed that CLNM was another important high-risk factor of LLNM (P=0.021, OR=5.444, 95% CI=1.290–22.969, χ2=17.867, P<0.001). The present study revealed that prophylactic central lymph node dissection is essential for PTMC surgery and that prophylactic lateral lymph node dissection is recommend for patients with LOP/C and CLNM, which can be performed by intraoperative frozen section pathological examination. This must be considered discreetly in the case of patients with age <45 years, tumor size >0.5 cm and multifocal lesions.

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“…The differences between US and pT final staging could be a matter of debate as this may modify the patient's surgical management in some cases: (1) lactic lymph node dissection as PTC lymph node tumoral spread increases with the thyroid tumor size [8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

Insight into Differentiated Thyroid Cancer Gross Pathological Specimen Shrinkage and Its Influence on TNM Staging

Chamorey¹,

Thariat²,

Hajjam³

et al. 2017

Eur Thyroid J

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Introduction: This study aimed at comparing thyroid cancer staging when taking into account the differences between the "T" assessment" using ultrasound (US) and histopathological measurements. Material and Methods: This retrospective study included all consecutive differentiated follicular thyroid cancer (DTC) and medullary thyroid cancer (MTC) patients who underwent postoperative histopathological staging assessment at a single institution. Anaplastic thyroid carcinomas were excluded from the present study. Each malignant thyroid nodule was precisely evaluated by measuring its long axis using both US and gross specimen histopathological examination. T stage classification was attributed to each tumor as regards US (solely according to the tumor dimension) and histopathology: (1) solely according to the tumor dimension and (2) according to the tumor dimension and extrathyroidal extension features when present. Results: Retrospective comparison between US and histopathology size of the operated thyroid nodules showed a mean diminution of 7.52% of the tumor long axis. Tumors ≤ 10 mm at histopathological examination showed a larger decrease in size of 13% (p = 0.054, statistically significant) compared to the US measurements. Ten out of 72 (13.8%) patients showed final T downstaging in comparison to US assessment: (US) T2 to T1b in 6 patients (1 MTC) and (US) T1b to T1a in 4 patients (1 MTC). Two (2.9%) DTC patients were downstaged from stage 2 to stage 1. Conclusion: Precise thyroid tumor US measurement may differ significantly from that obtained by histopathological assessment, which may result in a different TNM staging and subsequent patient management.

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Outcome of papillary thyroid microcarcinoma: Study of 1,990 cases

Cited by 23 publications

References 22 publications

Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results

Value of BRAF V600E in High-Risk Thyroid Nodules with Benign Cytology Results

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Insight into Differentiated Thyroid Cancer Gross Pathological Specimen Shrinkage and Its Influence on TNM Staging

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