Papillary microcarcinoma of the thyroid—Prognostic significance of lymph node metastasis and multifocality

Chow, Sin‐Ming; Law, Stephen C.K.; Chan, John K.; Au, Siu-Kie; Yau, Stephen S.-T.; Lau, W.S.

doi:10.1002/cncr.11442

Cited by 678 publications

(571 citation statements)

References 40 publications

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“…Someone think that CLND is unnecessary, because the reported mortality rates of PTMC range from 0% to 1%, and CLND provides no survival benefit (Appetecchia et al, 2002), CLND may increase the frequency of perioperative complications as well (Wada et al, 2003). However, other studies demonstrated that the risk of recurrence significantly increased in PTMC patients with CLNM (Chow et al, 2003). In addition, some investigators have showed that the operations for recurred lymph nodes in PTC increased the risk of postoperative complications (Vini et al, 2003) .…”

Section: Discussionmentioning

confidence: 99%

Could Tumor Size Be A Predictor for Papillary Thyroid Microcarcinoma: a Retrospective Cohort Study

Wang¹,

Wu²,

Chen³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Background: Central lymph node metastasis(CLNM) is common in papillary thyroid microcarcinoma (PTMC). The aim of this study was to define the pathohistologic risk grading based on surgical outcomes. Materials and Methods: Statistical analysis was performed to figure out the optimal cut-off values of size in preoperative ultrasound images for defining the risk of CLNM in papillary thyroid microcarcinoma. Receiver operating characteristic curves (ROC) studies were carried out to determine the cutoff value(s) for the predictor(s). All the patients were divided into two groups according to the above size and the clinic-pathological and immunohistochemical parameters were compared to determine the significance of findings. Results: The optimal cut-off value of tumor size to predict the risk of CLNM in papillary thyroid microcarcinoma was 0.575 cm (area under the curve 0.721) according to the ROC curves. Significant differences were observed on the multifocality, extrathyroidal extension and central lymph node metastasis between two groups which were divided according to the tumor size by the cutoff values. Patients in two groups showed different positive rate and intensity of Ki67. Conclusions: The size of PTMC in ultrasound images are helpful to predict the aggressiveness of the tumors, it could be an easy predictor for PTMC prognosis and assist us to choose treatment.

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Section: Discussionmentioning

confidence: 99%

Could Tumor Size Be A Predictor for Papillary Thyroid Microcarcinoma: a Retrospective Cohort Study

Wang¹,

Wu²,

Chen³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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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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“…8 Although its clinical significance in papillary microcarcinomas is somewhat controversial, several authors have reported that lymph node metastasis at presentation is correlated with loco-regional recurrence in papillary microcarcinomas. 5,[9][10][11] Moreover, lymph node metastasis is reported to be associated with distant metastasis of papillary microcarcinomas. [9][10][11] In the new TNM (tumor, node, metastases) staging system, lymph node metastasis is a more important factor than tumor size in overall staging.…”

mentioning

confidence: 99%

“…5,[9][10][11] Moreover, lymph node metastasis is reported to be associated with distant metastasis of papillary microcarcinomas. [9][10][11] In the new TNM (tumor, node, metastases) staging system, lymph node metastasis is a more important factor than tumor size in overall staging. 12 Overexpression of cyclin D1, 13 S100A4 14 and MUC1, 15 loss of p27 13,16 and presence of the BRAF mutation 17,18 have been suggested as important predictive factors for relapse or nodal metastasis of papillary thyroid carcinoma.…”

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confidence: 99%

S100A4 expression is associated with lymph node metastasis in papillary microcarcinoma of the thyroid

et al. 2008

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The detection of papillary microcarcinomas of the thyroid is increasing due to frequent use of ultrasound and fine-needle aspiration biopsy. Although most of the papillary microcarcinomas remain quiescent and follow an indolent clinical course, some behave aggressively and metastasize early, giving rise to clinically significant disease. There have been few studies concerning factors predictive of lymph node metastasis in papillary microcarcinomas. We analyzed the expression of S100A4, cyclin D1, p27 and MUC1, the presence of the BRAF V600E mutation and the clinicopathological features of the tumors, including patient age, tumor size (Z5 vs o5 mm), extrathyroidal extension, multifocality, histological subtype, sclerosis and encapsulation, in a series of 198 papillary microcarcinomas in relation to lymph node metastasis to determine the predictive factors of lymph node metastasis. On univariate analysis, tumor size of 5 mm or more, extrathyroidal extension, multifocality, sclerosis and the expression of S100A4 and cyclin D1 predicted lymph node metastasis, whereas patient age, expression of p27 and MUC1 and the BRAF V600E mutation did not. Moreover, tumor size 5 mm or more, multifocality and expression of S100A4, especially its strong expression in the invasive fronts, were significantly associated with macrometastasis and lateral node metastasis. On multivariate analysis, multifocality and expression of S100A4 were found to be common independent predictive factors of lymph node metastasis, macrometastasis and lateral node metastasis. In conclusion, S100A4 expression in papillary microcarcinomas may indicate the presence of nodal metastasis. Thus, S100A4 immunohistochemistry may be valuable for predicting metastatic potential in papillary microcarcinomas.

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Papillary microcarcinoma of the thyroid—Prognostic significance of lymph node metastasis and multifocality

Cited by 678 publications

References 40 publications

Could Tumor Size Be A Predictor for Papillary Thyroid Microcarcinoma: a Retrospective Cohort Study

Could Tumor Size Be A Predictor for Papillary Thyroid Microcarcinoma: a Retrospective Cohort Study

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

S100A4 expression is associated with lymph node metastasis in papillary microcarcinoma of the thyroid

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