Abstract
Papillary microcarcinoma of the thyroid (PMCT) is defined as papillary carcinoma measuring 1.0 cm or less. PCMT are frequently detected by ultrasonographic screening and ultrasonography-guided fine-needle aspiration biopsy. Although PMCT can pathologically show a high incidence of multifocality and lymph node metastasis in surgical specimens, most tumors grow slowly or not at all when they are monitored without surgery. In our observations only 6.7% of PMCT enlarged by 3.0 mm or more in diameter during 5 years of follow-up, and nodal metastases became detectable in 1.7% of patients overall. Observation without surgery could, therefore, be an attractive alternative for patients with low-risk PMCT; however, occult PMCT, which are diagnosed as the origin of lymph node or distant metastasis, show a worse prognosis. Even among incidentally detected PMCT, tumors with ultrasonographically detectable nodal metastasis are more likely to recur. Because such PMCT are most likely to recur in the regional lymph nodes, careful therapeutic neck dissection and total thyroidectomy are required. For incidentally detected and low-risk PMCT, careful observation without surgery might be acceptable, but careful and systematic surgery should be performed for patients with PMCT demonstrating aggressive characteristics.
Key Points
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Papillary microcarcinoma is incidentally found in autopsy specimens and in otherwise healthy humans
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Observation without surgery is an attractive alternative for patients with low-risk papillary microcarcinoma
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Ultrasonography is a useful tool for detecting and monitoring papillary microcarcinoma
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Careful surgical therapy is required for patients who have papillary microcarcinoma with high-risk factors, such as clinically apparent lymph node metastasis and massive extrathyroid extension
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References
Sobin LH and Wittekind CH (Eds; 2002) UICC: TNM Classification of Malignant Tumors, edn 6. New York: Wiley-Liss
Yokozawa T et al. (1995) Accurate and simple method of diagnosing thyroid nodules by the modified technique of ultrasound-guided fine needle aspiration biopsy. Thyroid 5: 141–145
Fukunaga FH and Yatani R (1975) Geographic pathology of occult thyroid carcinomas. Cancer 36: 1095–1099
Samson RJ (1977) Prevalence and significant of occult thyroid cancer. In Radiation-Associated Thyroid Carcinoma, 137–153 (Ed. DeGroot LJ) New York: Grune & Stratton
Nishiyama RH et al. (1977) The prevalence of small papillary thyroid carcinomas in 100 consecutive necropsies in an American population. In Radiation-Associated Thyroid Carcinoma, 123–135 (Ed. DeGroot LJ) New York: Grune & Stratton
Harach HR et al. (1985) Occult papillary carcinoma of the thyroid: a “normal” finding in Finland. A systematic autopsy study. Cancer 56: 531–538
Thorvaldsson SE et al. (1992) Latent thyroid carcinoma in Iceland at autopsy. Pathol Res Pract 188: 747–750
Lang W et al. (1988) Occult carcinomas of the thyroid. Am J Clin Pathol 90: 72–76
Yamamoto Y et al. (1990) Occult papillary carcinoma of the thyroid. Cancer 65: 1173–1179
Harach HR et al. (1991) Occult papillary microcarcinoma of the thyroid—a potential pitfall of fine needle aspiration cytology? J Clin Pathol 44: 205–207
Takebe K et al. (1994) Mass screening for thyroid cancer with ultrasonography [Japanese]. Karkinos 7: 309–317
Reiners C et al. (2004) Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14: 926–931
Takebe K et al. (1996) The detection of minimal thyroid cancer in mass screening with ultrasonography [Japanese]. Geka 58: 651–654
Kovacs GL et al. (2005) Epidemiology of thyroid microcarcinoma found in autopsy series conducted in areas of different iodine intake. Thyroid 15: 152–157
Davies L et al. (2006) Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA 295: 2164–2167
Sampson RJ and Key CR (1970) Smallest forms of papillary carcinoma of the thyroid. Arch Pathol 91: 334–339
Iida F et al. (1991) Clinical and pathologic properties of small differentiated carcinomas of the thyroid gland. World J Surg 15: 511–515
Hay ID et al. (1992) Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 112: 1139–1147
Rodriguez JM et al. (1997) Papillary thyroid microcarcinoma: clinical study and prognosis. Eur J Surg 163: 255–259
Lin KD et al. (1997) Clinical presentations and predictive variables of thyroid microcarcinoma with distant metastasis. Int Surg 82: 378–381
Rassael H et al. (1998) A rationale for conservative management of microscopic papillary carcinoma of the thyroid gland: a clinicopathological correlation of 90 cases. Eur Arch Otorhinolaryngol 255: 462–467
Sugitani I and Fumimoto Y (1999) Symptomatic versus asymptomatic papillary thyroid microcarcinoma: a retrospective analysis of surgical outcome and prognostic factors. Endocrine J 46: 209–216
Falvo L et al. (2002) Papillary microcarcinoma of the thyroid gland: analysis of prognostic factors including histological subtype. Eur J Surg 168: 28–32
Wada N et al. (2003) Lymph node metastasis from 259 papillary thyroid microcarcinomas. Ann Surg 237: 399–407
Chow SM et al. (2003) Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocally. Cancer 98: 31–40
Ito Y et al. (2004) Papillary microcarcinoma of the thyroid: how should it be treated? World J Surg 28: 1115–1121
Drucker WD et al. (2005) Papillary microcarcinoma of the thyroid. In Practical Management of Thyroid Cancer, 371–389 (Eds Mazzaferri EL et al.) Berlin: Springer
Ito Y et al. (2003) An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13: 381–388
Ito Y et al. (2005) Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg 30: 91–99
Miyauchi A et al. (1998) The role of ansa-to-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg 164: 927–933
Miyauchi A et al. (2001) Opposite ansa cervicalis to recurrent laryngeal nerve anastomosis to restore phonation in patients with advanced thyroid cancer. Eur J Surg 167: 540–541
Ito Y et al. (2004) Preoperative ultrasonographic examination for lymph node metastasis is useful when designing lymph node dissection for papillary microcarcinoma. World J Surg 28: 498–501
Yamashita H et al. (1999) Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer 86: 842–849
Baudin E et al. (1998) Microcarcinoma of the thyroid gland. The Gustave-Roussy Institute experience. Cancer 83: 553–559
Torlontano M et al. (2006) Comparative evaluation of recombinant human thyrotropin-stimulated thyroglobulin levels, 131I whole-body scintigraphy, and neck ultrasonography in the follow-up of patients with papillary thyroid microcarcinoma who have not undergone radioiodine therapy. J Clin Endocrinol Metab 91: 60–63
Pacini F et al. (2005) Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol 153: 651–659
Pacini F et al. (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154: 787–803
Mazzaferri EL (2006) Managing small thyroid cancers. JAMA 295: 2179–2182
Pelizzo MR et al. (2004) Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience. Nucl Med Commun 25: 547–552
Pelizzo MR et al. (2006) Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol [doi:10.1016/j.ejso.2006.07.001]
Pellegriti G et al. (2004) Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab 89: 3713–3720
Roti E et al. (2006) Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocriniol Metab 91: 2171–2178
Mazzaferri EL et al. (2003) A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 88: 1433–1441
Pacini F et al. (2006) Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. J Clin Endocrinol Metab 91: 926–932
Schlumberger M et al. (2004) Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 150: 105–112
Schlumberger M et al. (2004) Follow-up and management of differentiated thyroid carcinoma: a European perspective in clinical practice. Eur J Endocrinol 151: 539–548
Sugitani I et al. (1998) Clinicopathologic and immunohistochemical studies of papillary thyroid microcarcinoma presenting with cervical lymphadenopathy. World J Surg 22: 731–737
Antonelli A et al. (1995) Role of neck ultrasonography in follow-up of patients operated on for differentiated thyroid cancer. Thyroid 5: 25–29
Uruno T et al. (2005) Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 29: 483–485
Ito Y et al. (2005) Papillary microcarcinoma of the thyroid with preoperatively detectable lymph node metastasis show significantly higher aggressive characteristics on immunohistochemical examination. Oncology 68: 87–96
Khoo ML et al. (2002) Underexpression of p27/kip in thyroid papillary microcarcinomas with gross metastatic disease. Arch Otolaryngol Head Neck Surg 128: 253–257
Martenson H and Terins J (1985) Recurrent laryngeal nerve palsy in thyroid gland surgery related to operations and nerves at risk. Arch Surg 120: 475–482
Scheumann GF et al. (1996) Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma. Eur J Surg 162: 677–684
Ito Y et al. (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30: 780–786
Ito Y et al. (2006) Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45. Surg Today 36: 12–18
Ito Y et al. (2005) Ill-defined edge on ultrasonographic examination can be a marker of aggressive characteristic of papillary thyroid microcarcinoma. World J Surg 29: 1007–1012
Harach HR et al. (1984) Occult papillary carcinoma of the thyroid appearing as lung metastases. Arch Pathol Lab Med 108: 529–530
Strate SM et al. (1984) Occult papillary carcinoma of the thyroid with distant metastases. Cancer 54: 1093–1100
Hazard JB (1960) Small papillary carcinoma of the thyroid. Lab Invest 9: 86–97
Ito Y et al. (2005) Therapeutic strategies for papillary microcarcinoma of the thyroid. Curr Canc Ther Rev 1: 19–25
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Ito, Y., Miyauchi, A. A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroid. Nat Rev Endocrinol 3, 240–248 (2007). https://doi.org/10.1038/ncpendmet0428
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DOI: https://doi.org/10.1038/ncpendmet0428
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