scholarly journals Factors Influencing the Outcome of Patients with Incidental Papillary Thyroid Microcarcinoma

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Beatriz Mantinan ◽  
Antonia Rego-Iraeta ◽  
Alejandra Larrañaga ◽  
Enrique Fluiters ◽  
Paula Sánchez-Sobrino ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Distant Metastases ◽  
Significant Risk Factor ◽  
University Hospital ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma

Objective. To analyze some factors that could influence the outcome of patients with PTMC.Material and Methods. This is a longitudinal observational study. All patients diagnosed and treated for papillary thyroid microcarcinoma at the University Hospital of Vigo, between January 1994 and December 2003, were included in the present study. Demographic characteristics, tumour characteristics, TNM stage, rate of recurrence, and treatment with131I were the study variables.Results. Ninety-one patients (75 females) with an average age of years, range 19–81, were studied. Initial tumour staging was T1 in 90 patients and T4a in 1 case. Initial lymph node involvement was present in 4 cases (4.4%). We only found one case with distant metastases at diagnosis. Postsurgical evaluation of thyroid specimens revealed that 28 (30.7%) tumours were multifocal. The average size of the tumour was  cm, range 0.1–1. Univariate analysis reveals a statistically significant association between tumour multifocality and postsurgical131I therapy with the recurrence rate. In the multivariate analysis only multifocality (, HR 5.7) was a significant risk factor for the recurrence rate.Conclusions. Our results indicate that tumour multifocality is an independent predictor of relapse but neither the tumour size nor postsurgical131I therapy.

scholarly journals Papillary thyroid microcarcinoma: distinct form or cancer growth stage?

2021 ◽  
Vol 14 (4) ◽  
pp. 19-25
Author(s):  
Vladimir A. Solodkiy ◽  
Dmitri K. Fomin ◽  
Dmitri A. Galushko ◽  
Hayk G. Asmaryan
Keyword(s):  
Univariate Analysis ◽  
Central Zone ◽  
Distant Metastases ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
The Past ◽  
Thyroid Microcarcinoma ◽  
Metastatic Lesions ◽  
Thyroid Capsule

Background. Over the past decades an increase in the incidence of papillary thyroid microcarcinoma (PTMC) has been observed throughout the world owing to the improved diagnostics. There are many different opinions about the aggressiveness degree of this group of tumors, as well as about the tactics of managing patients with PTMC.Aim of the study is the identification of the prognostic factors responsible for the features of the clinical course, including the more aggressive one.Materials and methods. A study was carried out with a detailed analysis of a group of patients with papillary thyroid cancer ≤1 cm in size and the existing clinical data of regional and distant metastases. All patients underwent thyroidectomy with bilateral central cervical lymph node dissection. Factors such as gender, patient age, bilaterality, extrathyroid extension, the presence or absence of a capsule around the tumor node, the absence or presence of metastases in the central part were assessed. In 26.6% histological examination revealed metastatic lesions of the central group lymph nodes. Latent metastases were detected in 24.2% of women and 43% of men, in 36.7% of patients <55 and in 14.3% of patients ≥ 55 years, in 29.5% with the absence of the node capsule and in 19.3% with encapsulated tumors, in 48.1% with multicentric growth and in 19.5% with a solitary neoplasm, in 21.7% with a tumor size ≤0.5 cm and in 27.9% with a node of 0.6–1 cm, in 24% with the absence of invasion of the thyroid capsule and in 31% with the presence of extrathyroid invasion, in 21% of patients with typical, in 26% with follicular and 43% with mixed papillary cancer. 95 patients received radioiodine therapy. No additional metastases were found in them.Results. When conducting univariate analysis, the main signs influencing the development of metastases in the central zone were age up to 55 years (p = 0.009, χ2 = 6.919) and multicentric neoplasm (p = 0.004, χ2 = 8.530); in multivariate analysis, similarly, age younger 55 years (p = 0.000, Exp B = 0.011, CI 95.0% 0.001–0.106) and multifocality (p = 0.027, Exp B = 2.686, CI 95.0% 1.119–6.448).Conclusion. PTMC is not a separate group or tumor morphotype, and the determination of treatment tactics for this group of patients should be based not only on the size of the tumor, but on the clinical and biological parameters of the tumor.

Papillary thyroid microcarcinoma: Analysis of outcomes and features predicting risk of recurrence.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18569-e18569
Author(s):  
Chandra Shekhar Dravid ◽  
Priya Sr ◽  
P. S. Pai ◽  
D. Chaukar
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Adverse Events ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Thyroid Microcarcinoma ◽  
Radioiodine Ablation

e18569 Background: Papillary thyroid microcarcinoma (PTMC) is an enigmatic entity - diverse opinions exist on its clinical course and management. We aimed to analyse disease outcomes and to identify high-risk factors in PTMCs. Methods: This is a retrospective analysis of patients of PTMC treated in our hospital between 2000 and 2014. Clinico-radiological features, treatment details, long term outcomes and recurrence patterns were noted; these were analysed statistically. Results: 160 patients were studied; 61% were females; 86% were aged 55 years or below; 95% cases presented with an enlarged neck node or thyroid nodule or distant metastasis while 5% were incidentalomas. Total thyroidectomy with radioiodine ablation was done in 77% while hemithyroidectomy was done in 23% patients. Follow up ranged between 2 and 238 months. There were 11 (7%) disease related events (nodal or distant metastases or death due to persistent disease). 4 (2.5%) patients died of disease. On univariate analysis, a larger thyroid primary (p 0.001), pre-operatively radiologically identifiable disease in the thyroid (p 0.02) and the lesion not being an incidentaloma (p 0.01) were associated with development of adverse events. Multivariate analysis confirmed the latter two factors as high risk (p 0.05 and 0.00). Nodal metastasis increased with a larger primary (p 0.001), which was multifocal (p 0.00), bilateral (p 0.01) and showed extrathyroid extension (p 0.00). Distant metastases were related with advanced age (p 0.02), presence of involved nodes (p 0.04), larger primary tumour (p 0.15), multifocal tumour (p 0.17), bilateral foci (p 0.02) and extrathyroidal extension (p 0.06). Correspondingly, Kaplan Meier curves showed a better overall survival (OS) and disease free survival (DFS) with incidentalomas as compared to cases presenting with symptoms (Median OS 84 months vs 78 months; Median DFS 79 months vs 77 months) and cases where the lesion was not seen on radiology (Median OS 80 months vs 76 months; Median DFS 80 months vs 75 months). However neither was significant statistically. Addition of Radioiodine ablation did not confer survival advantage (p 0.6). Conclusions: PTMCs are associated with adverse events despite the size of the primary lesion. Stratification as per the above risk factors can improve event free survival. Conversely, aggressive treatment may be deferred in cases of lesions discovered incidentally or on routine screening.

scholarly journals Long-term Outcomes and Prognostic Factors in Papillary Thyroid Microcarcinoma Patients with Distant Metastases

2021 ◽  
Author(s):  
Huai-Yu Weng ◽  
Ting Yan ◽  
Wang-Wang Qiu ◽  
Chuang Xi ◽  
Li-Ying Hou ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Radioactive Iodine ◽  
Distant Metastases ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Long Term Outcomes ◽  
Thyroid Microcarcinoma ◽  
Male Sex

Abstract PurposesDistant metastasis from papillary thyroid microcarcinoma (PTMC) is extremely rare and the long-term outcome and independent prognostic factors remain unclear.The present study aimed to investigate clinicopathological characteristics and evaluate the long-term outcomes and prognostic factors of PTMC patients with distant metastases (DM) who underwent surgery and radioactive iodine (131I) treatment.MethodsWe retrospectively reviewed the medical records of 13,441 patients with thyroid cancer (including 1,697 cases with PTMC) who underwent 131I treatment at our institution between January 2008 and December 2019. PTMC patients with distant metastases with sufficient clinical follow-up data were enrolled in this cohort study. The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan–Meier method and the prognostic factors were assessed by Cox proportional hazards. ResultsThirty-three PTMC patients with DM were enrolled in this study. The median follow-up was 75 months (range: 5–151 months).The 5-year and 10-year OS rates were 96.97% and 81.41%, respectively, and the 5-year and 10-year PFS rates were 90.46% and 69.68%, respectively. Multivariate analysis showed that male sex(P=0.005) , radioactive iodine refractory PTMC (P=0.033) and symptomatic DM (P=0.022) were significantly associated with worse 10-year PFS in PTMC patients with DM. No independent predictor related to poor 10-year OS found in the present study.ConclusionsThe prognosis of PTMC patients becomes worse after the development of DM. Male sex, radioactive iodine refractory PTMC and symptomatic DM were identified as independent factors associated with PFS.

scholarly journals Papillary thyroid microcarcinoma with lung metastases: a case report and review of the literature

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Tadafumi Shimizu ◽  
Takaaki Oba ◽  
Tatsunori Chino ◽  
Ai Soma ◽  
Mayu Ono ◽  
...  
Keyword(s):  
Lung Metastasis ◽  
Lung Tumor ◽  
Lung Metastases ◽  
Standard Of Care ◽  
Distant Metastases ◽  
Needle Aspiration ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
The Right

Abstract Background Distant metastasis from papillary thyroid microcarcinoma (PTMC) is rare. Here we report a case of PTMC with multiple lung metastases. Case presentation A 64-year-old man presented to our hospital with abdominal pain. Computed tomography incidentally revealed multiple lung nodules. The lung tumor was histologically diagnosed as metastasis of papillary thyroid carcinoma (PTC) by core needle biopsy via thoracoscopy. The patient was referred to our department for further examination. Neck ultrasonography revealed a 0.9 cm hypoechoic nodule in the right lobe of the thyroid gland, which was diagnosed as PTC by fine-needle aspiration cytology. Subsequently, total thyroidectomy was performed, followed by radioiodine therapy. Iodine-131 (131-I) scintigraphy showed a strong accumulation in the lung metastasis. The patient presented no evidence of progression of lung metastasis for 25 months after the operation. Conclusions Lymph node metastasis or extraglandular extension has been reported in the few published cases of metastatic PTMC, including the present case, and the average age of these cases was 58.8 ± 12.0 years. Although active surveillance without surgical resection is expected to become a standard of care for PTMC, this case indicates that a subset of PTMC patients with risk factors may develop distant metastases. Hence, careful preoperative screening is required to avoid complications associated with completion thyroidectomy.

scholarly journals Risk factors of papillary thyroid microcarcinoma that predispose patients to local recurrence

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244930
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Marta Rzeszutko ◽  
Łukasz Nowak ◽  
Michał Aporowicz ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Local Recurrence ◽  
Vascular Invasion ◽  
Significant Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Multivariate Logistic Regression ◽  
Thyroid Microcarcinoma ◽  
Therapeutic Decisions ◽  
Tumor Shape

Background Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions. Methods We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008–2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features. Results Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32–15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97–5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002). Conclusions The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.

scholarly journals Papillary Thyroid Microcarcinoma with Lung Metastases: A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Tadafumi Shimizu ◽  
Takaaki Oba ◽  
Tatsunori Chino ◽  
Ai Soma ◽  
Mayu Ono ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Lung Metastasis ◽  
Lung Tumor ◽  
Lung Metastases ◽  
Distant Metastases ◽  
Needle Aspiration ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Remnant Thyroid

Abstract Introduction: Distant metastasis from papillary thyroid microcarcinoma (PTMC) is rare. Here we report a case of PTMC with multiple lung metastases.Case Presentation: A 64-year-old man presented to our hospital with abdominal pain. Computed tomography incidentally revealed multiple lung nodules. The lung tumor was histologically diagnosed as metastasis of papillary thyroid carcinoma (PTC) by core needle biopsy via thoracoscopy. The patient was referred to our department for further examination. Neck ultrasonography revealed a 0.8 cm hypoechoic mass in the right lobe of the thyroid gland, diagnosed as PTC by fine-needle aspiration cytology. Subsequently, total thyroidectomy was performed, followed by radioiodine therapy. Iodine-131 (131-I) scintigraphy showed a strong accumulation in the lung metastasis. The patient presented no evidence of progression of lung metastasis for 25 months after the operation. Discussion/Conclusions: Although there are few published cases of metastatic PTMC, lymph node metastasis or extraglandular extension was observed in most patients, including the present case, and the average age of these cases was 58.8 ± 12.0 years. Although active surveillance without surgical resection is expected to remain standard of care for PTMC, this case indicates that a subset of PTMC patients with risk factors may develop distant metastases. Careful preoperative screening is required to avoid complications associated with reoperation of the remnant thyroid gland.

scholarly journals Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

2020 ◽  
Vol 10 (16) ◽  
pp. 5532
Author(s):  
Radu Danila ◽  
Roxana Maria Livadariu ◽  
Daniel Vasile Timofte ◽  
Irina Trifescu ◽  
Tudor Bibire ◽  
...  
Keyword(s):  
Endocrine System ◽  
Hashimoto Thyroiditis ◽  
Clinicopathological Characteristics ◽  
University Hospital ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Basedow’S Disease ◽  
Aggressive Surgical Approach ◽  
Underlying Diseases

Papillary thyroid microcarcinoma (PTMC) is a common malignant disease of the endocrine system, which has rapidly increased in incidence and prevalence in recent decades. The aim of our paper was to identify correlations between pathological and clinical features of cases of PTMC. A total of 612 patients of both genders, who were operated on for benign thyroid diseases in the 3rd Surgical Unit of St. Spiridon University Hospital of Iasi, were monitored for a period of 2 years. According to pathological reports, PTMC was diagnosed in 144 cases. Of those cases, 81.2% were female and 18.8% were male, with an overall mean age of 54.77 ± 11.9 years. The mean diameter of tumors was 3.04 ± 2.2 mm (75.7% were under 5 mm), and 35.4% were multifocal tumors. Of all tumors studied, 76.4% were the follicular variant, 13.2% were conventional, and 10.4% of cases included tall cell, hobnail, or columnar variants. The underlying diseases were multinodular goiters (73.6%), adenomas (25%), Hashimoto thyroiditis (17.4%), Basedow’s disease, and other types of hyperthyroidism (4.9%), primarily hyperparathyroidism (7.6%), with a small percentage presenting a combination thereof. Extracapsular invasion was present in 14.6% while 5.6% presented perineural invasion and 0.7% of cases had vascular invasion. Lymphatic emboli were found in 9% of cases and lymph node metastasis in 5.6% of cases. PTMC is not as innocent as believed, and further studies, performed on larger batches, would be necessary in order to identify high oncological risk cases and to determine when a more aggressive surgical approach is indicated.

scholarly journals Cases of pN1b and pM1 Papillary Microcarcinoma of the Thyroid

2018 ◽  
Vol 01 (01) ◽  
pp. e6-e9
Author(s):  
Shinji Takebayashi ◽  
Shogo Shinohara ◽  
Keisuke Mizuno ◽  
Koji Saida ◽  
Kazuki Hayashi ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Malignant Tumors ◽  
Medical Center ◽  
Distant Metastases ◽  
Good Prognosis ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Male Patients

Introduction Papillary thyroid carcinoma has a relatively good prognosis among malignant tumors of the thyroid. Therefore, a “wait and see” strategy is often adopted for patients with micropapillary thyroid carcinoma. On the other hand, patients with papillary thyroid carcinoma with N1b or M1 disease are known to show a poor prognosis. Here, we investigated the differences in the characteristics between patients with papillary thyroid microcarcinoma with and without N1b metastatic nodes/distant metastases to identify the risk factors for metastasis. Methods The retrospective study was performed in patients with thyroid microcarcinoma who were treated at the Kobe City Medical Center General Hospital from 2007 to 2017. The characteristics of the patients with thyroid microcarcinoma who were classified as having N1b or M1 disease (N1b/M1 group) were compared with those of patients with the same cancer classified as having N0, N1a, or M0 disease (N0/N1a group). Results A total of 65 patients were enrolled in this study; 12 were classified into the N1b/M1 group and 53 were classified into the N0/N1a group. The proportion of males was significantly higher in the N1b/M1 group than in the N0/N1a group. There were no statistically significant differences in the distribution of the tumor sites, the ultrasonographic findings, or the frequency of the presence of multiple carcinomas. Although three patients died due to other causes, there were no patients who died due to papillary thyroid carcinoma. Conclusion No significant predictors were identified for classifying patients with papillary thyroid microcarcinoma into the N1b/M1 group in this study. However, our findings suggested that male patients with papillary thyroid microcarcinoma require more careful follow-up in comparison to female patients with this cancer.

scholarly journals MON-449 Thyroid Microcarcinoma Histopathology Relevance

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Letícia A M Sandoval ◽  
Bruna Dellatorre Diniz ◽  
Juliano Coelho ◽  
Gabriel de Jesus ◽  
Monalisa F Azevedo ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Needle Aspiration ◽  
University Hospital ◽  
Papillary Thyroid Microcarcinoma ◽  
Histological Evaluation ◽  
Papillary Thyroid ◽  
False Negatives ◽  
Surgical Specimen ◽  
Thyroid Microcarcinoma ◽  
New Diagnosis

Abstract INTRODUCTION: Thyroid carcinoma is the most common endocrine neoplasia. The predominant histological variant is the papillary subtype. Tumors with 1 centimeter diameter or less are defined as papillary thyroid microcarcinoma (PTMC). The clinical diagnosis of PTMC is challenging. The evaluation of the gland includes mostly image methods and fine-needle aspiration (FNA). Nevertheless, the sensibility of these techniques, when compared to total thyroid histology, is less than desired. AIM OF THE STUDY: Recognize the real prevalence of papillary thyroid microcarcinoma (PTMC) based on histological evaluation of the total gland among a group of adults in Brasilia, Brazil, and compare the data with the clinical suspicion of PTMC established by FNA and ultrasonography (USG). PATIENTS AND METHODS: Retrospective cohort study based on medical records of 76 patients who underwent surgical thyroidectomy treatment for several types of thyroid diseases at the University Hospital of Brasilia - Brazil, from 2005 to 2015. A full inclusion of the surgical specimen was made and stained with hematoxylin and eosin. All of the preparations were evaluated by an expert pathologist. The histopathological report was compared to the previous clinical diagnosis, which was based on FNA and USG of the gland. In addition, the exams results were stratified by the Bethesda criteria. RESULTS: Seventy-six individuals with the histopathology diagnosis of PTMC were included (68 were females). A total of 65 FNA and 57 USG results were evaluated, 6 patients had only the histopathologic diagnosis of PTMC. A total of 52 patients had both USG and FNA of the thyroid. All of the patients that had USG records had at least one thyroid nodule, 52,6% of them had multiple nodules. Regarding the FNA results, only 9,2% were classified as Bethesda I; 21,5% as Bethesda II; 7,7% Bethesda III; 7,7% Bethesda IV; 10,8% Bethesda V; 43,1% Bethesda VI. At this cohort, 19 patients were false negatives. The sensibility of FNA for diagnosis of PTMC was 67,79%. CONCLUSION: Despite careful evaluation of the patients, there might have false negatives results. Total thyroid total inclusion of surgical specimen is not a routine diagnostic tool, making less invasive new diagnosis methods desirable.

Sign in / Sign up

Export Citation Format

Share Document