2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma

Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender

“…Patients with lymph node metastasis have a high recurrence rate, and some cN0 PTMC patients are found to have lymph node metastasis after surgery [10]. In the present study, the cervical lymph node metastasis rate in the hyperechoic halo group was significantly lower than that in nonhyperechoic halo group.…”

“…The basic consensus on the treatment options for patients with thyroid carcinoma lymph node metastases has been clearly defined by scholars and medical workers in both China and worldwide. However, there is still much controversy over the choice of treatment for patients with clinically cervical lymph nodenegative (cN0) PTMC [10][11][12].…”

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

“…All patients underwent CLND (level VI) either therapeutic or prophylactic CLND, which is routinely recommended in China. 7 Total thyroidectomy was performed for PTMC patients with bilaterality, gross ETE (gETE), bilateral cervical LNM, or other high-risk features, who would potentially require radioactive iodine ablation therapy. Lateral lymph node dissection (LLND), including neck dissection of level II-IV (level I and V were only dissected when metastatic LNs were present in these compartments), was performed in patients for whom LLNM was confirmed by preoperative FNAC and washout thyroglobulin level.…”

Contrastive study of two screening criteria for active surveillance in patients with low-risk papillary thyroid microcarcinoma: a retrospective analysis of 1001 patients

“…According to the study of Kuma Hospital [ 11 ], the following characteristics are absent in patients diagnosed with harmless PTMC: aggressive features such as nodal or distant metastasis, macroscopic extrathyroidal extension, high-grade malignancy on cytology, evidence of progression, and attachment to the trachea or localization along the course of the recurrent laryngeal nerve. Patients with low-risk PTMC as defined by the CATO [ 12 ], for whom immediate surgery is not required, should satisfy the following conditions: nonaggressive histology, lesion diameter of ≤5 mm, lesions confined to the gland and no tumor invasion of locoregional tissues or structures, no local or distant metastases, no history of familial thyroid carcinoma history, no history of radiation exposure during childhood or adolescence, no intense mental stress, and active cooperation with the treatment (Table 6 ). Accordingly, patients who were screened out were divided into low-risk PTMC group defined by Kuma Hospital, high-risk PTMC group defined by Kuma Hospital and low-risk PTMC group defined by CATO, high-risk PTMC group defined by CATO (without considering subjective choices, mental factors, etc.).…”

“…These authors later established a detailed risk stratification for use when considering active surveillance as an alternative to immediate surgery in patients with PTMC with the goal of helping clinicians to determine the appropriateness of an observational management approach [ 10 ]. To prove the feasibility of active surveillance for low-risk PTMC and identify the characteristics of harmless lesions, we performed a retrospective study in which two such criteria were applied to our patients who had undergone surgical treatment: low-risk PTMC characteristics defined by Kuma Hospital and Chinese Association of Thyroid Oncology (CATO) consensus on PTMC management by active surveillance [ 11 , 12 ]. The aim of this study was to obtain authentic clinicopathological characteristics and identify the main indications for strict active surveillance.…”