Aktuelle Behandlungskonzepte des papillären Schilddrüsenmikrokarzinoms

Abstract

The increase in the incidence of thyroid cancer is accompanied by a mortality rate that is stable or perhaps even slightly decreasing. This phenomenon is due to the increased frequency of papillary microcarcinomas (thyroid tumors with a diameter of less than 1 cm), which is presumably attributable to the improved diagnosis enabled by high resolution ultrasound and fine needle aspiration cytology. The American and European Thyroid Associations have recently published new guidelines for the diagnosis and therapy of differentiated thyroid tumors. These guidelines are aimed at minimizing the diagnostic and therapeutic procedures without reducing their effectiveness. This goal is particularly important for papillary thyroid microcarcinoma patients, who have an excellent prognosis and almost normal life expectancy. This article summarizes the history of thyroid surgery and introduces papillary thyroid microcarcinoma--an important topic in modern thyroid oncology. Current methods for diagnosis, treatment and follow-up care of this disease are discussed.

Hashimoto’s thyroiditis, nodular goiter or follicular adenoma combined with papillary thyroid carcinoma play protective role in patients

“…Papillary thyroid microcarcinoma (PTMC) is a low-risk type of PTC [23], which is defined by the diameter ≤1 cm and has no local lymph node and/or distant organ metastasis and extra thyroid invasion. PTMC usually has an excellent prognosis [24], postoperative recurrence of PTMC is not reduced by total thyroidectomy. Non-total thyroidectomy is also a good choice for treatment of PTMC patients [25].…”

Papillary thyroid microcarcinoma: the significance of high risk features

“…Guidelines regarding the surgical management of PTC have continued to evolve and are currently based on clinical and pathological characteristics of the diagnosed individual and their thyroid cancer, respectively [9}. However, debate still exists regarding whether PTM should be managed in a manner similar to larger PTC [ 4 ]. PTM usually has an excellent prognosis and current American Thyroid Association Guidelines recommend that thyroid lobectomy alone is adequate treatment for unifocal intrathyroiodal cancers in the absence of a prior history of head and neck irradiation, familial thyroid carcinoma, or clinically detectable cervical metastases.…”

“…The clinical significance and recommendations for management of these PTMs is still evolving. In general, PTM is considered a clinically very low risk cancer type that uncommonly causes mortality, with a greater than 90% disease-free survival after long term follow up [ 2 , 4 , 5 ]. Reported rates for distant metastases and mortality from PTM are <0.05% [ 6 ].…”

“…The rising incidence of PTM, and its associated morbidity, requires risk stratification and guidelines for treatment. Currently, treatment of PTM is based upon stratification of cancer risk for aggressive behaviour, which is based on patient and cancer characteristics [ 2 , 4 ]. Cancers considered high risk include those that are: multifocal, have extrathyroidal extension, have vascular invasion, are incompletely resected, have lymph node metastases, especially if multiple nodes are involved, nodes are > 3cm in largest dimension, or if extra-nodal cancer extension is present, and if distant metastases are present.…”

A New Strategy for the Surgical Management of RLN Infiltrated by Well-Differentiated Thyroid Carcinoma

“…It is shown that a crucial step of the WDTC therapy is a complete surgical removal of the tumor tissue [11, 12] and macroscopically radical resection is the main parameter determining the survival of the patient [13]. …”