An Observation Trial Without Surgical Treatment in Patients with Papillary Microcarcinoma of the Thyroid

Abstract

The recent prevalence of ultrasound-guided fine-needle aspiration biopsy has resulted in a marked increase in the number of patients with papillary microcarcinoma (maximum diameter, </= 10 mm) of the thyroid detected by this sophisticated tool. On the other hand, it is debatable whether patients with papillary microcarcinoma should always undergo surgery after diagnosis, because a high incidence of occult papillary carcinoma has been observed in autopsy studies. Thus, we proposed observation without surgical therapy as a treatment option in 732 patients diagnosed with papillary microcarcinoma by the above technique from 1993 to 2001. One hundred sixty-two patients chose observation and were classified as the observation group. During the follow-up period for patients in the observation group, more than 70% of tumors either did not change or decreased in size compared to their initial size at diagnosis. They enlarged by more than 10 mm in 10.2%, and lymph node metastasis in the lateral compartments appeared in only 1.2% of patients during follow-up. On the other hand, 570 patients chose surgical treatment at diagnosis and 56 patients in the observation group who underwent surgery after a period of follow-up were classified as the surgical treatment group. Of these 626 patients, lymph node dissection was performed in 594 patients, and metastasis was confirmed histologically in 50.5%. Multiple tumor formation was seen in 42.8% of patients. In this group, the rate of recurrence was 2.7% at 5 years and 5.0% at 8 years after surgery. Our preliminary data suggest that papillary microcarcinomas do not frequently become clinically apparent, and that patients can choose observation while their tumors are not progressing, although they are pathologically multifocal and involve lymph nodes in high incidence.

In Papillary Thyroid Cancer, Preoperative Central Neck Ultrasound Detects Only Macroscopic Surgical Disease, But Negative Findings Predict Excellent Long-Term Regional Control and Survival

“…This notion is reinforced by Machens et al (28) who reported that at least 80% of patients with lateral nodal disease will have central compartment metastasis on histopathological examination. Several studies have reached the conclusion that while lymphatic extension is associated with an increased risk of regional recurrence, there appears to be a significant difference between histopathological disease and macroscopic nodal disease (11,29). Our findings further support this notion since microscopic nodal involvement was not a predictor for recurrence-free survival in this series.…”

The synergic effect of BRAF^V600E mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma

“…However, the most appropriate treatment of PTMC remains as a matter of debate. Corresponding strategies range from observation alone to surgical resection [41][42][43]. Therefore, the findings in the present study may help surgeon to make decision for unilateral PTMCs to some extent, and a research concentrating on the combined effect on unilateral PTMCs should be performed in future.…”

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

“…Differentiated thyroid carcinoma (particularly papillary carcinoma) involves cervical lymph nodes in 20%-50% of patients in most series using standard pathologic techniques (75)(76)(77)(78)(79), and may be present even when the primary tumor is small and intrathyroidal (37,80). The frequency of micrometastases may approach 90%, depending on the sensitivity of the detection method (81,82).…”