Features Predictive of Distant Metastasis in Papillary Thyroid Microcarcinomas

Jeon, Min Ji; Gu, KimWon; Choi, Yun Ju; KwonHyemi,; LeeYu-mi,; SungTae-Yon,; Ho, YoonJong; ChungKi-Wook,; Joon, HongSuck; Yong, KimTae; Shong, Young Kee; Eun, SongDong; Bae, KimWon

doi:10.1089/thy.2015.0375

Cited by 103 publications

(110 citation statements)

References 30 publications

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“…In fact, AS strategy in low-risk PTMC has been suggested by a Japanese group based on single observational studies, and concerns remain about disease progression during AS, especially in patients with an aggressive phenotype 17–19. Although AS has existed for approximately 10 years, it was only recently added to the international guidelines as a viable management strategy 5,14.…”

Section: Discussionmentioning

confidence: 99%

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

Choi¹,

Lee²,

Lee³

et al. 2018

CMAR

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PurposeActive surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) may reduce the risk of overtreatment of clinically insignificant cancer. However, the absence of predictor for the progression of PTMC resulted in treatment delay and potentially compromising cure of aggressive disease. Therefore, to anticipate potential damage of delayed surgery, we investigated the oncologic outcomes of patients with low-risk PTMC initially eligible for AS except clinically apparent lymph node metastasis (LNM), imitating delayed surgery with neck dissection.Materials and methodsA total of 5,348 patients, enrolled between 1987 and 2016, with low-risk PTMC initially eligible for AS were included regardless of LNM. We classified our study patients into two groups: Group I, lobectomy with prophylactic central cervical node dissection; Group II, total thyroidectomy with modified radical neck dissection for LNM. In addition, we investigated the oncological outcomes of patients with second-wave surgery due to lateral lymph node recurrence (Group III, subgroup of Group I).ResultsGroup I showed more favorable clinicopathological characteristics compared with Group II. In Group I, only 29 (0.58%) of 4,927 patients underwent second-wave surgery with neck dissection for lateral lymph node recurrences, whereas in Group II, all 22 (5.23%) of 421 patients underwent second-wave selective node dissection because of nodal recurrence. Disease-free survival rates were significantly different between Groups I and II (P<0.05). Of note, the recurrence rate of Group II was still significantly higher than that of Group III (5.2% vs 0%, respectively; P=0.021). In addition, Kaplan–Mayer survival analysis indicated poor disease-free survival rates in Group II compared with Group III (P<0.05).ConclusionThe long-term treatment outcome of PTMC without LNM was favorable even if the recurrence occurs during follow-up period compared with that of PTMC with LNM. It should be noted that AS might be able to cause poor prognosis due to clinically apparent LNM.

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Section: Discussionmentioning

confidence: 99%

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

Choi¹,

Lee²,

Lee³

et al. 2018

CMAR

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“…Less than 15% of low‐risk PMC grow to more than 3 mm or develop lymph node metastasis during follow‐up, and most importantly, no thyroid cancer death was reported among more than 1000 patients for more than 10 years of follow‐up . Expert thyroid pathologists proposed calling it papillary microtumor instead of carcinoma, and a proposal to classify PMC in the borderline tumor category was reported by Kakudo et al However, papillary microtumor has not become a popular diagnosis among pathologists and clinicians because a significant amount of PMC cases (15–35%) have lymph node metastasis at surgery and rare cases (<0.4%) develop distant metastasis …”

Section: Papillary Microcarcinomamentioning

confidence: 99%

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Kakudo

Bychkov

Bai

et al. 2018

Pathology International

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“…While size alone does not predict malignancy, the size criteria is recognized by all three guidelines in that thyroid cancers smaller than 1 cm are unlikely to increase risk of mortality (Jeon, et al 2016) or to be associated with distant metastases (Jeon et al 2016; Machens, et al 2005) especially when US does not show malignant cervical lymph nodes (Jeon et al 2016). Thus, a more conservative approach is commonly recommended.…”

Section: Introductionmentioning

confidence: 99%

Thyroid nodules and cancer management guidelines: comparisons and controversies

Nabhan¹,

Ringel²

2017

Endocrine-Related Cancer

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Thyroid cancer is an increasingly prevalent malignancy throughout the world. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. All of these guidelines recognize this increasing incidence, particularly of small papillary thyroid cancers, due in part to improved technology enabling early or even “over” diagnosis. Recent advances in molecular imaging and molecular methods have been developed to better characterize thyroid nodules, and a number of studies that have clarified risk stratification systems that can be modified over time allow for individualization of diagnosis, initial treatment, and subsequent follow-up strategies. Advances in surgical approaches and new treatments for patients with the most aggressive forms of thyroid cancer have all impacted on management guidelines. Despite substantial similarities, there also are important differences between recent guidelines for some of the common clinical scenarios encountered by physicians in clinical practice. In the present manuscript we will highlight similarities and differences between several of the most recently published guidelines focused on key areas of importance to clinical care and controversy. These are key areas for future research to strengthen the data to support future guideline recommendations.

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Features Predictive of Distant Metastasis in Papillary Thyroid Microcarcinomas

Cited by 103 publications

References 30 publications

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

Long-term oncologic outcomes of papillary thyroid microcarcinoma according to the presence of clinically apparent lymph node metastasis: a large retrospective analysis of 5,348 patients

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Thyroid nodules and cancer management guidelines: comparisons and controversies

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