Increase of papillary thyroid microcarcinoma and a plea for restrictive treatment: A retrospective study of 1,391 prospective documented patients

Gschwandtner, Elisabeth; Klatte, Tobias; Swietek, Natalia; Bures, Claudia; Kober, F.; Ott, Johannes; Schultheis, Andrea; Neuhold, N.; Hermann, Michael

doi:10.1016/j.surg.2015.06.015

Cited by 29 publications

(29 citation statements)

References 40 publications

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“…In the majority of PTMC cases, even with multifocality, a limited surgical approach without completion thyroidectomy, lymphadenectomy or radioiodine treatment was recommended as sufficient management. However, it was stated that in cases of intra-or pre-operative clinically suspected lymph node metastases, or in cases with post-operatively diagnosed risk factors, a standard radical procedure should be performed (40). In the present study, in the group of patients with NITMC, 57 (95.00%) radical surgeries were performed without the necessity of a second surgery.…”

Section: Tumor Size MM ---------------------------------------------mentioning

confidence: 68%

“…Notable observations concerning the surgical treatment of ITMC and NITMC were presented by Gschwandtner et al (40). To evaluate a less-radical approach, the study revealed that a non-incidental finding, nodal metastases at presentation, a young age, aggregate tumor size and subcapsular tumor localization were risk factors for lymph node metastases, and therefore did not recommend surgical treatment.…”

Section: Tumor Size MM ---------------------------------------------mentioning

confidence: 99%

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Incidental and non-incidental thyroid microcarcinoma

et al. 2016

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Abstract. There is no clear therapeutic approach for thyroid microcarcinoma (TMC). This may be as a consequence of recent observations that have reported biologically different types of TMC, which should be treated differently. The objective of the present study was to compare incidental TMC (ITMC) and non-incidental TMC (NITMC) in order to assess the differences in the incidence, diagnostic results, clinicopathological characteristics and surgical treatment. The study consisted of a retrospective chart review of 3,218 patients consecutively admitted and surgically treated in a single institution due to thyroid pathology. A total of 246 (7.64%) patients presented with a thyroid malignancy, and 97 (39.43%) of these individuals were diagnosed with TMC; 37 (38.14%) patients exhibited ITMC and 60 (61.86%) exhibited NITMC. All 37 (100.00%) patients with ITMC exhibited a papillary type of cancer. In the NITMC group, 1 (1.67%) patient presented with follicular microcarcinoma, 1 (1.67%) individual with papillary-and follicular-type microcarcinoma, 1 (1.67%) individual with medullary microcarcinoma, and the remaining 57 (95.00%) patients presented with papillary microcarcinoma. The number of younger patients (<45 years old) was higher in the NITMC group, but this difference was not significant (P=0.205). In all patients with ITMC, ultrasound-guided fine-needle aspiration biopsy did not reveal malignant processes. In the NITMC group, the number of larger tumors (>5 mm) was significantly higher compared with that in the ITMC group (P<0.001). ITMC was significantly associated with multinodular goiter (MNG) (P<0.001). Amongst the NITMC group, 18.33% of patients presented with cervical lymph node involvement (P<0.001). Overall, the incidence of TMC is high, and consists of ITMC and NITMC, although the prevalence of NITMC is higher than that of ITMC. The majority of ITMCs and NITMCs are composed of a papillary type of cancer. The majority of ITMCs have dimensions ≤5 mm in diameter and are significantly associated with MNG. In comparison with ITMC, NITMC more often presents with aggressive features such as cervical lymph node metastases, so the surgical approach to this tumor should be more radical.

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Section: Tumor Size MM ---------------------------------------------mentioning

confidence: 68%

Section: Tumor Size MM ---------------------------------------------mentioning

confidence: 99%

Incidental and non-incidental thyroid microcarcinoma

et al. 2016

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“…Papillary thyroid microcarcinoma (PTMC) is a subgroup of PTC, which refers to the tumor diameter is or less than 1cm in PTC according to the World Health Organization definition [1]. The incidence of PTMC increased year by year and reached as high as 11.8% of the total population in 2008 [2]. PTMCs are most often slow growing tumors and most can be removed surgically [2–5].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of PTMC increased year by year and reached as high as 11.8% of the total population in 2008 [2]. PTMCs are most often slow growing tumors and most can be removed surgically [2–5]. Although slow-growing PTMC can sometimes spread to the lymph nodes in the neck, positive lymph nodes do not usually worsen the generally excellent prognosis [2–5].…”

Section: Introductionmentioning

confidence: 99%

“…PTMCs are most often slow growing tumors and most can be removed surgically [2–5]. Although slow-growing PTMC can sometimes spread to the lymph nodes in the neck, positive lymph nodes do not usually worsen the generally excellent prognosis [2–5]. The involved lymph nodes can be surgically removed along with the thyroid, thus, most people diagnosed with PTMC will not die from it [2–5].…”

Section: Introductionmentioning

confidence: 99%

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A meta-analysis on the effect of operation modes on the recurrence of papillary thyroid microcarcinoma

Song

Huang

et al. 2016

Oncotarget

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Whether total thyroidectomy reduces the recurrence rate in patients with papillary thyroid microcarcinoma (PTMC) is currently controversy. Conclusions of sporadic, inconsistent, and mono-institutional studies need a meta-analysis to evaluate. 525 relevant studies were obtained from initial search on PubMed, 511 studies were excluded by inclusion and exclusion criteria. Eligible data were extracted from each included study. The Odds ratios (ORs) and 95% confidence interval (CI) were used to assess the difference in the recurrence rates between PTMC patients treated with total thyroidectomy and non-total thyroidectomy. OR and 95% CI were calculated using a fixed-effects or a random-effects model. The Q statistic was used to evaluate homogeneity and Beggs test was used to assess publication bias. 14 studies meeting the inclusion criteria were included in this meta-analysis. The over all recurrence rates of pooled patients with total thyroidectomy and non-total thyroidectomy were 2.83% and 2.84% respectively. Primary random-effects model analysis showed, no significant difference of recurrence rates existed between two operation modes (OR = 0.732, 95% CI: 0.444 - 1.208), while, high heterogeneity among studies was found, I-squared index (I2) = 40.2%. After remove one study with high heterogeneity, the OR of the pooled recurrence rates of the total thyroidectomy and the non-total thyroidectomy groups was 0.786 (95% CI: 0.363 - 1.701), further suggesting no significant difference of the recurrence rate exists between two operation modes. Our meta-analysis demonstrated postoperative recurrence of PTMC is not reduced by total thyroidectomy, non-total thyroidectomy is also a good choice to treat PTMC patients.

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