Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma

Buffet, C; Golmard, Jean Louis; Hoang, Catherine; Trésallet, Christophe; Fédiaevsky, Laurence Du Pasquier; Fierrard, Hélène; Aurengo, André; Ménégaux, Fabrice; Leenhardt, Laurence

doi:10.1530/eje-12-0105

Cited by 77 publications

(68 citation statements)

References 38 publications

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“…Several authors have reported that PTMCs that have >5 mm in size had a higher incidence of lymph node involvement, capsule invasion and multifocality, compared with those ≤5 mm [29,36], whereas other studies have shown no differences [37]. In our study we demonstrated that tumor size (< or ≥5 mm) was an independent risk factor for extrathyroidal extension.…”

Section: Discussioncontrasting

confidence: 43%

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan

Boilă

Paşcanu

et al. 2016

Acta Medica Marisiensis

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Background: Papillary thyroid microcarcinoma (PTMC) defines a group of papillary thyroid carcinomas, incidentally discovered, measuring 1 cm or less. The aim of our study was to evaluate the incidence and the pathological characteristics of PTMCs in our institution in the last 25 years, with special emphasis on the prognostic factors related to PTMCs. Material and methods: We performed a retrospective, cohort study on 255 PTMCs, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and 2014. Results: A significant increase in the incidence of PTMCs was observed in the 2004-2014 period, compared to 1990-2003 (7.6%, 229 PTMCs/3005 thyroid specimens vs. 1.2%, 23 PTMCs/1885 thyroid specimens). Conventional PTMCs accounted for most of PTMC cases (n=123 cases, 48.2%), followed by the follicular variant of PTC (n=117 cases, 45.9%). The increasing incidence of PTMCs was associated with a significant increase in the routine number of blocks sampled per case over the study period (R2 =0.72, p < 0.001). By means of the univariate and multivariate analysis, three risk factors were predictive for extrathyroidal extension in PTMCs: multifocality (Odds ratio [OR] 4.97, p-0.002), tumor size ≥ 5mm (OR 8.97, p-0.008) and lymph node involvement (OR 17.66 p<0.005). Conclusion: The incidence of PTMCs has revealed a significant increasing trend in our institution over the last 25 years. Multifocality, lymph node involvement and tumor size ≥ 5mm were found to be risk factors for extrathyroidal extension. These prognostic factors must be evaluated and clearly mentioned in the pathological report, to help a correct estimation of biological potential of the lesion and an appropriate postoperative management.

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Section: Discussioncontrasting

confidence: 43%

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan

Boilă

Paşcanu

et al. 2016

Acta Medica Marisiensis

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“…Total thyroidectomy followed by RIA is often performed as initial treatment for patients with PTMC (8,30). However, there has been accumulating information justifying a less invasive treatment for PTMC, due to its excellent prognosis following less extensive surgery (4,16,17,31-33), or even observation without surgery (34,35).…”

Section: Discussionmentioning

confidence: 99%

“…Those observations suggested that there is a group of PTMCs that have already acquired highly malignant potential. However, the basic mechanism underlying the development of aggressive characteristics in these tumors has not yet been identified.The reported risk factors for PTMC recurrence were shown to be male gender (8,9), extent of primary surgery (10), presence of lymph node metastases at initial diagnosis (3,(8)(9)(10)(11)(12), tumor multifocality (3,8,12) and capsular invasion (9,(11)(12)(13)(14). Furthermore, male gender, tumor multifocality and capsular invasion are considered to be risk factors characteristic of lymph node metastasis (13,15).…”

mentioning

confidence: 99%

E-cadherin expression and cell proliferation in the primary tumor and metastatic lymph nodes of papillary thyroid microcarcinoma

Nakamura

Onoda

Noda

et al. 2013

Molecular and Clinical Oncology

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Abstract. Although papillary thyroid microcarcinoma (PTMC) has an excellent prognosis, certain cases exhibit aggressive clinical manifestations. In this study, we assessed the expression of E-cadherin and Ki-67 in primary PTMC tumors and metastatic lymph nodes, in order to investigate the mechanism underlying the mainly indolent but potentially malignant nature of PTMC. A total of 93 PTMC patients treated in our institute were included in this study. All primary tumors and 57 metastatic lymph nodes were immunohistochemically stained and a total of 73 tumors (78.5%) were positive for E-cadherin. E-cadherin expression was significantly less common at the invasive front (58.1%, P<0.01) compared to that at the center of the tumor. Tumors that had lost E-cadherin expression at the invasive front frequently presented with lymph node metastasis (70.6%). Small tumors (≤5 mm diameter) expressed E-cadherin significantly more frequently compared with larger tumors (P=0.04); however, no other particular characteristic was found to correlate with the status of E-cadherin expression in the primary tumors. E-cadherin expression was detected in 49 (86.0%) of the 57 metastatic foci and correlated significantly with the expression status at the invasive front of the tumor (P=0.02). The Ki-67 index was universally low and was not correlated with the clinicopathological characteristics or the E-cadherin expression of the tumors. These results suggested that cancer cells in the metastatic lymph nodes exhibit indolent characteristics, similar to those of the primary PTMC. However, the metastatic cancer cells may have already completed the process of epithelial-to-mesenchymal transition (EMT) and mesenchymal-to-epithelial transition (MET), suggesting an innate malignant potential. IntroductionAccording to the World Health Organization classification system for thyroid tumors, papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma (PTC) measuring ≤10 mm in its greatest dimension (1). The occurrence of PTMC is on the increase worldwide (2-4), along with the frequent application of neck ultrasonography (US) (5,6). PTMC is generally characterized by an indolent clinical course and has an excellent prognosis, with a disease-specific mortality of <0.5% (6). However, certain PTMC cases were found to be clinically aggressive (6,7). According to the observations of Sugitani et al (7), PTMC patients with bulky lymph node metastases or extrathyroidal invasion were at the highest risk for a cancer-specific fatal outcome. Those observations suggested that there is a group of PTMCs that have already acquired highly malignant potential. However, the basic mechanism underlying the development of aggressive characteristics in these tumors has not yet been identified.The reported risk factors for PTMC recurrence were shown to be male gender (8,9), extent of primary surgery (10), presence of lymph node metastases at initial diagnosis (3,(8)(9)(10)(11)(12), tumor multifocality (3,8,12) and capsular invasion (9,(11)(12)(13)(14...

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“…Факторы риска рецидива микро-карцином различны, из них выделяют мужской воз-раст, мультифокальность, инвазию в капсулу [13,[52][53]. При этом мультифокальность обнаруживается в 7-56% случаев микрокарцином [5-6, 10, 19, 38-40].…”

Section: агрессивное лечение микрокарцином или их агрессивное течение?unclassified

“…При подтверждении поражения лимфоузлов лечение необходимо продол-жить и провести абляцию остаточной тиреоидной ткани радиоактивным йодом [9,[43][44][45][46][47][48][51][52]. б) Большинство экспертов против тиреоидэкто-мии и лимфодиссекции при одиночной микрокарци-номе без метастатического поражения лимфоузлов, потому что после гемитиреоидэктомии частота реци-дивов низкая [13,40,43,44,[55][56][57], часть считает необходимым объемом тотальную тиреоидэктомию, которую можно дополнить терапией радиоактивным йодом [5,9,[51][52]. в) Множество микрокарцином случайно выяв-ляют при плановом гистологическом исследовании, что напрямую зависит от толщины среза тиреоидной ткани.…”

Section: агрессивное лечение микрокарцином или их агрессивное течение?unclassified

Papillary thyroid microcarcinoma

et al. 2015

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Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma

Cited by 77 publications

References 38 publications

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

E-cadherin expression and cell proliferation in the primary tumor and metastatic lymph nodes of papillary thyroid microcarcinoma

Papillary thyroid microcarcinoma

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