Should All Papillary Thyroid Microcarcinomas Be Aggressively Treated?

Yu, Xinhua; Yin, Wei; Sippel, Rebecca S.; Chen, Herbert

doi:10.1097/sla.0b013e318230036d

Cited by 274 publications

(219 citation statements)

References 27 publications

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“…If this were the case, total thyroidectomy might prove beneficial in this group. We performed a subset analysis of Black 13 Similar to our study, they compared total thyroidectomy against thyroid lobectomy in patients with two or more risk factors. Contrary to our study, they found that total thyroidectomy provided a survival advantage in this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Yu et al evaluated risk factors for mortality in patients with papillary thyroid microcarcinoma. 13 The study included 18 445 patients from the Surveillance, Epidemiology, and End Results database. Similar to our study, they found that age greater than 45 years, male sex, and African American or minority race were associated with increased risk of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…12 Yu et al evaluated risk factors for mortality in patients with papillary thyroid microcarcinoma. 13 They found that African American or minority race was associated with an increased risk of mortality. However, their cohort included patients with nodal and distant metastasis, which are known poor prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

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Racial disparities in papillary thyroid microcarcinoma survival

Megwalu

Saini

2016

J. Laryngol. Otol.

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Objective: To evaluate the impact of race on survival in patients with papillary thyroid microcarcinoma.Methods: The study cohort included 17 668 patients diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute.Results: Black patients had lower overall survival than other racial groups ( p < 0.001). Black patients had significantly worse overall survival (hazard ratio = 2.59) after adjusting for sex, marital status, age, year of diagnosis, multifocal disease and type of surgery. A subset analysis of Black patients revealed no significant difference in overall survival for total thyroidectomy versus lobectomy ( p = 0.15).Conclusion: Black race is a negative prognostic factor in thyroid cancer, which cannot be explained by advanced disease stage. Further research on mechanisms by which race affects survival is needed to reveal areas of opportunity for interventions aimed at reducing health disparities in cancer care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Racial disparities in papillary thyroid microcarcinoma survival

Megwalu

Saini

2016

J. Laryngol. Otol.

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“…3 Fortunately, tumor-related mortality has remained very low, and reported to be 0.5% for microcarcinoma. 4 Despite this, the optimal management of microcarcinoma remains a subject of ongoing debate. A subset of microcarcinoma is associated with local recurrence and nodal metastasis.…”

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confidence: 99%

“…A subset of microcarcinoma is associated with local recurrence and nodal metastasis. 4,5 The identification of this aggressive subset is critical to better triaging of the patients with regard to the need for additional therapy. 6 Clinicopathological factors, eg, age more than 45 years, tumor size greater than 5 mm, male sex, multifocality, lymph nodes metastasis, and extrathyroidal extension have been reported to predict poor prognosis.…”

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BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

et al. 2013

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BRAF V600E mutation has emerged as a marker of aggressive behavior in papillary thyroid carcinoma but its significance in microcarcinoma is not entirely clear. One-hundred and twenty-nine papillary thyroid microcarcinomas were tested for BRAF V600E mutation by single-strand conformation polymorphism, and their clinicopathologic features (age, sex, tumor size, multifocality, nodal metastases, histologic subtype, tumor cell morphology, architecture, tumor-associated stromal reaction, tumor interface to non-neoplastic thyroid (well circumscribed vs infiltrative), extrathyroidal extension, lymphovascular invasion, intratumoral multinucleated giant cells, and adjacent non-neoplastic thyroid pathology) were examined. Compared with tumors without the mutation (39/129, 30%), the mutated microcarcinomas (90/129, 70%) showed significantly higher prevalence of infiltrative tumor borders (78/90 vs 23/39, P ¼ 0.001), tumor-associated stromal desmoplasia/fibrosis and/or sclerosis (80/90 vs 25/39, P ¼ 0.002), classic nuclear features of papillary thyroid carcinoma (90/90 vs 35/39, P ¼ 0.008) and cystic change (43/90 vs 11/39, P ¼ 0.05). BRAF V600E mutation was more frequent in classic (75%), tall cell (91%), and other variants (470%) than in follicular variant (21%) of papillary thyroid microcarcinoma. Tumors without the mutation were significantly more likely to be solid, well circumscribed, and lacked desmoplasia/fibrosis or sclerosis. However, on multivariate analysis, only the follicular variant of papillary microcarcinoma was significantly associated with the absence of mutation (odds ratio (95% confidence interval): 0.09 (0.01-0.54)). Lymph node metastases (n ¼ 24) were more frequent in microcarcinomas with mutation than without (21/24 vs 3/24, P ¼ 0.02). All patients with lateral cervical node metastasis (n ¼ 9), and all but one tumor with extrathyroidal extension (n ¼ 17/18) showed BRAF V600E mutation. No significant differences were noted in age, sex, tumor size, multifocality, lymphovascular invasion, psammoma bodies, stromal calcification, intratumoral multinucleated osteoclastic-type giant cells, and lymphocytic infiltration between the two groups of tumors. BRAF V600E mutation is an early event in thyroid carcinogenesis, and is associated with distinctive morphology and aggressive features even in papillary thyroid microcarcinomas.

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Screening for Thyroid Cancer

Lin

Bowles

Williams

et al. 2017

JAMA

521

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IMPORTANCEThe incidence of detected thyroid cancer cases has been increasing in the United States since 1975. The majority of thyroid cancers are differentiated cancers with excellent prognosis and long-term survival.OBJECTIVE To systematically review the benefits and harms associated with thyroid cancer screening and treatment of early thyroid cancer in asymptomatic adults to inform the US Preventive Services Task Force.

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Should All Papillary Thyroid Microcarcinomas Be Aggressively Treated?

Abstract: Although PTMC is generally associated with an excellent prognosis, 0.5% patients may die of PTMC. The presence of 2 or more risk factors is strongly associated with cancer-related mortality and can help to identify patients who should be considered for more aggressive management.

Cited by 274 publications

References 27 publications

Racial disparities in papillary thyroid microcarcinoma survival

Racial disparities in papillary thyroid microcarcinoma survival

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

Screening for Thyroid Cancer

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