Risk factors of papillary thyroid microcarcinoma that predispose patients to local recurrence

Background Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions. Methods We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008–2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features. Results Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32–15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97–5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002). Conclusions The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.

Download Full-text

Preoperative prediction of papillary thyroid microcarcinoma via multiparameter ultrasound

Acta Radiologica ◽

10.1177/0284185117692167 ◽

2017 ◽

Vol 58 (11) ◽

pp. 1303-1311 ◽

Cited By ~ 8

Author(s):

Hui Juan Ma ◽

Jing Chun Yang ◽

Zhen Peng Leng ◽

Ying Chang ◽

Hua Kang ◽

...

Keyword(s):

Logistic Regression ◽

Roc Curve ◽

Imaging Modality ◽

Multivariate Logistic Regression Analysis ◽

Strain Ratio ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Roc Curve Analysis ◽

Thyroid Microcarcinoma ◽

Heterogeneous Enhancement

Background Accurate diagnosis of papillary thyroid microcarcinoma (PTMC) is important for further management. Ultrasound (US) is the most frequently used imaging modality for PTMC. Purpose To evaluate the diagnostic value of conventional US, contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) for patients with PTMC. Material and Methods In total, 135 patients with subcentimeter thyroid nodules who underwent conventional US, CEUS, and RTE before surgery were enrolled. A multivariate logistic regression analysis was performed to assess the independent predictors of PTMC. The diagnostic performances of conventional US, CEUS, and RTE were evaluated with a receiver operating characteristic (ROC) curve analysis. Results A taller-than-wide shape was identified as the strongest predictor of PTMC (odds ratio [OR], 25.21), followed by heterogeneous enhancement (OR, 24.03), marked hypoechogenicity (OR, 21.71), poorly defined margin (OR, 5.51), strain ratio (OR, 2.59), and age (OR, 0.92; all P values < 0.05). Heterogeneous enhancement on CEUS showed the highest positive predictive value (PPV; 88.0%) and an accuracy of 83.7%. A logistic regression model was created to predict PTMC using conventional US, CEUS, and RTE. The area under the ROC curve was 0.97, with a sensitivity of 88.6% and a specificity of 94.6%. Conclusion Conventional US combined with CEUS and RTE can improve the diagnostic accuracy of PTMC.

Download Full-text

Prophylactic central neck dissection and local recurrence in papillary thyroid microcarcinoma: a meta-analysis

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2018.05.004 ◽

2019 ◽

Vol 85 (2) ◽

pp. 237-243 ◽

Cited By ~ 5

Author(s):

Hui Su ◽

Yujie Li

Keyword(s):

Local Recurrence ◽

Neck Dissection ◽

Meta Analysis ◽

Central Neck Dissection ◽

Papillary Thyroid Microcarcinoma ◽

Central Neck ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma ◽

Prophylactic Central Neck Dissection

Download Full-text

Factors Influencing the Outcome of Patients with Incidental Papillary Thyroid Microcarcinoma

Journal of Thyroid Research ◽

10.1155/2012/469397 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Beatriz Mantinan ◽

Antonia Rego-Iraeta ◽

Alejandra Larrañaga ◽

Enrique Fluiters ◽

Paula Sánchez-Sobrino ◽

...

Keyword(s):

Recurrence Rate ◽

Tumour Size ◽

Univariate Analysis ◽

Significant Risk ◽

Distant Metastases ◽

Significant Risk Factor ◽

University Hospital ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma

Objective. To analyze some factors that could influence the outcome of patients with PTMC.Material and Methods. This is a longitudinal observational study. All patients diagnosed and treated for papillary thyroid microcarcinoma at the University Hospital of Vigo, between January 1994 and December 2003, were included in the present study. Demographic characteristics, tumour characteristics, TNM stage, rate of recurrence, and treatment with131I were the study variables.Results. Ninety-one patients (75 females) with an average age of years, range 19–81, were studied. Initial tumour staging was T1 in 90 patients and T4a in 1 case. Initial lymph node involvement was present in 4 cases (4.4%). We only found one case with distant metastases at diagnosis. Postsurgical evaluation of thyroid specimens revealed that 28 (30.7%) tumours were multifocal. The average size of the tumour was cm, range 0.1–1. Univariate analysis reveals a statistically significant association between tumour multifocality and postsurgical131I therapy with the recurrence rate. In the multivariate analysis only multifocality (, HR 5.7) was a significant risk factor for the recurrence rate.Conclusions. Our results indicate that tumour multifocality is an independent predictor of relapse but neither the tumour size nor postsurgical131I therapy.

Download Full-text

A Papillary Thyroid Microcarcinoma Revealed by a Single Bone Lesion with No Poor Prognostic Factors

Case Reports in Endocrinology ◽

10.1155/2013/719304 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Yann Godbert ◽

Benedicte Henriques-Figueiredo ◽

Anne-Laure Cazeau ◽

Xavier Carrat ◽

Marc Stegen ◽

...

Keyword(s):

Total Thyroidectomy ◽

Bone Lesion ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Tissue Mass ◽

Surgical Specimen ◽

Left Chest ◽

Thyroid Microcarcinoma ◽

Therapeutic Decisions ◽

Single Bone

Objectives. Thyroid carcinomas incidence, in particular papillary variants, is increasing. These cancers are generally considered to have excellent prognosis, and papillary microcarcinomas are usually noninvasive. Many prognostic histopathology factors have been described to guide therapeutic decisions. Most patients are treated with total thyroidectomy without radioiodine treatment or partial surgery.Case Summary. A 65-year-old man with no significant medical history presented with pain in the left chest wall that had been present for several months. A computed tomography (CT) found a large tissue mass of 4 cm responsible for lysis of the middle arch of the 4th rib on the left. It was a single lesion, highly hypermetabolic on the 18-FDG PET/CT. The histology analysis of the biopsy and surgical specimen favored an adenocarcinoma with immunostaining positive for TTF1 and thyroglobulin (Tg). The total thyroidectomy carried out subsequently revealed a 4 mm papillary microcarcinoma with vesicular architecture of the right lobe, well delimited and distant from the capsule without vascular embolisms. After two radioiodine treatments, the patient is in complete clinical, biological, and radiological remission.Conclusion. This extremely rare case of a singular bone metastasis revealing a papillary thyroid microcarcinoma illustrates the necessity of further research to better characterize the forms of papillary thyroid microcarcinomas with potentially poor prognosis.

Download Full-text