Papillary thyroid microcarcinoma: distinct form or cancer growth stage?

Background. Over the past decades an increase in the incidence of papillary thyroid microcarcinoma (PTMC) has been observed throughout the world owing to the improved diagnostics. There are many different opinions about the aggressiveness degree of this group of tumors, as well as about the tactics of managing patients with PTMC.Aim of the study is the identification of the prognostic factors responsible for the features of the clinical course, including the more aggressive one.Materials and methods. A study was carried out with a detailed analysis of a group of patients with papillary thyroid cancer ≤1 cm in size and the existing clinical data of regional and distant metastases. All patients underwent thyroidectomy with bilateral central cervical lymph node dissection. Factors such as gender, patient age, bilaterality, extrathyroid extension, the presence or absence of a capsule around the tumor node, the absence or presence of metastases in the central part were assessed. In 26.6% histological examination revealed metastatic lesions of the central group lymph nodes. Latent metastases were detected in 24.2% of women and 43% of men, in 36.7% of patients <55 and in 14.3% of patients ≥ 55 years, in 29.5% with the absence of the node capsule and in 19.3% with encapsulated tumors, in 48.1% with multicentric growth and in 19.5% with a solitary neoplasm, in 21.7% with a tumor size ≤0.5 cm and in 27.9% with a node of 0.6–1 cm, in 24% with the absence of invasion of the thyroid capsule and in 31% with the presence of extrathyroid invasion, in 21% of patients with typical, in 26% with follicular and 43% with mixed papillary cancer. 95 patients received radioiodine therapy. No additional metastases were found in them.Results. When conducting univariate analysis, the main signs influencing the development of metastases in the central zone were age up to 55 years (p = 0.009, χ2 = 6.919) and multicentric neoplasm (p = 0.004, χ2 = 8.530); in multivariate analysis, similarly, age younger 55 years (p = 0.000, Exp B = 0.011, CI 95.0% 0.001–0.106) and multifocality (p = 0.027, Exp B = 2.686, CI 95.0% 1.119–6.448).Conclusion. PTMC is not a separate group or tumor morphotype, and the determination of treatment tactics for this group of patients should be based not only on the size of the tumor, but on the clinical and biological parameters of the tumor.

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Papillary thyroid microcarcinoma: Analysis of outcomes and features predicting risk of recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18569 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18569-e18569

Author(s):

Chandra Shekhar Dravid ◽

Priya Sr ◽

P. S. Pai ◽

D. Chaukar

Keyword(s):

Risk Factors ◽

High Risk ◽

Adverse Events ◽

Univariate Analysis ◽

Distant Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Free Survival ◽

Thyroid Microcarcinoma ◽

Radioiodine Ablation

e18569 Background: Papillary thyroid microcarcinoma (PTMC) is an enigmatic entity - diverse opinions exist on its clinical course and management. We aimed to analyse disease outcomes and to identify high-risk factors in PTMCs. Methods: This is a retrospective analysis of patients of PTMC treated in our hospital between 2000 and 2014. Clinico-radiological features, treatment details, long term outcomes and recurrence patterns were noted; these were analysed statistically. Results: 160 patients were studied; 61% were females; 86% were aged 55 years or below; 95% cases presented with an enlarged neck node or thyroid nodule or distant metastasis while 5% were incidentalomas. Total thyroidectomy with radioiodine ablation was done in 77% while hemithyroidectomy was done in 23% patients. Follow up ranged between 2 and 238 months. There were 11 (7%) disease related events (nodal or distant metastases or death due to persistent disease). 4 (2.5%) patients died of disease. On univariate analysis, a larger thyroid primary (p 0.001), pre-operatively radiologically identifiable disease in the thyroid (p 0.02) and the lesion not being an incidentaloma (p 0.01) were associated with development of adverse events. Multivariate analysis confirmed the latter two factors as high risk (p 0.05 and 0.00). Nodal metastasis increased with a larger primary (p 0.001), which was multifocal (p 0.00), bilateral (p 0.01) and showed extrathyroid extension (p 0.00). Distant metastases were related with advanced age (p 0.02), presence of involved nodes (p 0.04), larger primary tumour (p 0.15), multifocal tumour (p 0.17), bilateral foci (p 0.02) and extrathyroidal extension (p 0.06). Correspondingly, Kaplan Meier curves showed a better overall survival (OS) and disease free survival (DFS) with incidentalomas as compared to cases presenting with symptoms (Median OS 84 months vs 78 months; Median DFS 79 months vs 77 months) and cases where the lesion was not seen on radiology (Median OS 80 months vs 76 months; Median DFS 80 months vs 75 months). However neither was significant statistically. Addition of Radioiodine ablation did not confer survival advantage (p 0.6). Conclusions: PTMCs are associated with adverse events despite the size of the primary lesion. Stratification as per the above risk factors can improve event free survival. Conversely, aggressive treatment may be deferred in cases of lesions discovered incidentally or on routine screening.

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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.

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Long-term Outcomes and Prognostic Factors in Papillary Thyroid Microcarcinoma Patients with Distant Metastases

10.21203/rs.3.rs-734874/v1 ◽

2021 ◽

Author(s):

Huai-Yu Weng ◽

Ting Yan ◽

Wang-Wang Qiu ◽

Chuang Xi ◽

Li-Ying Hou ◽

...

Keyword(s):

Prognostic Factors ◽

Radioactive Iodine ◽

Distant Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Long Term Outcomes ◽

Thyroid Microcarcinoma ◽

Male Sex

Abstract PurposesDistant metastasis from papillary thyroid microcarcinoma (PTMC) is extremely rare and the long-term outcome and independent prognostic factors remain unclear.The present study aimed to investigate clinicopathological characteristics and evaluate the long-term outcomes and prognostic factors of PTMC patients with distant metastases (DM) who underwent surgery and radioactive iodine (131I) treatment.MethodsWe retrospectively reviewed the medical records of 13,441 patients with thyroid cancer (including 1,697 cases with PTMC) who underwent 131I treatment at our institution between January 2008 and December 2019. PTMC patients with distant metastases with sufficient clinical follow-up data were enrolled in this cohort study. The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan–Meier method and the prognostic factors were assessed by Cox proportional hazards. ResultsThirty-three PTMC patients with DM were enrolled in this study. The median follow-up was 75 months (range: 5–151 months).The 5-year and 10-year OS rates were 96.97% and 81.41%, respectively, and the 5-year and 10-year PFS rates were 90.46% and 69.68%, respectively. Multivariate analysis showed that male sex(P=0.005) , radioactive iodine refractory PTMC (P=0.033) and symptomatic DM (P=0.022) were significantly associated with worse 10-year PFS in PTMC patients with DM. No independent predictor related to poor 10-year OS found in the present study.ConclusionsThe prognosis of PTMC patients becomes worse after the development of DM. Male sex, radioactive iodine refractory PTMC and symptomatic DM were identified as independent factors associated with PFS.

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Papillary thyroid microcarcinoma with lung metastases: a case report and review of the literature

Thyroid Research ◽

10.1186/s13044-021-00106-0 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Tadafumi Shimizu ◽

Takaaki Oba ◽

Tatsunori Chino ◽

Ai Soma ◽

Mayu Ono ◽

...

Keyword(s):

Lung Metastasis ◽

Lung Tumor ◽

Lung Metastases ◽

Standard Of Care ◽

Distant Metastases ◽

Needle Aspiration ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma ◽

The Right

Abstract Background Distant metastasis from papillary thyroid microcarcinoma (PTMC) is rare. Here we report a case of PTMC with multiple lung metastases. Case presentation A 64-year-old man presented to our hospital with abdominal pain. Computed tomography incidentally revealed multiple lung nodules. The lung tumor was histologically diagnosed as metastasis of papillary thyroid carcinoma (PTC) by core needle biopsy via thoracoscopy. The patient was referred to our department for further examination. Neck ultrasonography revealed a 0.9 cm hypoechoic nodule in the right lobe of the thyroid gland, which was diagnosed as PTC by fine-needle aspiration cytology. Subsequently, total thyroidectomy was performed, followed by radioiodine therapy. Iodine-131 (131-I) scintigraphy showed a strong accumulation in the lung metastasis. The patient presented no evidence of progression of lung metastasis for 25 months after the operation. Conclusions Lymph node metastasis or extraglandular extension has been reported in the few published cases of metastatic PTMC, including the present case, and the average age of these cases was 58.8 ± 12.0 years. Although active surveillance without surgical resection is expected to become a standard of care for PTMC, this case indicates that a subset of PTMC patients with risk factors may develop distant metastases. Hence, careful preoperative screening is required to avoid complications associated with completion thyroidectomy.

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Long-term outcomes and prognostic factors in papillary thyroid microcarcinoma patients with distant metastases

Endocrine ◽

10.1007/s12020-021-02906-8 ◽

2021 ◽

Author(s):

Huai-Yu Weng ◽

Ting Yan ◽

Wang-Wang Qiu ◽

Chuang Xi ◽

Li-Ying Hou ◽

...

Keyword(s):

Prognostic Factors ◽

Distant Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Long Term Outcomes ◽

Thyroid Microcarcinoma

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Papillary Thyroid Microcarcinoma with Lung Metastases: A Case Report and Review of the Literature

10.21203/rs.3.rs-380438/v1 ◽

2021 ◽

Author(s):

Tadafumi Shimizu ◽

Takaaki Oba ◽

Tatsunori Chino ◽

Ai Soma ◽

Mayu Ono ◽

...

Keyword(s):

Thyroid Gland ◽

Lung Metastasis ◽

Lung Tumor ◽

Lung Metastases ◽

Distant Metastases ◽

Needle Aspiration ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma ◽

Remnant Thyroid

Abstract Introduction: Distant metastasis from papillary thyroid microcarcinoma (PTMC) is rare. Here we report a case of PTMC with multiple lung metastases.Case Presentation: A 64-year-old man presented to our hospital with abdominal pain. Computed tomography incidentally revealed multiple lung nodules. The lung tumor was histologically diagnosed as metastasis of papillary thyroid carcinoma (PTC) by core needle biopsy via thoracoscopy. The patient was referred to our department for further examination. Neck ultrasonography revealed a 0.8 cm hypoechoic mass in the right lobe of the thyroid gland, diagnosed as PTC by fine-needle aspiration cytology. Subsequently, total thyroidectomy was performed, followed by radioiodine therapy. Iodine-131 (131-I) scintigraphy showed a strong accumulation in the lung metastasis. The patient presented no evidence of progression of lung metastasis for 25 months after the operation. Discussion/Conclusions: Although there are few published cases of metastatic PTMC, lymph node metastasis or extraglandular extension was observed in most patients, including the present case, and the average age of these cases was 58.8 ± 12.0 years. Although active surveillance without surgical resection is expected to remain standard of care for PTMC, this case indicates that a subset of PTMC patients with risk factors may develop distant metastases. Careful preoperative screening is required to avoid complications associated with reoperation of the remnant thyroid gland.

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Cases of pN1b and pM1 Papillary Microcarcinoma of the Thyroid

International Journal of Practical Otolaryngology ◽

10.1055/s-0038-1666794 ◽

2018 ◽

Vol 01 (01) ◽

pp. e6-e9

Author(s):

Shinji Takebayashi ◽

Shogo Shinohara ◽

Keisuke Mizuno ◽

Koji Saida ◽

Kazuki Hayashi ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Malignant Tumors ◽

Medical Center ◽

Distant Metastases ◽

Good Prognosis ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Thyroid Microcarcinoma ◽

Male Patients

Introduction Papillary thyroid carcinoma has a relatively good prognosis among malignant tumors of the thyroid. Therefore, a “wait and see” strategy is often adopted for patients with micropapillary thyroid carcinoma. On the other hand, patients with papillary thyroid carcinoma with N1b or M1 disease are known to show a poor prognosis. Here, we investigated the differences in the characteristics between patients with papillary thyroid microcarcinoma with and without N1b metastatic nodes/distant metastases to identify the risk factors for metastasis. Methods The retrospective study was performed in patients with thyroid microcarcinoma who were treated at the Kobe City Medical Center General Hospital from 2007 to 2017. The characteristics of the patients with thyroid microcarcinoma who were classified as having N1b or M1 disease (N1b/M1 group) were compared with those of patients with the same cancer classified as having N0, N1a, or M0 disease (N0/N1a group). Results A total of 65 patients were enrolled in this study; 12 were classified into the N1b/M1 group and 53 were classified into the N0/N1a group. The proportion of males was significantly higher in the N1b/M1 group than in the N0/N1a group. There were no statistically significant differences in the distribution of the tumor sites, the ultrasonographic findings, or the frequency of the presence of multiple carcinomas. Although three patients died due to other causes, there were no patients who died due to papillary thyroid carcinoma. Conclusion No significant predictors were identified for classifying patients with papillary thyroid microcarcinoma into the N1b/M1 group in this study. However, our findings suggested that male patients with papillary thyroid microcarcinoma require more careful follow-up in comparison to female patients with this cancer.

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