scholarly journals Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Hengqiang Zhao ◽  
Le Cui
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Kaplan Meier ◽  
Extent Of Surgery

It remains controversial whether patients with papillary thyroid microcarcinoma (PTMC) benefit from total thyroidectomy (TT) or thyroid lobectomy (TL). We aimed to investigate the impact of extent of surgery on the prognosis of patients with unilateral PTMC. Patients were obtained from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Cancer-specific survival (CSS) and overall survival (OS) were evaluated by Cox regression and Kaplan–Meier curves with propensity score matching. Of 31167 PTMC patients enrolled, 22.2% and 77.8% of which underwent TL and TT, respectively. Patients with TT were more likely to be younger, females, present tumors of multifocality, extrathyroidal extension, cervical lymph node metastasis (CLNM), distant metastasis, and receive radioactive iodine (RAI) compared with those receiving TL. The multivariate Cox regression model showed that TT was not associated with an improved CSS and OS compared with TL with hazard ratio (HR) and 95% confidence interval (CI) of 0.53 (0.25-1.12) and 0.86 (0.72-1.04), respectively. In addition, the Kaplan–Meier curves further confirmed the similar survival between TL and TT after propensity score matching. The subgroup analysis showed that TT was associated with better CSS for patients < 55 years, those with tumors of gross extrathyroidal extension, CLNM (N1b), and cases not receiving RAI with HR 95% CI of 0.13 (0.02-0.81), 0.12 (0.02-0.66), 0.11 (0.02-0.64) and 0.36 (0.13-0.90), respectively. TT predicted a trend of better OS for patients with N1b and distant metastasis after adjustment. In addition, TT was associated with better CSS than TL for patients with risk factors like N1b combined with gross extrathyroidal extension, and/or multifocality after matching. In conclusion, TL may be enough for low-risk PTMC patients. TT may improve the prognosis of unilateral PTMC patients with 2 or more risk clinicopathologic factors like CLNM, multifocality, extrathyroidal extension and a younger age compared with TL.

US-guided Microwave Ablation of Low-Risk Papillary Thyroid Microcarcinoma: Longer-Term Results of a Prospective Study

2020 ◽  
Vol 105 (6) ◽  
pp. 1791-1800 ◽  
Author(s):  
Wen-Wen Yue ◽  
Lu Qi ◽  
Dan-Dan Wang ◽  
Shou-Jun Yu ◽  
Xi-Ju Wang ◽  
...  
Keyword(s):  
Prospective Study ◽  
Distant Metastasis ◽  
Microwave Ablation ◽  
Large Population ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Function Evaluation ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma

Abstract Background Papillary thyroid microcarcinoma (PTMC) has become a main cause of the extremely high incidence of thyroid carcinoma. This study aimed to evaluate the longer-term effectiveness of ultrasound (US)-guided microwave ablation (MWA) for treatment of low-risk PTMC with a large population. Methods This prospective study was approved by ethics committee of our institution. MWA was performed under US-guidance for 119 unifocal PTMC patients without clinically cervical or distant metastasis. The target ablation zone exceeded the tumor edge judged by contrast-enhanced US to avoid marginal residue and recurrence. US and thyroid function evaluation were followed at 1, 3, 6, and 12 months after treatment and every 6 to 12 months thereafter. Any adverse event associated with MWA was evaluated. Results The follow-up duration after MWA was 37.2 ± 20.9 months (range 12-101 months). Tumor volume decreased significantly from 1.87 ± 1.03 mL immediately after MWA to 0.01 ± 0.04 mL at the final evaluation (P < 0.001), with a mean volume reduction ratio of 99.4 ± 2.2% and 107 cases (93.9%) got complete remission. A patient was detected with cervical lymph node metastasis at 26-month follow-up and underwent 1 additional MWA treatment successfully. No distant metastasis was observed. All the acquired histological pathology results confirmed the absence of residual or recurrent tumor cells after MWA. No delayed complications associated with MWA were encountered for all patients. Conclusions Percutaneous MWA is technically feasible for complete PTMC destruction and showed well longer-term effectiveness; thus, it seems to be an effective nonsurgical therapy to complement the current recommendation for selected low-risk PTMC patients.

Ultrasound Assessment of Degrees of Extrathyroidal Extension in Papillary Thyroid Microcarcinoma

2014 ◽  
Vol 20 (10) ◽  
pp. 1037-1043 ◽  
Author(s):  
Sun Moon ◽  
Dong Kim ◽  
Seong Kim ◽  
Tae Ha ◽  
Ha Park ◽  
...  
Keyword(s):  
Extrathyroidal Extension ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Ultrasound Assessment
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