Abstract
Purpose: In this study we aimed to determine, the multcentricity rates in patients with papillary microcarcinoma and the surgical method that should be applied.
Materials and Methods: A total of 1818 patients underwent thyroid surgery and we evaluated 379 patients retrospectively, who were reported to have thyroid cancer histopathologically. In these patients, 137 patients with papillary microcarcinoma were determined. We reviewed medical records of patients, for mulicentricity and frequency of microcarcinoma. Patients were classified according to MACIS, EORTC and TNM classification systems for thyroid cancer.
Results: Thirty-three (24%) of 137 patients with papillary microcarcinoma were detected to be multicentric. In 7 (21%) there were two or more tumor foci. The incidence of cancer was 33% in the other lobe when there was more than one foci in the same lobe. In all patients preoperative ultrasonography of the thyroid gland was multinodular. Ultrasonographic findings suspicious for malignancy were sought and in 44% patients these findings were present. Fine needle aspiration biopsy was performed in 31 patients and results of 23 patients were benign. Frozen section was performed 58 patients, where 17 patients had a benign frozen section report.
Conclusion: The risk of multicentricity in papillary microcarcinoma patients should be taken into account for determining the optimal surgical treatment. To prevent missing microcarcinoma foci, ultrasonography should be applied meticulously.
Keywords:
Papillary microcarcinoma, multicentricity, thyroid
References
1Sakorafas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev 2005; 31: 423–438. [DOI:10.1016/j.ctrv.2005.04.009]
2Pelizzo MR , Boschin IM, Toniato A, Piotto A, Bernante P, Pagetta C, Rampin L, Rubello D. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol 2006; 32: 1144-1148. [DOI:10.1016/j. ejso.2006.07.001.]
3Kucuk NO, Tari P, Tokmak E, Aras G. Treatment for microcarcinoma of the thyroid: clinical experience. Clin Nucl Med 2007; 32: 279–281.
4Cheema Y, Olson S, Elson D, Chen H. What is the biology and optimal treatment for papillary microcarcinoma of the thyroid? J Surg Res 2006; 134: 160–162. [DOI:10.1016/j.jss.2006.04.014]
5Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid-prognostic significance of lymph node metastasis and multifocality. Cancer 2003; 98: 31– 40. [DOI 10.1002/ cncr.11442.]
6Fagin JA. Perspective: lessons learned from molecular genetic studies of thyroid cancer--insights into pathogenesis and tumor-specific therapeutic targets. Endocrinology 2002; 143:2025-2028. [DOI:10.1210/en.143.6.2025.]
7Roti E, Degli Uberti EC, Bondanelli M, Braverman LE. Thyroid papillary microcarcinoma: a descriptive and metaanalysis study. Eur J Endocrinol 2008; 159: 659–673. [DOI:10.1530/EJE-07-0896.]
8Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50- year period. Surgery 1992; 112: 1139–1146.
9Greene FL, Page DL, Fleming ID. AJCC Cancer Staging Handbook: TNM Classification of Malignant Tumors, 6th ed. New York: Springer-Verlag, 2002.
10Byar DP, Green SB, Dor P, Williams ED, Colon J, van Gilse HA, Mayer M, Sylvester RJ, van Glabbeke M. A prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. Thyroid Cancer Cooperative Group. Eur J Cancer 1979; 15: 1033–1041. [DOI:10.1016/0014-2964(79)90291-3]
11Dietlein M, Luyken WA, Schicha H, Larena-Avellaneda A. Incidental multifocal papillary microcarcinomas of the thyroid: is subtotal thyroidectomy combined with radioiodine ablation enough? Nucl Med Commun 2005; 26: 3–8. [DOI:10.1097/00006231-200501000-00002]
12Solbiati L, Osti V, Cova L, Tonolini M. Ultrasound of thyroid, parathyroid glands, and neck lymph nodes. Eur Radiol 2001; 11: 2411–2424. [DOI:10.1007/s00330-001- 1163-7]
13Rosen IB, Azadian A, Walfish PG, Salem S, Lansdown E, Bedard YC. Ultrasoundguided fine-needle aspiration biopsy in the management of thyroid disease. Am J Surg 1993; 166: 346-349. [DOI:10.1016/ S0002-9610(05)80329-0]
14Besic N, Zgajnar J, Hocevar M, Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. Ann Surg Oncol 2009; 16: 920–928. [DOI:10.1160/nukmed-0059]
15Lin JD, Kuo SF, Chao TC, Hsueh C. Incidental and nonincidental papillary thyroid microcarcinoma. Ann Surg Oncol 2008; 15: 2287–2292. [DOI:10.1245/s10434- 008-9958-2]
16Schönberger J, Marienhagen J, Agha A, Rozeboom S, Bachmeier E, Schlitt H, Eilles C. Papillary microcarcinoma and papillary cancer of the thyroid
