Management of papillary microcarcinoma of the thyroid gland

DESIGN: To investigate the frequency, treatment and clinical behaviour of differentiated microcarcinoma of the thyroid gland (PTMC). PATIENTS AND METHODS: Out of 376 patients submitted to surgical treatment for differentiated thyroid cancer from June 1980 to October 2003, 77 had been identified has having a PTMC (63 females, 14 males; mean age 43+/-13 years). Sixty-seven patients (87%) met the AMES risk definition for low (group I) and 10 (13%) for high-risk (group II) definition. The surgical procedures were lobo-isthmusectomy (n=14) or subtotal thyroidectomy (n=20) and total thyroidectomy (n=43) with node dissection in 15 cases. Follow-up ranging from 9 to 274 months (mean 124+/-84). RESULTS: Overall patient survival rates were 100 and 94% at 20 years in groups I and II, respectively (p=ns). There were no significant differences in surgical complications and in survival in patients submitted to total thyroidectomy when compared to partial thyroid resection. The presence of cervical node metastasis did not affect patient survival (p=0.8). The overall mean survival time was 266 months. CONCLUSIONS: Despite the overall excellent prognosis, PTMC was associated with a 1% disease-related mortality, a 2.5% local recurrence rate, 1% lymph-node recurrence rate, and 1% distant metastasis rate. We recommend total thyroidectomy accompanied by modified neck dissection if enlarged nodes are diagnosed.     

Papillary thyroid microcarcinoma: a surgical perspective

Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid cancer measuring less than 10mm in its greatest diameter. It is the most common form of thyroid cancer, detected in up to 36% in autopsy studies. The wide availability and use of neck ultrasonography in the evaluation of carotid arteries and of the thyroid resulted in an increased detection of PTMC. PTMC is often multifocal. The diagnosis is usually based on a combination of clinical examination, laboratory investigations, and specialized radiological techniques (mainly neck ultrasonography combined with fine-needle aspiration cytology). A common scenario is the diagnosis of PTMC as an incidental finding following thyroidectomy for a presumably benign thyroid disease. Despite some controversy, most authors agree that PTMC should be treated by total or near-total thyroidectomy, provided it can be performed safely. Because of its many and major advantages, in our clinical practice, total or near-total thyroidectomy is the procedure of choice for the management of PTMC. Given the high incidence of PTMC as an incidental finding and the frequent multi-focality, we also favor total or near-total thyroidectomy for the surgical management of nodular thyroid disease (multinodular goiter or dominant presumably benign thyroid nodule/s). Despite some controversy, we perform central neck lymph node dissection electively, in the presence of cervical lymphadenopathy. Radioiodine ablation therapy may be used as an adjuvant therapy. Prognostic factors (such as tumor multicentricity, positive lymph nodes, capsular or vascular invasion) or scoring systems (such as the AMES) can be used to select patients for radioiodine adjuvant therapy. Suppression therapy is needed after surgical management. Despite the potential for neck lymph node and even distant metastases, the biological behavior of PTMC is in general benign and the prognosis is very good.     

The BRAFT1799A Mutation is not Associated with Occult Contralateral Carcinoma in Patients with Unilateral Papillary Thyroid Microcarcinoma

Background: The phenomenon of occult carcinoma maybe observed in patients with clinically unilateralpapillary thyroid microcarcinoma (PTMC). Although many studies have reported that the BRAFT1799A mutation isassociated with aggressive PTMC, the relationship between BRAFT1799A mutation and occult carcinoma is unclear.The aim of this study was to investigate the risk factors, including BRAFT1799A mutation, for occult contralateralcarcinoma in clinically unilateral PTMC accompanied by benign nodules in the contralateral lobe. Materialsand Methods: From January 2011 to December 2013,we prospectively enrolled 89 consecutive PTMC patientswith clinically unilateral carcinoma accompanied by benign nodules in the contralateral lobe who received atotal thyroidectomy and cervical lymph node dissection. BRAFT1799A mutation was tested by pyrosequencing onpostoperative paraffin specimens. The frequency and predictive factors for occult contralateral carcinoma wereanalyzed with respect to the following variables: age, gender, family history, tumor size, presence of Hashimotothyroiditis, extrathyroidal extension, central lymph node metastasis, multifocality of primary tumor, or BRAFT1799Amutation. Results: A total of 36 patients (40.4%) had occult PTMC in the contralateral lobe. The median diameterof the occult tumors was 0.33±0.21 cm. The BRAFT1799A mutation was found in 38 cases (42.7%). According to theunivariate analysis, there were no significant differences between the presence of occult contralateral carcinomaand age, gender, family history, tumor size, presence of Hashimoto thyroiditis, extrathyroidal extension, centrallymph node metastasis, multifocality of primary tumor, or BRAFT1799A mutation. Conclusions: Using currentmethods, it is difficult to preoperatively identify patients with PTMC, and further research is needed to determinepredictive factors for the presence of occult contralateral carcinoma in patients with unilateral PTMC.     

原发性甲状腺功能亢进症合并甲状腺乳头状癌临床特征分析

目的:分析原发性甲状腺功能亢进症合并甲状腺乳头状癌（papillary thyroid carcinoma,PTC）患者的超声及临床病理特征,探讨影响淋巴结转移的危险因素。方法:回顾性分析2011 年1月至2016 年12 月于青岛大学附属医院行手术治疗且病理证实为甲状腺乳头状癌的原发性甲状腺功能亢进症（甲亢）患者的超声及临床病理特征;通过χ2检验方法比较微小癌（直径≤1 cm）与非微小癌（直径>1 cm）组间临床病理特征的差异;通过χ2检验、t检验及logistic 回归分析方法分析影响颈部淋巴结转移的危险因素。结果:80例甲亢合并PTC患者女性（93.75%）多于男性(6.25%),中位年龄48岁。术前超声结果以低回声结节（93.75%）、微钙化（67.50%）、边界不清（87.50%）为主要特征;术后病理显示微小癌居多（78.75%）,微小癌组中颈部淋巴结转移、复发危险度中/高危及TNM分期III-IV期的比率均低于非微小癌组（均P<0.05）;本研究中颈部淋巴结转移比例为41.25%,转移组原发癌灶直径、患者年龄<45岁以及非微小癌所占比例均明显增大（均P<0.05）,相关分析显示,原发癌灶直径增大与颈淋巴结转移独立相关（P<0.05）。结论:甲亢合并PTC女性为主,微小癌居多,其恶性程度低于非微小癌;原发癌灶直径增大是甲亢合并PTC淋巴结转移的独立危险因素。     

Expression of Ki67 in Papillary Thyroid Microcarcinoma and its Clinical Significance

Purpose: To investigate the expression of Ki67 protein in papillary thyroid microcarcinoma(PTMC), and toanalyze its clinical significance. Materials and Methods: Ki67 protein expression was evaluated in the tissues of108 human PTMC and 50 other benign papillary hyperplasia of thyroid specimens using immunohistochemistry.Results: The expression intensity of Ki67 in PTMC and benign papillary hyperplasia of thyroid specimenswere 1.45±1.83% and 0.46±0.46%.The positive expression rates were 46.3% and 14%. There were significantdifferences between these two groups (p<0.01). There was no significant variation of the expression intensityand positive expression rates of Ki67 in PTMC with gender, age, position of the tumor and the level of TSHpre-operation (p>0.05), but these parameters varied with tumor size, invasion by membrane and cervical lymphnode metastasis (p<0.05 or p<0.01). Conclusions: The expression of Ki67 in PTMC was related to tumor size,invasion by membrane and cervical lymph node metastasis, and could be the important indicator for judgingclinical progress and estimating prognosis.     

全腔镜甲状腺微小癌的手术探讨——附14例报道

目的 在总结全腔镜甲状腺良性疾病手术的基础上探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma, PTMC）的手术可行性。方法 对60例甲状腺良性疾病患者、新开展的14例PTMC患者全腔镜手术的临床资料进行回顾性分析,总结、分析全腔镜PTMC手术的可行性及经验。结果 甲状腺良性病变的腔镜手术中,结节平均大小（2.79±0.66）cm,手术时长（162.77±32.39）min。14例腔镜下PTMC中,均行单侧腺叶全切+同侧中央（Ⅵ）区淋巴结清扫,平均肿瘤直径（0.65±0.26）cm,平均单侧手术时长（200.77±24.37）min,清扫中央区淋巴结（5.73±2.86）个,术中中位出血量为17 ml。14例腺叶均完整切除,其中4例出现术后暂时性无症状性低钙血症,未出现声音嘶哑。结论 在具有一定全腔镜甲状腺良性疾病手术经验的基础上,选择PTMC行全腔镜手术是安全、可行的;钢丝拉钩、纳米碳、神经监测等辅助技术可用来充分暴露视野及提高手术的安全性。     

经腋下径路无注气内镜下甲状腺微小乳头状癌手术与传统手术的对照研究

目的：通过与传统手术对比,评价经腋下径路无注气内镜下甲状腺微小乳头状癌手术的可行性、安全性及有效性。方法：回顾性分析2008年10月至2013年9月我科接受39例患者选择经腋下径路无注气内镜下手术（内镜组）的女性甲状腺微小乳头状癌患者资料,并选择同期78例年龄与内镜组相匹配并接受开放手术女性甲状腺微小乳头状癌患者（开放组）作为对照分析内镜组和传统组的手术时间、手术出血量、肿瘤大小、淋巴结清扫个数、淋巴结阳性个数、淋巴结阳性率、引流量、术后住院时间、术后并发症发生率、肿瘤复发率及术后3个月时随访美观满意度等指标。结果：内镜组手术时间较传统组长（86.15±12.54 min vs 50.64±8.03 min）,引流量较传统组多（82.33±21.98ml vs 69.60±16.44ml）,术后3个月美容评分较传统组低（1.05±0.22 vs 3.90±1.20）,差异有统计学意义。两组间手术出血量、肿瘤大小、淋巴结清扫个数、淋巴结阳性个数、淋巴结阳性率、暂时性喉返神经麻痹发生率和暂时性低钙血症发生率差异无统计学意义,两组患者术后随访未见肿瘤复发或转移。结论：经腋下径路无注气内镜下甲状腺微小乳头状癌手术安全、可行、有效,美容效果优于传统手术,可为有美观需求的部分甲状腺微小乳头状癌患者提供新的选择。     

Papillary thyroid microcarcinoma (PTMC): Prognostic factors, management and outcome in 403 patients

AIM: To investigate an "optimal" therapeutic management of patients with papillary thyroid microcarcinoma (PTMC). METHODS: We evaluated a group of 403 consecutive patients affected by PTMC operated on by the same surgeon. Prognostic factors were evaluated by uni- and multivariate statistical analysis. RESULTS: After a mean follow-up of 8.5 years, 372 patients were living without disease (undetectable serum thyroglobulin levels), 24 patients were living with disease (increased serum thyroglobulin levels), 6 patients were deceased due to causes different from thyroid cancer, and 1 patient was deceased due to metastatic thyroid cancer. No statistically significant prognostic factor was found at uni- and multivariate analysis. However, it is worth noting that in patients with a larger primary tumour (size> or =5mm) and treated by partial thyroidectomy alone, the prevalence of recurrent disease was higher than in patients treated by total thyroidectomy and (131)I administration. CONCLUSION: It appears reasonable to perform total thyroidectomy (possibly associated with central compartment node dissection), (131)I whole body scan (followed by (131)I therapy when necessary) and TSH-suppressive hormonal therapy in patients with PTMC.     

Ultrasound-guided percutaneous microwave ablation versus surgery for papillary thyroid microcarcinoma

Background: Papillary thyroid microcarcinoma (PTMC) has high incidence and low disease-specific mortality. However, active surveillance is not accepted by most patients owing to high physical or psychological pressures. The emergence of ablation technologies is supplanting traditional surgery. Our goal was to compare the clinical outcomes of microwave ablation (MWA) and surgery for T1aN0M0 PTMC.

Methods: A total of 92 consecutive patients with T1aN0M0 PTMC were studied retrospectively. Forty-six patients had been treated with MWA, and the other 46 had undergone surgery. MWA was performed using extensive ablation extending from the nodule’s lower pole to the upper pole. Surgery was performed by total thyroidectomy or thyroid lobectomy. We compared the two groups in terms of mean length of stay, cost, mean blood loss, surgical incision, operating room (OR) time, quality of life (QOL) assessment, complications, and therapeutic efficacy over a follow-up period of 42 months.

Results: The mean length of stay, cost, mean blood loss, surgical incisions, OR time, and complications in the MWA group were significantly lower than those of the surgery group. The QOL after MWA was higher than it was after surgery. The nodule volume decreased significantly from 53.61?±?48.43?mm³ to 4.84?±?6.55?mm³ (p?Conclusions: MWA may be considered a minimally invasive alternative to surgery for solitary T1aN0M0 PTMC with low incidence of complications and good therapeutic effect.     

Incidental papillary microcarcinoma of the thyroid.

Papillary microcarcinoma (PMC) is a thyroid tumor measuring 10mm or less in maximum diameter and comprise up to 30% of all papillary thyroid cancers. Most of them are detected incidentally and defined as incidental papillary microcarcinoma (IPC相似文献   

Childhood and adolescent thyroid carcinoma

OBJECTIVES: This analysis was performed to evaluate the influence of clinical and treatment factors on local tumor control, control of distant metastasis, survival, and complications in children and adolescents with thyroid carcinoma. METHODS: The records of 56 children and adolescents with papillary and follicular carcinoma of the thyroid were reviewed. They ranged in age from 4 to 20 years. There were 43 females and 13 males. At diagnosis, 15 (27%) patients had disease confined to the thyroid, 34 (60%) had additional lymph node metastasis to the neck or upper mediastinum, and 7 (13%) also had lung metastasis. Treatment consisted of a total thyroidectomy in 48 patients, a subtotal thyroidectomy in 4 patients, and a lobectomy in 4 patients. All 56 patients received postoperative thyroid hormone suppressive therapy. (131)I was administered to 82% (46 of 56) of patients after their initial surgery. RESULTS: The overall survival rate was 98% with a follow-up of 0.6-30.7 years (with a median follow-up of 11.0 years). The one death that occurred in this patient population was the result of a congenital heart defect and was unrelated to thyroid carcinoma. The 10-year progression-free survival rate was 61%. Nineteen patients (34%) experienced a recurrence of their thyroid carcinoma. The time to first recurrence of disease ranged from 8 months to 14.8 years (mean, 5.3 years). None of those with disease confined to the thyroid developed recurrent disease. The recurrence rate was 50% (17 of 34) in patients with lymph node metastasis and 29% (2 of 7) in patients with lung metastasis (P = 0.02). Tumor characteristics were evaluated for time to first recurrence utilizing the logistic likelihood ratio test to predict disease recurrence. Thyroid capsule invasion (P = 0.02), soft tissue invasion (P = 0.03), positive margins (P = 0.006), and tumor location at diagnosis (thyroid only vs. thyroid and lymph nodes vs. thyroid, lymph nodes, and lung metastasis, P = 0.02) were significant for developing recurrent disease. Patients younger than 15 years old at diagnosis were more likely to have more extensive tumor at diagnosis than patients who were 15 years and older (thyroid only vs. thyroid and lymph nodes vs. thyroid, lymph nodes, and lung metastasis, P = 0.02). CONCLUSION: Carcinoma of the thyroid in children and adolescents has little risk of mortality but a high risk of recurrence. Younger patients present with a more advanced stage of disease and are more likely to have disease recurrence. Total thyroidectomy and lymph node dissection, followed by postoperative (131)I therapy, thyroid hormone replacement (suppressive) administration, and diligent surveillance are warranted.     

甲状腺微小癌的外科手术治疗研究

目的 比较甲状腺微小癌全切术与传统手术的疗效.方法 比较82例经甲状腺全切术治疗的甲状腺微小癌患者(观察组)与82例经传统手术治疗的甲状腺微小癌患者(对照组)的疗效、手术指标(手术时间、出血量、切口长度、住院时间)、术后并发症发生情况和术后1年复发率、颈部淋巴结转移率、远处转移率.结果观察组患者治疗的总有效率为95.12%(39/41),高于对照组的78.05%(32/41),差异有统计学意义(P﹤0.05).观察组患者的手术时间、出血量、切口长度和住院时间分别为(41.5±11.4)min、(42.5±12.8)ml、(5.2±1.0)cm、(4.4± 1.2)d,均低于对照组的(68.7±14.6)min、(83.6±10.6)ml、(6.2±1.4)cm、(6.3±1.4)d,差异均有统计学意义(P﹤0.05).治疗后观察组患者的并发症发生率为7.32%(3/41),低于对照组的29.27%(12/41),差异有统计学意义(P﹤0.05).术后1年观察组患者的复发率、颈部淋巴结转移率和远处转移率分别为4.88%(2/41)、4.88%(2/41)、7.32%(3/41),均低于对照组的19.51%(8/41)、21.95%(9/41)、26.83%(11/41),差异均有统计学意义(P﹤0.05).结论 甲状腺全切术治疗甲状腺微小癌的疗效明显,对患者造成的创伤较小;同时可以明显减少术后并发症、复发率和转移率,有利于患者早日康复,值得临床推广应用.     

甲状腺微小癌48例分析

[目的]探讨甲状腺微小癌的临床特征及其诊治方法.[方法]回顾性分析1994年2月至2002年12月收治的48例甲状腺微小癌.[结果]37例合并甲状腺其它良性病变,10例颈部淋巴结转移.3例表现为多灶性.1例术后8年出现远处转移.[结论]甲状腺微小癌常因合并甲状腺其它良性病变或淋巴结转移而被发现,少数有多个病灶.绝大多数预后良好.     

Comprehensive evaluation of risk factors for lymph node metastasis in patients with papillary thyroid carcinoma

With the increasing incidence of papillary thyroid cancer (PTC), it is important to risk-stratify patients who may have a more aggressive tumor biology. The present study aimed to evaluate the risk factors for lymph node metastasis (LNM) in patients with PTC, which may provide a significant reference for clinical diagnosis and treatment. In total, 1,045 patients with PTC [313 with PT microcarcinoma (PTMC) and 732 with non-PTMC] between August 2016 and August 2019 were investigated. The B-type Raf kinase (BRAF) V600E mutation was tested in all samples. The clinical data (sex, age, tumor location, sample type and pathological features) were retrospectively analyzed. Logistic regression analysis was performed to evaluate independent risk factors for LNM. A total of 181/313 (57.8%) PTMC cases and 145/732 (19.8%) non-PTMC cases had a BRAF V600E mutation. In the PTMC cases, significant differences in sex and sample type were identified (BRAF V600E mutation vs. wild-type). In the non-PTMC cases, significant differences in sex and age were identified (BRAF V600E mutation vs. wild-type). Female sex and tumor diameter ≤1 cm were significant independent predictors of LNM in PTC. In PTMC, female sex was a significant independent predictor of LNM. A bilateral tumor was an independent protective factor for LNM in PTC, PTMC and non-PTMC. The BRAF V600E mutation rate of ultrasound-guided fine-needle aspiration cytology was higher compared with FFPE in PTMC (P=0.018). In contrast to previous studies, the results of the present study suggested that being female and having a tumor of diameter ≤1 cm were risk factors for LNM, and that the BRAF wild-type of PTMC may be more aggressive than other types. Notably, the position of the tumor in the bilateral thyroid was also an independent protective factor for LNM. Therefore, ultrasound-guided fine-needle aspiration should be recommended for gene analysis (BRAF V600E) in PTMC. In addition, clinicians should consider an individualized treatment according to gene mutations, sex, age, tumor size and the location of the tumor, in order to achieve an improved therapeutic efficacy.     

Papillary thyroid microcarcinoma: prognostic factors and treatment

BACKGROUND AND OBJECTIVES: Within the group of patients with papillary thyroid microcarcinoma (PTMC), the prognostic factors have not been well defined and the optimal treatment has not been proved. The aim of this study was to find out the factors associated with the tumor recurrence in the patients with PTMC. METHODS: A total of 228 patients with PTMC (189 females, 39 males; age 14-85 years, median 46 years) were treated at our Institute between 1975 and 2006. The data on patients' gender, age, extent of disease, pathomorphological characteristics, therapy, locoregional control, disease-free survival and disease-specific survival were collected. Statistical correlation between possible prognostic factors and the duration of disease-free interval was analyzed by univariate and Cox's multivariate survival analysis. RESULTS: The tumor diameter ranged from 0.1 to 10 mm (mean 6.1 mm). The median length of observation was 84 months (range 1-385). During the follow-up period, the recurrence was diagnosed in 7 patients (6 locoregional and 1 distant). Multivariate analysis showed that tumor size and lymph node metastases were independent prognostic factors for disease-free interval. CONCLUSIONS: Longer disease-free interval was found in the patients with a tumor diameter < or =6 mm and without lymph-node metastases.     

甲状腺乳头状微小癌颈部淋巴结转移的影响因素分析

目的:探讨甲状腺乳头状微小癌（PTMC）发生淋巴结转移（LNM）的影响因素。方法:收集535例行甲状腺切除术且病理证实为PTMC患者的临床资料,比较PTMC患者中有和无淋巴结转移、不同转移区域、不同肿瘤直径组间临床病理特征,分析淋巴结转移与临床病理特征的相关性。结果:PTMC合并淋巴结转移组192例（35.89%）,非淋巴结转移组343例（64.11%）,两组比较,淋巴结转移组年龄<55岁、男性、癌灶多发、双侧分布、直径>0.5 cm、合并桥本氏甲状腺炎（HT）、中/高危复发危险分层比例显著升高,差异均有统计学意义（均P＜0.05）;中央区淋巴结转移（CLNM）组147例（76.56%）,颈侧区淋巴结转移（LLNM）组45例（23.44%）,与CLNM组比较:LLNM组癌灶多发、双侧分布、合并HT比例升高,BRAF基因突变率比例降低,差异均有统计学意义（均P＜0.05）;肿瘤直径≤0.5 cm组187例（34.95%）,直径>0.5 cm组348例（65.05%）,与直径≤0.5 cm组比较:直径>0.5 cm组癌灶多发、双侧分布、合并LNM、包膜外侵犯、中/高危复发危险分层比例升高,差异均有统计学意义（均P＜0.05）;多因素Logistics回归分析显示年龄<55岁、男性、癌灶多发、直径>0.5 cm、合并HT是LNM的独立危险因素（均P＜0.05）。结论:年龄<55岁、男性、癌灶多发、直径>0.5 cm、合并HT是PTMC淋巴结转移的独立危险因素,颈部淋巴结转移增加PTMC复发风险。     

中央区颈淋巴结清扫术对甲状腺微小癌的治疗价值

目的探讨中央区颈淋巴结清扫术对甲状腺微小癌的治疗价值。方法回顾性分析65例甲状腺微小癌患者的临床资料。结果65例患者中,淋巴结转移阳性率为40％。全程获访的62例患者全部存活,未发现远处转移,复发转移率低,无远期并发症。结论中央区颈淋巴结清扫术是治疗甲状腺微小癌的一种较佳的手术方式。     

61例甲状腺微小乳头状癌临床诊治分析

背景与目的：近年来,甲状腺微小乳头状癌的发病率逐年增高。在诊断、治疗方面业界存在诸多分歧。该研究通过分析患者资料,总结并探讨甲状腺微小乳头状癌的临床诊治特点。方法：回顾性分析2012年2月-2015年1月于山西大医院耳鼻咽喉头颈外科收治的61例经病理证实的甲状腺微小乳头状癌患者资料。结果：61例患者术前均行颈部高分辨率超声检查,准确率为86.89%。所有患者均接受手术治疗,接受患侧叶及峡部切除+同侧中央区淋巴结清扫术者共39例,其中11例同期行对侧叶部分切除术;接受甲状腺全切+双侧中央区淋巴结清扫术者共22例。5例同期行颈侧淋巴结清扫术。27例发生中央淋巴结转移(44.3%),5例发生颈侧区淋巴结转移(8.2%)。年龄<45岁、多灶性病变、肿瘤位置跨越或接近中线、肿瘤最大径大于等于5 mm者更易发生颈部淋巴结转移(P<0.05),中央区淋巴结转移率分别为66.7%、60.7%、66.7%和53.8%。结论：高分辨率超声检查对甲状腺微小乳头状癌诊断灵敏度较高,规范化及个体化的手术方式对甲状腺微小乳头状癌患者具有重要意义。     

甲状腺微小癌63例临床诊疗分析

目的 探讨甲状腺微小癌的临床特征、诊断和外科治疗方式。方法 回顾性分析2005年1月至2014年8月63例甲状腺微小癌患者的临床资料,对诊断情况、手术方式、临床病理特征及随访结果进行分析。结果 术前彩超怀疑甲状腺微小癌32例（50.8％）;术前彩超引导下细针穿刺活检4例（6.4％）,确诊3例（4.8％）;术中冰冻切片病理确诊41例（74.6％）,63例均经术后病理组织学证实为乳头状癌。63例中行甲状腺全切除12例,双侧次全切除17例,患侧及峡部全切除+对侧次全切除20例,患侧次全切除+对侧及峡部全切除8例,患侧及峡部全切除4例,患侧及峡部全切除+对侧部分切除2例;2例行功能性淋巴结清扫,4例行中央区淋巴结清扫。术后随访1年3个月至10年11个月,失访1例;62例患者均存活,其中1例复发,行残余甲状腺全切除术。结论 甲状腺微小癌手术治疗总体预后相对较好,但个别病例有较强的侵袭性,应强调治疗方案个体化。     

Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

Background and Objectives

: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.

Methods

: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.

Results

: Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.

Conclusions

: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.