Papillary thyroid microcarcinoma: A study of 900 cases observed in a 60-year period

Ian D. Hay, Maeve E. Hutchinson, Tomas Gonzalez-Losada, Bryan McIver, Megan E. Reinalda, Clive S. Grant, Geoffrey B. Thompson, Thomas J. Sebo, John R. Goellner

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359 Scopus citations

Abstract

Background: The study aims were to characterize patients with papillary thyroid microcarcinoma (PTM) and to describe post-surgical outcome. Methods: Nine hundred PTM patients had initial treatment at Mayo Clinic during 1945-2004. Mean follow-up was 17.2 years. Recurrence and mortality details were derived from a computerized database. Results: Median tumor size was 7 mm; 98% were intrathyroidal. 273 patients (30%) had neck nodal involvement; 3 (0.3%) had distant metastases at diagnosis. Seven-hundred and sixty-five (85%) underwent bilateral lobar resection (BLR; total-, near-total, or bilateral subtotal thyroidectomy). Regional nodes were removed by either "node picking" (27%) or compartmental dissection (23%). Tumor resection was incomplete in 5 (0.6%). Radioiodine remnant ablation (RRA) was performed in 155 (17%). Overall survival did not differ from expected for an age and gender matched control group (P = .96); 3 patients (0.3%) died of PTM. None of the 892 patients with initial complete tumor resection developed metastatic spread during 20 postoperative years. Twenty-year and 40-year tumor recurrence rates were 6% and 8%, respectively. Higher recurrence rates were seen with multifocal tumors (P = .004) and node-positive patients (P < .001). Neither more extensive surgery nor RRA reduced recurrence rates compared to unilateral lobectomy. Conclusion: More than 99% of PTM patients are not at risk of distant spread or cancer mortality. RRA after BLR did not improve postoperative outcome.

Original languageEnglish (US)
Pages (from-to)980-988
Number of pages9
JournalSurgery
Volume144
Issue number6
DOIs
StatePublished - Dec 1 2008

ASJC Scopus subject areas

  • Surgery

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    Hay, I. D., Hutchinson, M. E., Gonzalez-Losada, T., McIver, B., Reinalda, M. E., Grant, C. S., Thompson, G. B., Sebo, T. J., & Goellner, J. R. (2008). Papillary thyroid microcarcinoma: A study of 900 cases observed in a 60-year period. Surgery, 144(6), 980-988. https://doi.org/10.1016/j.surg.2008.08.035