TY - JOUR
T1 - Papillary thyroid microcarcinoma
T2 - A study of 900 cases observed in a 60-year period
AU - Hay, Ian D.
AU - Hutchinson, Maeve E.
AU - Gonzalez-Losada, Tomas
AU - McIver, Bryan
AU - Reinalda, Megan E.
AU - Grant, Clive S.
AU - Thompson, Geoffrey B.
AU - Sebo, Thomas J.
AU - Goellner, John R.
PY - 2008/12/1
Y1 - 2008/12/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.surg.2008.08.035
DO - 10.1016/j.surg.2008.08.035
M3 - Article
C2 - 19041007
AN - SCOPUS:56749152334
SN - 0039-6060
VL - 144
SP - 980
EP - 988
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
ER -