Abstract
BackgroundPapillary Microcarcinoma (PMC) of thyroid is a rare type of differentiated thyroid cancer (DTC), which according to the World Health Organization measures 1.0 cm or less. The gold standard of treatment of PMC is still controversy. Our aim was to contribute in resolving the debate on the therapeutic choices of the surgical and adjuvant I-131 (RAI) treatment in PMC.MethodsFrom 2000 to 2012, 326 patients were found to have PMC and were retrospectively reviewed for clinicopathological characteristics, treatment outcomes and prognostic factors.ResultsMean age of cohort was 42.6 years (range: 18–76) and the mean tumor size was 0.61 cm ± 0.24; lymph node involvement was seen in 12.9 % of cases. Median follow up period was 8.05 years (1.62–11.4). Total 23 all site recurrences (7.13 %) were observed; more observed in patients without I-131 ablation (p <0.0001). Ten year DFS rates were 89.6 %. Cox regression Model analysis revealed size, histopathologic variants, multifocality, extrathyroidal extension, lymphovascular space invasion, nodal status, and adjuvant RAI ablation the important prognostic factors affecting DFS.DiscussionDespite excellent DFS rates, a small proportion of patients with PMC develop recurrences after treatment. Adjuvant RAI therapy improves DFS in PMC patients with aggressive histopathologic variants, multifocality, ETE, LVSI, tumor size (> 0.5 cm) and lymph node involvement. Failure of RAI ablation to decrease risk in N1a/b supports prophylactic central neck dissection during thyroidectomy, however more trials are warranted.ConclusionAdjuvant I-131 ablation following thyroidectomy in PMC patients, particularly with poor prognostic factors improves DFS rates.
Highlights
Papillary Microcarcinoma (PMC) of thyroid is a rare type of differentiated thyroid cancer (DTC), which according to the World Health Organization measures 1.0 cm or less
We aimed to evaluate the different prognostic factors for disease-free survival (DFS) in PMC patients in our population, and to determine the DFS in patients with PMC treated with or without adjuvant radioactive iodine-131 (RAI) ablation following thyroidectomy
We were able to determine overall five and ten year DFS rates of 94.7 % and 89.6 % respectively after aggressive treatment by total thyroidectomy followed by RAI ablation in the majority of cases
Summary
Papillary Microcarcinoma (PMC) of thyroid is a rare type of differentiated thyroid cancer (DTC), which according to the World Health Organization measures 1.0 cm or less. Our aim was to contribute in resolving the debate on the therapeutic choices of the surgical and adjuvant I-131 (RAI) treatment in PMC. With the use of these high resolution transducers, papillary microcarcinoma (PMC), i.e. tumor size 1 cm or less can be detected [4, 5]. Still there is much debate regarding the most appropriate treatment of PMC ranging from observation alone to over-treatment with surgery followed by adjuvant RAI ablation [7,8,9,10].
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Schedule a callMore From: Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
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