Abstract
ObjectiveTo investigate the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) for surgery by comparing the difference between PTMC and larger papillary thyroid carcinoma (LPTC).MethodsWe analyzed the differences in the clinicopathological characteristics, prognosis, B-type RAF kinase (BRAF)V600E mutational status and expression of angiogenic factors, including pigment epithelium-derived factor (PEDF), Vascular Endothelial Growth Factor (VEGF), and hypoxia-inducible factor alpha subunit (HIF-1α), between PTMC and LPTC by retrospectively reviewing the records of 251 patients with papillary thyroid carcinoma, 169 with PTMC, and 82 with LPTC (diameter >1 cm).ResultsThere were no significant differences in the gender, age, multifocality, Hashimoto’s thyroiditis, TNM stage, PEDF protein expression, rate of recurrence, or mean follow-up duration between patients with PTMC or LPTC. The prevalence of extrathyroidal invasion (EI), lymph node metastasis (LNM), and BRAF mutation in patients with PTMC was significantly lower than in patients with LPTC. In addition, in PTMC patients with EI and/or LNM and/or positive BRAF (high-risk PTMC patients), the prevalence of extrathyroidal invasion, Hashimoto's disease, lymph node metastasis, tumor TNM stage, PEDF positive protein expression, the rate of recurrent disease, and the mRNA expression of anti-angiogenic factors was almost as high as in patients with larger PTC, but with no significant difference.ConclusionsExtrathyroid invasion, lymph node metastases, and BRAFV600E mutation were the high risk factors of PTMC. PTMC should be considered for the same treatment strategy as LPTC when any of these factors is found. Particularly, PTMC with BRAFV600E gene mutations needed earlier surgical treatment. In addition, the high cell subtype of PTMC with BRAFV600E gene mutation is recommended for total thyroidectomy in primary surgery to reduce the risk of recurrence.
Highlights
Papillary thyroid carcinoma is the most common pathological type of thyroid carcinoma and accounts for 80%-90% of all thyroid malignancies [1,2,3] with increased incidence rapidly occurring in most countries
There were no significant differences in the gender, age, multifocality, Hashimoto’s thyroiditis, TNM stage, pigment epithelium-derived factor (PEDF) protein expression, rate of recurrence, or mean follow-up duration between patients with papillary thyroid microcarcinoma (PTMC) or larger papillary thyroid carcinoma (LPTC)
The high cell subtype of PTMC with BRAFV600E gene mutation is recommended for total thyroidectomy in primary surgery to reduce the risk of recurrence
Summary
Papillary thyroid carcinoma (thyroid carcinoma papillary, PTC) is the most common pathological type of thyroid carcinoma and accounts for 80%-90% of all thyroid malignancies [1,2,3] with increased incidence rapidly occurring in most countries. The World Health Organization (WHO) defines papillary thyroid microcarcinoma (PTMC) as a tumor diameter of 10 mm of PTC, regardless of its invasion or lymph node metastasis and distant metastasis [4]. Because PTMC could not be touched, it was difficult to find in the early stages of the disease and was occasionally found in a postoperative pathological examination of thyroid benign disease or autopsy. Most PTMCs were found only because the lymph nodes or distant metastases ( it is rare) were determined. The biological characteristics of PTMC tumors have gradually attracted more attention from researchers. The viewpoint of the biological behavior of PTMC is that it tends to be benign, leading to a decrease in the attention from clinicians. The clinical and pathological characteristics of PTMC for surgery needs to be further determined
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