Diagnosis and treatment of papillary thyroid microcarcinoma :447 cases

Abstract

Objective To analyze clinical features of papillary thyroid microcarcinoma(PTMC) and to evaluate the diagnosis and treatment for PTMC.Methods The clinical data of 447 cases of PTMC receiving surgical treatment and confirmed by pathology were reviewed.Color Doppler ultrasonography was used to identify thyroid nodules and cervical lymph nodes,and frozen section was used to confirm the pathological diagnosis during operation.104 cases received unilateral lobectomy,22 cases received unilateral lobectomy plus isthmectomy,321 cases received total thyroidectomy,257 cases underwent central neck dissection,and 54 cases underwent lateral neck dissection(level Ⅵ included).All cases took levothyroxine to maintain low TSH level after operation,and were followed up through telephone or in out-patient clinic.Results Central compartment node metastasis was found in 144 patients,and lateral neck metastasis was found in 41 cN1 cases.The age,extra-capsular invasion and multifocal carcinoma were independent risk factors of PTMC.The number of positive nodes in level Ⅵ was positively correlated with the risk of lateral node metastasis.395 cases were followed-up successfully for 20 to 42 months,with the media follow-up of 32 months.During the follow-up,recurrence or metastasis was found in 15 cases,and no death happened.Conclusions PTMC has no specific symptoms,and was difficult to be diagnosed before operation.Physical examination and color Doppler ultrasonography should be used as routine examination.Thyroid lobectomy and total thyroidectomy plus central node dissection should be major surgical treatment for PTMC patients.Lateral neck dissection should be considered in all cN1 patients. Key words: Thyroid neoplasm ; Papillary carcinoma; Thyroidectomy; Neck dissection