Immediate Surgery Might Be a Better Option for Subcapsular Thyroid Microcarcinomas.

Jun Jiang,Hui Lu

doi:10.1155/2019/3619864

Abstract

For high-risk papillary thyroid microcarcinomas (PTMCs), immediate surgery is recommended. This study aimed to evaluate the location of PTMCs in the thyroid lobe and determine whether location is associated with an aggressive biology and the necessity of immediate surgery. This retrospective study included 288 patients who underwent initial surgery for PTMC. Clinical data were extracted. Subcapsular thyroid microcarcinomas (STMs) and nonsubcapsular thyroid microcarcinomas (NSTMs), distinguished by ultrasound, were compared in terms of tumour size, extrathyroidal extension, cervical lymph node metastasis, and multifocality. The preoperative ultrasound features predictive of recurrent laryngeal nerve (RLN) involvement were assessed. There were no statistical differences in tumour size (P = 0.985), multifocality (P = 0.866), lymph node metastases to the central compartment (P = 0.154), or lateral lymph node metastases (P = 0.929) between STM and NSTM groups. Macroscopic extrathyroidal extension was exclusively found in the STM group. For assessing RLN involvement, the sensitivity, specificity, and positive predictive value of the presence of an abnormal thyroid capsule margin between the STM and the presumed RLN course, assessed on preoperative ultrasonography images, were 100%, 43.3%, and 43.3%, respectively. Immediate surgery appears to be a better option than conservative treatment for these high-risk STM patients.

Highlights

Papillary thyroid carcinoma (PTC) is the most common well-differentiated thyroid carcinoma
It is worth noting that the definition of papillary thyroid microcarcinomas (PTMCs) is PTC with a maximal diameter of ≤1 cm, regardless of its biological behaviour
All these patients were diagnosed as PTMC on ultrasonographyguided fine needle aspiration biopsy (FNAB)

Summary

Introduction

Papillary thyroid carcinoma (PTC) is the most common well-differentiated thyroid carcinoma. The majority of newly diagnosed PTCs are papillary thyroid microcarcinomas (PTMCs), defined as PTC ≤ 1 cm in maximal diameter [1, 2], primarily due to the routine use of high-resolution ultrasonography in regular health examinations [3]. Subcapsular thyroid microcarcinomas (STMs) can progress to extrathyroidal extension (ETE), possibly invading important surrounding tissues such as the trachea, recurrent laryngeal nerve (RLN), or carotid artery; they are not necessarily associated with biological aggressiveness. For these STMs, individualised treatment strategies including active surveillance, lobectomy, or total thyroidectomy with or without cervical lymph node dissection should be carefully considered [2, 7]

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