Abstract
BackgroundThe morbidity of papillary thyroid microcarcinomas is increasing worldwide. Surgery is the main treatment for papillary thyroid microcarcinomas, and the choice of surgical method partly depends on the T stage of the tumor. However, according to the American Joint Commission on Cancer staging system (7th edition), the T stage of papillary thyroid microcarcinomas with different tumor extent is unclear. We aimed to study the effect of tumor extent and other factors on central lymph node metastasis to explore the relationship between tumor extent and T stage and to identify the risk factors predicting central lymph node metastasis in papillary thyroid microcarcinomas.MethodsWe included 1092 patients diagnosed with solitary papillary thyroid microcarcinomas between July 2011 and April 2016. The tumor extent and other central lymph node metastasis risk factors were retrospectively analyzed.ResultsUnivariate analysis revealed that capsule invasion and extracapsular extension (P = 0.013, <0.001; respectively) were significantly correlated with central lymph node metastasis. On multivariate analysis, extracapsular extension was independent central lymph node metastasis predictors (odds ratio 3.092, 95% CI 1.744–5.484), while capsule invasion was not (odds ratio 1.212, 95% CI 0.890–1.651). In addition, multivariate analysis revealed that male sex, tumor size >5 mm, and age <45 years were independent central lymph node metastasis predictors (odds ratio 2.072, 2.356, 2.302; 95% CI 1.483–2.894, 1.792–3.099, 1.748–3.031; respectively).ConclusionsThis study supported that capsule invasion and tumor limited to the thyroid in papillary thyroid microcarcinomas were suitable for the lower T1, that is, capsule invasion in papillary thyroid microcarcinomas might not belong to the minimal extrathyroid extension included in T3 of TNM staging. In addition, patients with risk factors of extrathyroid extension, male sex, age <45 years, or tumor size >5 mm in papillary thyroid microcarcinomas should consider a more aggressive surgical treatment.
Highlights
The morbidity of papillary thyroid microcarcinomas is increasing worldwide
As described in the American Joint Commission on Cancer staging system (7th edition), the T stage of Papillary thyroid microcarcinoma (PTMC) varies with the relationship between the tumor and the thyroid capsule: tumor limited to the thyroid is T1a while PTMC with minimal extrathyroid extension is T3
There are three cases of their relationship in clinical work: tumor limited to the thyroid, capsule invasion, and capsular penetration with extension into the sternothyroid muscle or perithyroidal soft tissue
Summary
The morbidity of papillary thyroid microcarcinomas is increasing worldwide. Surgery is the main treatment for papillary thyroid microcarcinomas, and the choice of surgical method partly depends on the T stage of the tumor. According to the American Joint Commission on Cancer staging system (7th edition), the T stage of papillary thyroid microcarcinomas with different tumor extent is unclear. As described in the American Joint Commission on Cancer staging system (7th edition), the T stage of PTMC varies with the relationship between the tumor and the thyroid capsule: tumor limited to the thyroid is T1a while PTMC with minimal extrathyroid extension (e.g., extension to sternothyroid muscle or perithyroid soft tissues) is T3. There are three cases of their relationship in clinical work: tumor limited to the thyroid (including primary tumor adjacent to the thyroid capsule), capsule invasion (no capsular penetration), and capsular penetration with extension into the sternothyroid muscle or perithyroidal soft tissue (extrathyroidal extension). Whether capsule invasion of PTMC belongs to T1a or T3 and whether we should choose the same operation for PTMC with capsule invasion and extrathyroidal extension is a problem that we clinicians are confused
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