Bilateral Papillary Thyroid Microcarcinoma Research Articles

A modified, single-incision, gasless, endoscopic thyroidectomy and bilateral central neck dissection via axillary approach technique for bilateral papillary thyroid microcarcinoma: A preliminary report

BackgroundOur objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). MethodBetween April 2020 and November 2021, 22 patients with bilateral PTMC underwent single-incision, gasless, transaxillary endoscopic TT + BCND. The patients’ clinicopathologic characteristics, surgical completeness and complications were analyzed. ResultSingle-incision, gasless, transaxillary endoscopic TT + BCND was successful performed in all patients. The median (IQR) total surgical time was 143 (85–160) min. Only two patients experienced transient unilateral RLN palsy or transient hypocalcemia. All these complications resolved within 1 month after surgery. The median duration of hospital stay after surgery was 4 (3–4.5) days. The median hospitalization expense for these patients was 3848 (3781–4145) USD. The median number of lymph node yielded was 10.5 (8–15). The cosmetic outcomes were well-received by all individuals. ConclusionIn certain cases, gasless, transaxillary endoscopic TT + BCND procedure performed through a single incision proved to be a secure alternative for managing bilateral PTMC.

The Efficacy and Safety of Radiofrequency Ablation for Bilateral Papillary Thyroid Microcarcinoma.

ObjectiveTo investigate the long-term clinical results of radiofrequency ablation (RFA) for bilateral papillary thyroid microcarcinoma (PTMC).Materials and MethodsFrom October 2014 to February 2018, 47 patients (37 females, 10 males, mean age 43.39 ± 9.26 years) with 100 bilateral PTMC (mean volume 75.22 ± 73.87 mm3) treated by RFA were included in this retrospective study. Bilateral PTMC was defined as at least one tumor located in the contralateral lobe. Patients were followed up at 1, 3, 6, 12 months and every 6–12 months thereafter. Volume, volume reduction ratio (VRR) and local tumor recurrence were evaluated during the follow-up period.ResultsAfter a mean follow-up period of 47.77 ± 11.54 months, the mean volume of bilateral PTMC decreased from 75.22 ± 73.87 mm3 to 0.09 ± 0.44 mm3. The mean VRR was 99.94 ± 0.28% and the complete disappearance rate was 92.00%. During the follow-up, one patient (2.13%) developed lymph node metastasis and two patients (4.26%) had recurrent PTMC. All the recurrent lesions underwent additional RFA and two of them disappeared completely. No life-threatening or delayed complications occurred.ConclusionsWith sufficient preoperative evaluation, RFA might be a promising alternative for bilateral PTMC patients who were unsuitable for surgery or refused surgery.

The occurrence of and predictive factors for multifocality and bilaterality in patients with papillary thyroid microcarcinoma.

Thyroidectomy or hemithyroidectomy may be performed as treatment for papillary thyroid microcarcinoma (PTMC). However, in cases of bilateral PTMCs, only thyroidectomies should be recommended. Sometimes bilateral PTMC may be undetected in presurgical evaluations, so reoperation might be necessary after a partial thyroid resection. The aim of this study was to assess the occurrence of and predictive factors for the multifocality and bilaterality of PTMCs.We performed a retrospective review of 4716 consecutive patients with thyroid tumors. Of these patients, 434 (9.2%) had thyroid malignancies. All patients underwent thyroidectomies with central and/or lateral lymph node dissection between January 2008 and December 2017. PTMC was identified in 177 (3.75%) individuals.Solitary PTMC was observed in 114 (64.4%) patients, multifocal PTMC was seen in 48 (27.1%) patients, and bilateral PTMC was detected in 15 (8.5%) patients. The occurrence of solitary PTMC increased from 11.1% in 2008 to 61.9% in 2017. The occurrence of multifocal tumors significantly decreased from 77.8% in 2008 to 6.3% to 18.4% in 2013 to 2016 (P < .05). The occurrence of bilateral tumors, with respect to all PTMC cases, did not change during the 10-year period. We observed significantly higher rates of hypoechogenicity, more microcalcifications, more irregular margins, larger tumor sizes, and higher vascularity in the patients with multifocal and bilateral tumors than in the patients with solitary tumors (P < .0001 for all).The occurrence of bilateral PTMC is not very common. In patients with PTMC, thyroidectomy should be considered when microcalcifications, an irregular tumor shape, unclear margins, hypoechogenicity, high vascularity, and a large tumor size are observed. These clinicopathological features are prognostic factors for multifocal and bilateral PTMC.

Papillary thyroid microcarcinoma with synchronous asymptomatic advanced esophageal squamous cell carcinoma: A case report and review of the literature.

Papillary thyroid microcarcinoma (PTMC) is a subset of papillary thyroid carcinoma, with tumors measuring ≤1.0 cm in maximum diameter. Esophageal squamous cell carcinoma (ESCC) is the most common histopathological subtype of the various esophageal malignancies. The present study reports a rare synchronous presentation of PTMC and asymptomatic ESCC manifesting as lateral cervical lymph node enlargement. The patient, a 70-year-old male who presented to the Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China)with no significant symptoms, was identified to have bilateral thyroid nodules by ultrasonography and enlarged lymph nodes on the left side of the neck by palpation. A diagnosis of PTMC with lateral cervical lymph node metastasis was established and the patient underwent right lobectomy, partial left lobectomy and lymph node biopsy. Pathological analysis of the intraoperative frozen biopsy indicated bilateral PTMC and metastatic lymph node SCC from a different primary location. Furthermore, histological examination of the biopsied lymph nodes revealed bilateral PTMC and poorly-differentiated SCC, which was verified as ESCC by gastroscopy and postoperative histopathological examination. A review of the present literature indicated that no similar case has been reported thus far. The patient succumbed three months after attending Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China) for additional treatment.

Bilateral versus unilateral papillary thyroid microcarcinoma: predictive factors and associated histopathological findings following total thyroidectomy

The extent of thyroidectomy for papillary thyroid microcarcinoma (PTMC) is debatable. This study investigated the rate and predictive factors of bilateral versus unilateral PTMC with the objective of identifying those patients who may benefit from total thyroidectomy. Between January 2001 and December 2008, 2019 patients who underwent total thyroidectomy were examined. A total of 319 patients diagnosed histopathologically as PTMC were included in the study. The predictive value of age at diagnosis, gender, tumor size, multifocality, lymph node metastasis, thyroid capsule invasion and nonincidental diagnosis using univariate and multivariate analyses were retrospectively analyzed. Of the 319 patients with PTMC, 77 (24.1%) presented bilateral disease. In univariate analysis, size of tumor ≥5 mm (p<0.001), multifocality (p<0.001), lymph node metastases (p<0.001), thyroid capsule invasion (p<0.001) and nonincidental diagnosis (p=0.002) were significantly associated with bilaterality. In multivariate analysis, tumor size (p<0.001), multifocality of the primary tumor in the unilateral lobe (p<0.001) and lymph node metastasis (p<0.001) were independent predictive factors for bilateral PTMC. Tumor size ≥5 mm and multifocality of the primary carcinoma in the unilateral lobe were independent risk factors for bilateral PTMC. Total thyroidectomy should be considered for these patients, which is of importance for the prediction of possible recurrence of disease.

Factors predictive of papillary thyroid micro-carcinoma with bilateral involvement and central lymph node metastasis: a retrospective study

BackgroundThe optimal resection extent for papillary thyroid microcarcinoma (PTMC) remains controversial. The objective of the study was to investigate risk factors of bilateral PTMC and central lymph node metastasis (CLNM) to guide surgical strategies for PTMC patients.MethodsWe retrospectively reviewed 211 PTMC patients who underwent total thyroidectomy (TT) and 122 clinical lymph node-negative (cN0) cases that underwent prophylactic central lymph node dissection (CLND) between 2010 and 2011. The frequency, pattern, and predictive factors for bilateral PTMC and CLNM in these patients were studied using univariate and multivariate analysis with respect to the following variables: age, gender, extrathyroidal extension (ETE), T stage, with Hashimoto thyroiditis (HT), tumor size and multifocality based on final pathology, and preoperative evaluation using ultrasonography (US).ResultsFifty-four of 211 (25.6%) patients had bilateral PTMC. In multivariate analysis, multifocality (P < 0.001, OR = 23.900) and tumor size ≥7 mm (P = 0.014, OR = 2.398) based on US were independent predictive factors for bilateral PTMC which was also independently associated with multifocality (P < 0.001, OR = 29.657) and tumor size ≥7 mm (P = 0.005, OR = 2.863) based on final pathology. Among 122 cN0 patients who underwent prophylactic CLND, we found 49.2% of patients had CLNM. CLNM was independently associated with men, age <50 years and tumor size ≥7 mm based on final pathology or preoperative US.ConclusionsTT should be considered for PTMC patients who are found multifocality and tumor size ≥7 mm based on preoperative US. CLND need be considered in cN0 patients who are men, aged <50 years or tumor size ≥7 mm based on preoperative US.

Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients

There is debate concerning the clinical significance of papillary thyroid microcarcinoma (PTMC), and therefore, the rise in the incidence of PTMC creates management dilemmas. The purpose of this study was to analyse the clinicopathological characteristics of PTMC in an island region that has a high prevalence of goitre and to determine risk factors for the worst prognosis. Data from 1874 patients who underwent a total thyroidectomy between January 2002 and December 2008 were reviewed retrospectively. A total of 276 patients who were diagnosed with PTMC in a final pathology report were included in the study. A PTMC was defined as a papillary thyroid carcinoma with a diameter ≤ 10 mm. Clinicopathological features were evaluated by both univariate and multivariate analyses. Of the 276 patients with PTMC, 219 patients (79·3%) were incidentally diagnosed. Two hundred and two patients had carcinomas of ≤ 5 mm, and 74 patients presented with carcinomas that ranged in size from 0·6 to 1·0 cm. Lymph node metastasis was diagnosed in 3·5% of patients with tumours ≤ 5 mm, and 21·6% of patients presented tumours > 5 mm. Upon multivariate analysis, clinically suspected diagnosis, a tumour size > 5 mm and an age over 45 years at diagnosis were independent risk factors for capsule invasion, while tumour multifocality, bilaterality, size of tumour > 5 mm and thyroid capsule invasion were independent risk factors for lymph node metastasis at diagnosis. Patients presenting multifocal, bilateral PTMC with a maximum diameter > 5 mm and thyroid capsule invasion may have an increased risk of lymph node metastasis. These factors should be considered in the follow-up for these patients.