Surgery For Papillary Thyroid Microcarcinoma Research Articles

Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database.

Over-treatment of papillary thyroid microcarcinoma (PTMC) has become a common issue. Although active surveillance (AS) has been proposed as an alternative treatment to immediate surgery for PTMC, its inclusion criteria and mortality risk have not been clearly defined. The purpose of this study was to investigate whether surgery can achieve significant survival benefits in patients with larger tumor diameter of papillary thyroid carcinoma (PTC), in order to evaluate the feasibility of expanding the threshold for active surveillance. This study retrospectively collected data of patients with papillary thyroid carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The propensity score matching (PSM) method was used to minimize confounding factors and selection bias between the surgery and non-surgery groups, and to compare the clinical and pathological characteristics between the two groups based on the SEER cohort. Meanwhile, the impact of surgery on prognosis was compared using Kaplan-Meier estimates and Cox proportional hazard models. A total of 175,195 patients were extracted from the database, including 686 patients who received non-surgical treatment, and were matched 1:1 with patients who received surgical treatment using propensity score matching. The Cox proportional hazard forest plot showed that age was the most important factor affecting overall survival (OS) of patients, while tumor size was the most important factor affecting disease-specific survival (DSS) of patients. In terms of tumor size, there was no significant difference in DSS between PTC patients with tumor size of 0-1.0cm who underwent surgical treatment and those who underwent non-surgical treatment, and the relative survival risk began to increase after the tumor size exceeded 2.0cm. Additionally, the Cox proportional hazard forest plot showed that chemotherapy, radioactive iodine, and multifocality were negative factors affecting DSS. Moreover, the risk of death increased over time, and no plateau phase was observed. For patients with papillary thyroid carcinoma (PTC) staged as T1N0M0, AS is a feasible management strategy. As the tumor diameter increases, the risk of death without surgical treatment gradually increases, but there may be a threshold. Within this range, a non-surgical approach may be a potentially viable management strategy. However, beyond this range, surgery may be more beneficial for patient survival. Therefore, it is necessary to conduct more large-scale prospective randomized controlled trials to further confirm these findings.

Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience.

PurposeTo report the results of our preliminary experience in treating patients with papillary thyroid microcarcinoma (PTMC) with image-guided thermal ablation, in particular estimating the feasibility, safety and short-term efficacyMaterials and MethodsFrom 2018 patients with cytologically proven PTMC < 10 mm were discussed in a multidisciplinary team and evaluated for feasibility of image-guided thermal ablation. In case of technical feasibility, the three possible alternatives (i.e., image-guided thermal ablation, surgery, and active surveillance) were discussed with patients. Patients who agreed to be treated with image guided thermal ablation underwent radiofrequency (RFA) or laser ablation under local anesthesia and conscious sedation. Treatment feasibility, technical success, technique efficacy, change in thyroid function tests, side effects, minor and major complications, patients satisfaction and pain/discomfort perception during and after treatment, and disease recurrence during follow-up were recorded.ResultsA total of 13 patients were evaluated, and 11/13 (84.6%) patients (9 female, 2 male, mean age 49.3 ± 8.7 years) resulted suitable for image-guided thermal ablation. All 11 patients agreed to be treated with image-guided thermal ablation. In addition, 3/11 (27.3%) were treated with laser ablation and 8/11 (72.7%) with RFA. All procedures were completed as preoperatively planned (technical success 100%). Technique efficacy was achieved in all 11/11 (100%) cases. Ablated volume significantly reduced from 0.87 ± 0.67 ml at first follow-up to 0.17 ± 0.36 at last follow-up (p = 0.003). No change in thyroid function tests occurred. No minor or major complications occurred. All patients graded 10 the satisfaction for the treatment, and mean pain after the procedure was reported as 1.4 ± 1.7, and mean pain after the procedure as 1.2 ± 1.1 At a median follow-up of 10.2 months (range 1.5–12 months), no local recurrence or distant metastases were found.ConclusionsImage guided thermal ablations appear to be feasible and safe in the treatment of PTMC. These techniques hold the potential to offer patients a minimally invasive curative alternative to surgical resection or active surveillance. These techniques appear to be largely preferred by patients.

BRAFV600E mutation is associated with aggressive features in papillary thyroid carcinomas\u2009\u2264\u20091.5\xa0cm

BackgroundWhile some studies suggest that the BRAF V600E mutation correlates with a high-risk phenotype in papillary thyroid microcarcinoma (PTMC), more evidence is necessary before this mutation can be used to help guide decision making in the management of small thyroid nodules. This study investigated whether BRAF V600E mutation is associated with aggressive features in PTMC (≤ 1 cm) and small PTC (1–1.5 cm).MethodsRetrospective chart review was performed on 121 patient cases. Patients who underwent thyroid surgery for PTMC (≤ 1 cm) or small PTC (1–1.5 cm) were included if molecular testing was done for BRAF V600E mutation. Two study groups were created based on tumour size: PTMC (n = 55) and small PTC (n = 66). The groups were analysed for the presence of a BRAF V600E mutation and aggressive features, including macroscopic extrathyroidal extension (ETE), lymph node metastasis (LNM), and high-risk histological features (tall cell, columnar cell, hobnail, solid/trabecular, and diffuse sclerosing). The Fischer exact test was used to calculate statistical significance.ResultsBRAF V600E mutations were detected in 43.6% of PTMC and 42.4% of small PTC. Of the mutated PTMC nodules, 54.1% demonstrated aggressive characteristics as compared to 19.4% of the non-mutated PTMCs (p = 0.010). Of the mutated small PTC tumours, 82.1% had aggressive features. In contrast, 28.9% of the non-mutated small PTCs showed aggressive features (p < 0.001).ConclusionsOur findings demonstrate an association between a BRAF V600E mutation and aggressive features in PTMC (≤ 1 cm) and small PTC (1–1.5 cm). Therefore, determining the molecular status of these thyroid nodules for the presence of BRAF V600E can help guide patient management.Graphical

Application of carbon nanoparticles combined with intraoperative neuromonitoring in papillary thyroid microcarcinoma surgery.

To improve the lymph node dissection as well as protect parathyroid gland and recurrent laryngeal nerve, the carbon nanoparticles and intraoperative neuromonitoring were applied in papillary thyroid microcarcinoma surgery. Carbon nanoparticles and intraoperative neuromonitoring were used in the experimental group, whereas the control group were not. Routine pathological examination was performed. The lymph nodes dissected was significantly higher in the experimental group, but the metastatic lymph nodes were not. The number of mistakenly dissected parathyroid gland and postoperative hypoparathyroidism were 3 and 13 in the experimental group respectively, significantly less than 10 and 25 in the control group. The incidences of overall, transient and persistent recurrent laryngeal nerve palsy in the experimental group were 5.5%, 5.5% and 0% respectively, whereas in the control group were 8.6%, 6.9% and 1.7%. Carbon nanoparticles can improve lymph node dissection in papillary thyroid microcarcinoma surgery, and the combination of carbon nanoparticles with intraoperative neuromonitoring can reduce surgical complications and improve patient quality of life.

Radiofrequency Ablation Is Noninferior to Surgery for Papillary Thyroid Microcarcinoma After 5 Years

Radiofrequency Ablation Is Noninferior to Surgery for Papillary Thyroid Microcarcinoma After 5 Years

Clinical experience and efficacy of endoscopic surgery for papillary thyroid microcarcinoma through total areola approach

To investigate the experience and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC) through total areola approach. Methods: A total of 117 PTMC patients, who were diagnosed pathologically in Minimally Invasive Surgical Center, Second Xiangya Hospital, Central South University from June 2016 to December 2017, were divided into a endoscopic surgery group (n=72) and an open surgery group (n=45). The number of dissected central lymph nodes, blood loss, amount of drainage, occurrence of postoperative complication and recurrence were collected and compared. Results: Compared with the open surgery group, the blood loss was less and the operative time was longer in the endoscopic surgery group (P<0.05). There were no significant differences between the 2 groups in the number of dissected central lymph nodes, amount of drainage and occurrence of postoperative complication (all P>0.05). The mean follow-up time was more than 20 months, and there was no recurrence in the 2 groups. Conclusion: Endoscopic thyroidectomy with central compartment neck dissection through total areola approach is safe and feasible in patients with PTMC. It has many advantages, such as no scar on neck, less blood loss, shorter hospital stay and more acceptable to young patients.

Clinical feasibility of imaging with indocyanine green combined with carbon nanoparticles for sentinel lymph node identification in papillary thyroid microcarcinoma

Background:Although several previous studies demonstrated the feasibility and efficacy of indocyanine green (ICG) for thyroid cancer surgery, ICG was administered through venous injection and focused on parathyroid gland protection. We thus aimed to study the feasibility of imaging using ICG combined with carbon nanoparticles (CNs) in the identification of sentinel lymph nodes (SLNs) in patients diagnosed with papillary thyroid microcarcinoma (PTMC).Methods:Two approaches were applied to detect lymph nodes in PTMC surgery. Patients were randomized into 2 groups. ICG and CNs were injected into the thyroid in Group A. In Group B, only CNs was injected. Black-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs. SLN and central lymph node (CLN) dissection was completed in both groups. The pathological and postoperative outcomes were compared between 2 groups.Results:There were 40 patients in Group A and 60 in Group B. A total of 138 SLNs were identified; 72 and 66 SLNs were detected and dissected in Groups A and B, respectively. The number of SLNs identified (per patient) in Group A was higher than that in Group B (P = .027). The number of harvested CLNs was 161 and 192 in Groups A and B, respectively, out of which 45 and 48 lymph nodes with metastasis were confirmed by permanent pathology. The CLN metastatic rate in Group A was higher than that in Group B (P = .048).Conclusion:Imaging using ICG combined CNs is feasible and safe for SLN identification in PTMC patients. Compared with using only CNs, more SLNs can be removed and more metastatic lymph nodes can be confirmed when using the combined method. Although the combined method appears to accurately stage tumors, further research is needed.

Meta-analysis of the influence of prophylactic central lymph node dissection on the prognosis of patients with thyroid micropapillary carcinoma

Objective: To evaluate the efficacy and safety of prophylactic central neck dissection (pCND) in papillary thyroid microcarcinoma (PTMC). Method: The PubMed, EMbase, Web of Knowledge, CBM, Wanfang, and CNKI databases were searched, and controlled trials and cohort studies of central lymph node dissection for cervical cancer in PTMC surgery were collected. The search time was from the establishment of the library to September 2018. Meta-analysis was performed on 4 articles that met the inclusion criteria to calculate the relative risk. Result: A total of 1 169 cases were included in 4 retrospective cohort studies. In addition to conventional thyroidectomy, pCND reduced the risk of local recurrence and did not increase the recurrent laryngeal nerve (RLN) injury (temporary or permanent), the incidence of permanent hypocalcemia. Postoperative temporary hypocalcemia is more common after surgery with pCND.Conclusion: Prophylactic central lymph node dissection reduces local recurrence rates without increasing long-term complications compared with thyroid and tumor resection alone.

The learning curve of endoscopic thyroid surgery for papillary thyroid microcarcinoma: CUSUM analysis of a single surgeon\u2019s experience

BackgroundWith the development of surgical technics, endoscopic thyroid surgery has been gradually accepted and utilized in thyroid disease treatment, including thyroid carcinoma. This study aimed to evaluate the learning curve for endoscopic hemithyroidectomy (EHT) with ipsilateral central neck dissection (CND) and investigate how many cases must be performed before a surgeon becomes competent and proficient in this approach.MethodsNinety-nine consecutive patients who underwent EHT with ipsilateral CND for papillary thyroid microcarcinoma by a single surgeon between June 2015 and October 2017 were analyzed. Multidimensional cumulative summation (CUSUM) analysis was performed to evaluate the learning curve.ResultsThe CUSUM graph showed the learning curve ascended in the first 31 cases and declined in the following cases. The number of lymph nodes removed in phase 2 (the following 68 cases) was significantly more than that in phase 1 (the first 31 cases) (5.06 ± 1.44 vs. 4.19 ± 1.51, P = 0.001). The operation time in phase 2 was shorter than that in phase 1 (123.38 ± 12.71 min vs. 132.90 ± 13.95 min, P = 0.008) and the rate of accidental removal of parathyroid gland decreased from 35.5% in phase 1 to 16.2% in phase 2 (P = 0.040). There was a declining trend but no significant difference in the rate of postoperative complications (9.7% in phase 2 vs. 4.4% in phase 1, P = 0.309).ConclusionEHT with ipsilateral CND performed by surgeons was mastered after 31 cases, and the safety and feasibility of this endoscopic approach can also be demonstrated.

Thyroid surgery for differentiated thyroid cancer - recent advances and future directions.

Population-based studies have demonstrated that an increasing number of incidental thyroid nodules are being identified. The corresponding increase in thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of thyroid cancers and to more thyroid surgeries being performed. Small papillary thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated thyroid cancer, as the complications related to thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparathyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus thyroid surgery for papillary thyroid microcarcinoma, the extent of thyroid surgery and lymphadenectomy for low-risk differentiated thyroid cancer, and the use of molecular testing to guide decision-making about whether surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated thyroid cancer. Additionally, innovative thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following thyroidectomy.

Ultrasound-guided percutaneous microwave ablation versus surgery for papillary thyroid microcarcinoma

Background: Papillary thyroid microcarcinoma (PTMC) has high incidence and low disease-specific mortality. However, active surveillance is not accepted by most patients owing to high physical or psychological pressures. The emergence of ablation technologies is supplanting traditional surgery. Our goal was to compare the clinical outcomes of microwave ablation (MWA) and surgery for T1aN0M0 PTMC.Methods: A total of 92 consecutive patients with T1aN0M0 PTMC were studied retrospectively. Forty-six patients had been treated with MWA, and the other 46 had undergone surgery. MWA was performed using extensive ablation extending from the nodule’s lower pole to the upper pole. Surgery was performed by total thyroidectomy or thyroid lobectomy. We compared the two groups in terms of mean length of stay, cost, mean blood loss, surgical incision, operating room (OR) time, quality of life (QOL) assessment, complications, and therapeutic efficacy over a follow-up period of 42 months.Results: The mean length of stay, cost, mean blood loss, surgical incisions, OR time, and complications in the MWA group were significantly lower than those of the surgery group. The QOL after MWA was higher than it was after surgery. The nodule volume decreased significantly from 53.61 ± 48.43 mm3 to 4.84 ± 6.55 mm3 (p < .001) at the 42-month follow-up, exhibiting a percentage volume reduction of 81.33 ± 36.87%. No recurrence or metastasis occurred in either group during the follow-up period.Conclusions: MWA may be considered a minimally invasive alternative to surgery for solitary T1aN0M0 PTMC with low incidence of complications and good therapeutic effect.

The Extent of Surgery for Papillary Thyroid Microcarcinoma: The Controversy Continues

The Extent of Surgery for Papillary Thyroid Microcarcinoma: The Controversy Continues

Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma

Robotic operations have enabled a safer and more meticulous approach to thyroidectomy with the notable benefit of improved cosmesis and decreases in postoperative pain and swallowing discomfort. The aim of this study was to document the early surgical outcomes of robotic thyroidectomy in patients with papillary thyroid carcinoma (PTC) by comparing it with conventional open thyroidectomy. From October 2007 to September 2008, 458 patients with PTC underwent thyroidectomy at the Yonsei University Health System. Of these patients, 266 patients were in the conventional open group and 192 patients were in the robotic group. These 2 groups were compared retrospectively with respect to clinicopathologic characteristics and surgical outcomes. The mean follow-up period was 29.1 months. Mean tumor size, incidence of capsular invasion, multiplicity, and central nodal metastasis showed no significant difference between the 2 groups. Total thyroidectomy was performed more frequently in the open group. In terms of operation times, the robotic group had a significantly greater length of time for total thyroidectomy and subtotal thyroidectomy. The total number of retrieved central lymph nodes was greater in the open group (5.7 vs 4.6, P = .004). The 2 groups showed no differences in intraoperative and postoperative complications. The postoperative serum thyroglobulin levels were similar in both groups (0.25 vs 0.22 ng/mL, P = .648) and 2-year follow-up sonography of 433 patients revealed no recurrences. No abnormal I(131) uptake was observed in whole-body scans in either group. Robotic thyroidectomy was similar to conventional open thyroidectomy in terms of early surgical outcomes but offers advantages. We conclude that robotic thyroidectomy offers a safe, feasible alternative to conventional open thyroidectomy in patients with PTC.

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

Central compartment lymph node (CCLN) management in patients without clinical or radiologic evidence of CCLN metastasis is debatable. The aim of the present study was to evaluate outcomes of surgery for papillary thyroid microcarcinoma (PTMC) with prophylactic ipsilateral CCLN dissection (PI-CCND) in a large cohort of patients treated at one single institution in a 5-year follow-up. Between January 2000 and December 2005, 2192 patients with papillary thyroid carcinoma underwent thyroid surgery. Inclusion criteria were patients with PTMC, absence of clinical or radiologic evidence of CCLN metastasis, and a follow-up for a period ≥60 months. Data from 842 patients were retrieved in the current retrospective cohort study. PI-CCND was routinely performed in addition to thyroid surgery in all cases. Ipsilateral CCLN metastasis was found in 218 patients (25.9%). Postoperative complications included 76 cases of transient hypoparathyroidism (9%), 11 cases of permanent hypoparathyroidism (2.6%), four cases of vocal cord palsy (0.5%), and one case of bleeding (0.1%). Univariate analysis and multivariate logistic regression analysis revealed that CCLN metastasis was statistically significantly correlated with tumor size and extracapsular invasion. Recurrence has been observed to date in 19 patients (2.26%). No CCLN site recurrence occured in patients who underwent PI-CCND. This study demonstrates the technical feasibility and safety of PI- CCND, which is a better way to determine lymph node status for a more accurate staging of disease and risk stratification. PI-CCND should be considered even if clinical or radiological exams are negative for CCLN metastasis.

Analysis of Relationship between Prognostic Factors and Number of Fine-Needle Aspiration Cytology (FNAC) Prior to Surgery for Papillary Thyroid Microcarcinoma According to Size

Analysis of Relationship between Prognostic Factors and Number of Fine-Needle Aspiration Cytology (FNAC) Prior to Surgery for Papillary Thyroid Microcarcinoma According to Size