Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2011

01-07-2011 | Endocrine Tumors

Minimal Extrathyroidal Extension in Patients with Papillary Thyroid Microcarcinoma: Is It a Real Prognostic Factor?

Authors: Hee Jung Moon, MD, Eun-Kyung Kim, MD, Woong Youn Chung, MD, Jung Hyun Yoon, MD, Jin Young Kwak, MD

Published in: Annals of Surgical Oncology | Issue 7/2011

Login to get access

Abstract

Background

The clinical impact of minimal extrathyroidal extension (ETE) in patients with conventional papillary thyroid microcarcinoma (PTMC) is still controversial. The clinicopathologic characteristics of patients with or without minimal ETE or recurrence and the clinical impact of minimal ETE were investigated.

Methods

This study included 288 patients with conventional PTMC (mean age, 46.6 years; 262 female and 26 male subjects) and more than 5 years of follow-up. Patients were divided into two groups according to ETE and recurrence, and clinicopathologic characteristics between two groups were investigated. Disease-free survival was calculated to compare the clinical impact of minimal ETE between patients with and without ETE.

Results

Mean size (6.9 mm) of PTMCs in patients with minimal ETE (n = 89) was significantly larger than that in those (5.8 mm) without (n = 199) (P < 0.001). Tumor size [odds ratio (OR) = 1.185; 95% confidence interval (CI) 1.052–1.334], central lymph node (LN) metastasis at diagnosis (OR 2.105; 95% CI 1.182–3.750), and not well-defined margin on ultrasound (OR 3.808; 95% CI 1.055–13.736) were significantly associated with minimal ETE. Twelve patients (4.2%) had recurrence. No clinicopathologic factor was associated with recurrence. Disease-free survival was not significantly different between patients with and without minimal ETE (P = 0.671).

Conclusions

Minimal ETE was statistically significantly associated with tumor size, central LN metastasis, and not well-defined margin on ultrasound. Minimal ETE had no impact on recurrence in patients with conventional PTMC.
Literature
1.
Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7.PubMedCrossRef
2.
Lee J, Rhee Y, Lee S, et al. Frequent, aggressive behaviors of thyroid microcarcinomas in Korean patients. Endocr J. 2006;53:627–32.PubMedCrossRef
3.
4.
DeLellis RA, Lloyd RV, Heitz PU, Eng C. WHO classification of tumors. Pathology and genetics. Lyon: IARC Press; 2004.
5.
Ito Y, Miyauchi A, Inoue H, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34:28–35.PubMedCrossRef
6.
Cappelli C, Castellano M, Braga M, et al. Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol. 2007;95:555–60.PubMedCrossRef
7.
Chow S, Law SC, Chan JK, Au S, Yau S, Lau W. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003;98:31–40.PubMedCrossRef
8.
Lin KD, Lin JD, Huang HS, Jeng LB, Ho YS. Skull metastasis with brain invasion from thyroid papillary microcarcinoma. J Formos Med Assoc. 1997;96:280–2.PubMed
9.
Liou M, Lin J, Chung M, Liau C, Hsueh C. Renal metastasis from papillary thyroid microcarcinoma. Acta Otolaryngol. 2005;125:438–42.PubMedCrossRef
10.
Arora N, Turbendian HK, Kato MA, Moo TA, Zarnegar R, Fahey TJ. Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid. 2009;19:473–7.PubMedCrossRef
11.
Edge SB, Compton CC, Byrd DR. AJCC cancer staging manual, 7th edition. New York: Springer; 2010.
12.
Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP. Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg. 1995;170:467–70.PubMedCrossRef
13.
Brierley JD, Panzarella T, Tsang RW, Gospodarowicz MK, O’Sullivan B. A comparison of different staging systems predictability of patient outcome. Thyroid carcinoma as an example. Cancer. 1997;79:2414–23.PubMedCrossRef
14.
Byar DP, Green SB, Dor P, et al. A prognostic index for thyroid carcinoma. A study of the EORTC Thyroid Cancer Cooperative Group. Eur J Cancer. 1979;15:1033–41.PubMed
15.
Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988;104:947–53.PubMed
16.
DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990;71:414–24.PubMedCrossRef
17.
Greenle FL, Page DL, Fleming ID. AJCC cancer staging manual, 6th edition. New York: Springer; 2002.CrossRef
18.
Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114:1050–7.PubMed
19.
Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102:1088–95.PubMed
20.
Ito Y, Tomoda C, Uruno T, et al. Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45 years. Surg Today. 2006;36:12–8.PubMedCrossRef
21.
Ito Y, Tomoda C, Uruno T, et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg. 2006;30:780–6.PubMedCrossRef
22.
Lundgren CI, Hall P, Dickman PW, Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case–control study. Cancer. 2006;106:524–31.PubMedCrossRef
23.
Ortiz S, Rodrguez JM, Soria T, et al. Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg. 2001;124:261–5.PubMedCrossRef
24.
Palme CE, Waseem Z, Raza SN, Eski S, Walfish P, Freeman JL. Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004;130:819–24.PubMedCrossRef
25.
Wada N, Nakayama H, Suganuma N, et al. Prognostic value of the sixth edition AJCC/UICC TNM classification for differentiated thyroid carcinoma with extrathyroid extension. J Clin Endocrinol Metab. 2007;92:215–8.PubMedCrossRef
26.
Loh KC, Greenspan FS, Gee L, Miller TR, Yeo PP. Pathological tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients. J Clin Endocrinol Metab. 1997;82:3553–62.PubMedCrossRef
27.
Bisi H, Fernandes VS, de Camargo RY, Koch L, Abdo AH, de Brito T. The prevalence of unsuspected thyroid pathology in 300 sequential autopsies, with special reference to the incidental carcinoma. Cancer. 1989;64:1888–93.PubMedCrossRef
28.
Bramley MD, Harrison BJ. Papillary microcarcinoma of the thyroid gland. Br J Surg. 1996;83:1674–83.PubMedCrossRef
29.
Franssila KO, Harach HR. Occult papillary carcinoma of the thyroid in children and young adults. A systemic autopsy study in Finland. Cancer. 1986;58:715–9.PubMedCrossRef
30.
Noguchi S, Yamashita H, Uchino S, Watanabe S. Papillary microcarcinoma. World J Surg. 2008;32:747–53.PubMedCrossRef
31.
Yamamoto Y, Maeda T, Izumi K, Otsuka H. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer. 1990;65:1173–9.PubMedCrossRef
32.
Hay ID, Hutchinson ME, Gonzalez-Losada T, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008;144:980–7.PubMedCrossRef
33.
Kwak JY, Kim E, Chung WY, Moon HJ, Kim MJ, Choi JR. Association of BRAFV600E mutation with poor clinical prognostic factors and US features in Korean patients with papillary thyroid microcarcinoma. Radiology. 2009;253:854–60.PubMedCrossRef
34.
Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid. 2009;19:707–16.PubMedCrossRef
35.
Kwak JY, Kim E, Youk JH, et al. Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid. 2008;18:609–14.PubMedCrossRef
36.
Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRef
37.
Lee YS, Nam K, Chung WY, Chang H, Park CS. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci. 2010;25:541–5.PubMedCrossRef
38.
Besic N, Pilko G, Petric R, Hocevar M, Zgajnar J. Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol. 2008;97:221–5.PubMedCrossRef
39.
Lim D, Baek K, Lee Y, et al. Clinical, histopathological, and molecular characteristics of papillary thyroid microcarcinoma. Thyroid. 2007;17:883–8.PubMedCrossRef
40.
Lombardi CP, Bellantone R, De Crea C, et al. Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg. 2010;34:1214–21.PubMedCrossRef
41.
Sobin LH, Wittekind Ch, Greene FL, Hutter R, Klimpfinger M. TNM classification of malignant tumors, 5th edition. New York: Wiley; 1997.
Metadata
Title
Minimal Extrathyroidal Extension in Patients with Papillary Thyroid Microcarcinoma: Is It a Real Prognostic Factor?
Authors
Hee Jung Moon, MD
Eun-Kyung Kim, MD
Woong Youn Chung, MD
Jung Hyun Yoon, MD
Jin Young Kwak, MD
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1556-z

Other articles of this Issue 7/2011

Annals of Surgical Oncology 7/2011 Go to the issue

Urologic Oncology

Dynamic Sentinel Node Biopsy for Inguinal Lymph Node Staging in Patients with Penile Cancer: A Systematic Review and Cumulative Analysis of the Literature

Breast Oncology

The Florid Subtype of Lobular Carcinoma In Situ: Marker or Precursor for Invasive Lobular Carcinoma?

Healthcare Policy and Outcomes

Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands

Translational Research and Biomarkers

Overexpression of Metastasis-Associated Protein 1 is Significantly Correlated with Tumor Angiogenesis and Poor Survival in Patients with Early-Stage Non-Small Cell Lung Cancer

Breast Oncology

Ongoing Consideration of Cavity Evaluation Devices in the Treatment of Breast Cancer

Urologic Oncology

Association Between the Number of Dissected Lymph Nodes During Pelvic Lymphadenectomy and Cancer-Specific Survival in Patients with Lymph Node–Negative Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy