“Occult” papillary carcinoma of the thyroid: a questionable entity - ScienceDirect

European Journal of Cancer

Volume 29, Issue 13, 1993, Pages 1817-1820

European Journal of Cancer

https://doi.org/10.1016/0959-8049(93)90528-N Get rights and content

Abstract

A series of 72 cases of “occult” thyroid papillary cancer, i.e. tumours of less than 1.5 cm in diameter, was analysed. The patients—26 males and 46 females—were treated surgically, 25 by lobectomy and isthmusectomy and 47 by total thyroidectomy. In 51 cases nodal neck dissection was performed, bilateral in 2 cases. 9 thyroidectomised patients received radiometabolic therapy. Hormone therapy (T₄) was continuously administered to 57 patients. The median duration of follow-up was 99 months (60–189). All the patients were alive (except one who died from other causes) and free of disease at last control. No relapses in the thyroid were observed in the conservatively treated patients. 2 patients of the 47 radically operated upon subsequently presented nodal metastasis and underwent neck dissection. The so-called “occult” thyroid papillary cancer does not differ from other papillary cancers with respect to morphological, clinical and prognostic factors—it differs only in size. Considering occult papillary tumours as an entity is questioned in this paper.

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Cited by (34)

A review of 227 cases of small papillary thyroid carcinoma
2007, European Journal of Surgical Oncology
Citation Excerpt :
Patients with PTC usually have a very good prognosis and a mortality rate of less than 10 % at 10 years after surgery. Furthermore papillary microcarcinoma (PMC) originally proposed by Harzard and later defined by the World Health Organization (WHO) as a tumor of 1.0 cm or less in diameter,3 exhibits more favorable outcomes than larger tumors in a number of studies4–6 despite the fact that some PMCs also might develop locoregional recurrences, distant metastases and cause death of the patients.7,8 With improved preoperative diagnostic techniques, including fine-needle aspiration cytology and high-resolution ultrasonography, PMC can be diagnosed before definitive surgery and thyroid cancer also tends to be diagnosed at an early stage.7,9,10
To review differences in biological aggressiveness, clinical behaviors or selected surgical treatments between the PMC and the slightly larger PTC of 1.0 < T ≤ 2.0 cm.
Two hundred and twenty-seven cases of papillary thyroid carcinoma not larger than 2.0 cm, diagnosed and treated at the Kuma Hospital, Kobe, Japan, with a 10-year follow-up from 1992 to 2003, were reviewed.
The small PTCs demonstrated excellent outcomes, and persistent/recurrent disease was identified in only nine patients (4 %). None of the patients died of the disease. A multivariate analysis revealed that massive extrathyroidal extension at presentation was the only independent prognostic factor for locoregional recurrence. Subdivision into PMCs and slightly larger tumors (1 < T ≤ 2 cm) did not affect the excellent outcomes, but the patients in the latter subgroup received more lymph node surgery and displayed more aggressive clinicohistological features such as higher rates of extrathyroidal extension, lymph node metastasis, loss of polarity, invasive growth pattern and loss of cohesiveness.
Small PTC not larger than 2.0 cm could be considered as favorable a prognosis as PMC.
Papillary thyroid microcarcinoma: A surgical perspective
2005, Cancer Treatment Reviews
Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid cancer measuring less than 10 mm in its greatest diameter. It is the most common form of thyroid cancer, detected in up to 36% in autopsy studies. The wide availability and use of neck ultrasonography in the evaluation of carotid arteries and of the thyroid resulted in an increased detection of PTMC. PTMC is often multifocal. The diagnosis is usually based on a combination of clinical examination, laboratory investigations, and specialized radiological techniques (mainly neck ultrasonography combined with fine-needle aspiration cytology). A common scenario is the diagnosis of PTMC as an incidental finding following thyroidectomy for a presumably benign thyroid disease. Despite some controversy, most authors agree that PTMC should be treated by total or near-total thyroidectomy, provided it can be performed safely. Because of its many and major advantages, in our clinical practice, total or near-total thyroidectomy is the procedure of choice for the management of PTMC. Given the high incidence of PTMC as an incidental finding and the frequent multifocality, we also favor total or near-total thyroidectomy for the surgical management of nodular thyroid disease (multinodular goiter or dominant presumably benign thyroid nodule/s). Despite some controversy, we perform central neck lymph node dissection electively, in the presence of cervical lymphadenopathy. Radioiodine ablation therapy may be used as an adjuvant therapy. Prognostic factors (such as tumor multicentricity, positive lymph nodes, capsular or vascular invasion) or scoring systems (such as the AMES) can be used to select patients for radioiodine adjuvant therapy. Suppression therapy is needed after surgical management. Despite the potential for neck lymph node and even distant metastases, the biological behavior of PTMC is in general benign and the prognosis is very good.
Relation between clinical presentation and prognosis of patients with papillary thyroid microcarcinoma
2003, Medicina Clinica
Analizar a los pacientes con microcarcinoma papilar (MCP) de tiroides para intentar establecer su pronóstico al diferenciar los diagnosticados pre y postoperatoriamente.
Estudio retrospectivo de 83 pacientes con MCP, estableciendo dos grupos en función del momento del diagnóstico. Se compararon su clínica, histología y seguimiento, y se analizaron la supervivencia y el intervalo libre de enfermedad (ILE) entre los dos grupos.
El grupo A (pacientes diagnosticados preoperatoriamente) incluyó a 30 pacientes (36,1%) y el grupo B (de diagnóstico postoperatorio) a 53 (63,9%). Se detectó recurrencia en 5 pacientes, todos del grupo A. La supervivencia global fue del 98,8% y el ILE global del 94% (83,3% para el grupo A y el 100% para el B, con diferencias significativas; p = 0,01).
Es útil separar a los pacientes con MCP de tiroides diagnosticados pre o postoperatoriamente, ya que su evolución es diferente y, por lo tanto, requieren un tratamiento y seguimiento diferente.
We aimed to analyze patients with papillary thyroid microcarcinoma (PTM) in order to establish the prognosis according to the differences observed between those diagnosed before surgery and those diagnosed postoperatively.
Retrospective study of 83 PTM patients who were distributed in 2 groups. Clinical, histological and follow-up data were compared. Survival and disease-free interval (DFI) were analyzed in both groups.
Group A (diagnosed before surgery): 30 patients (36.1%); group B (diagnosed postoperatively): 53 patients (63.9%). Five group A patients had a relapse. Overall survival was 98.8% and overall DFI was 94% (83.3% in group A and 100% in group B, p = 0.01).
It is useful to differentiate patients with PTM diagnosed before surgery from those whose PTM was diagnosed after since their evolution is different.
Critical commentary to occult papillary carcinoma of the thyroid gland with extensive osseous metastases - A case report with review of the literature
1999, Pathology Research and Practice
A systematic review of primary active surveillance management of low-risk papillary carcinoma
2016, Current Opinion in Oncology
Thyroid microcarcinoma approach. A ten year experience
2013, Annali Italiani di Chirurgia

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