Evaluation of surgical results of micropapillary thyroid cancers according to tumor size and focality

Year 2017, , 123 - 126, 01.09.2017

Bekir Uçan , Muhammed Erkam Sencar Muhammed Kızılgül , Mustafa Özbek İlknur Öztürk Ünsal , Erman Çakal

https://doi.org/10.21601/ortadogutipdergisi.266085

Abstract

Aim: There
is no consensus regarding the recommended surgical approach in the treatment of
micropapillary thyroid carcinoma (MTC) or whether additional treatment with
radioactive iodine is necessary or not. The aim of this study was to
investigate the surgical findings and pathological results of micropapillary
thyroid cancer with tumor size of  ≤5 mm
or >5 mm and also in the presence of unifocal or multifocality.

Material and Method: We
enrolled 209 patients with MTC who underwent surgery at the Diskapi Training
and Research Hospital between 2008 and 2012, in a retrospective study design.
We divided patients into two groups according to whether tumor size of  ≤5 mm or >5 mm and also categorized based
on the presence of unifocal or multifocality.

Results: One
hundred and three patients (13 male, 90 female) with tumor size of ≤5 mm were categorized
as group 1 and 106 patients (12 male, 94 female) with tumor size of >5 mm
were categorized as group 2. Central lymph node dissection was more often
performed in group 2 ( 40 (43.5%) to 20 (22.2%), p:0.002). Capsule invasion were
identified in 6 (6%) of the patients in group 1 and in 20 (19.4%) of the
patients in group 2 (p = 0.004). There was no statistically significant
difference between the two groups regarding the presence of multifocality (24
(%23.8) patients in group 1 and 33 (%32) patients in group 2;  p=0.18). Lymph node metastasis was more
common in group 2 when compared to group 1 (4 (%4) to 13 (%12.6), p=0.027).
Five patients (5%) with microscopically positive surgical margins were found
group 2 however, none of the patients in group 1 had microscopically positive
surgical margins (p:0.025).

Conclusion:
Although all tumors lower than 1cm categorized as micropapillary cancer, the
recurrence of the disease is more common in the presence of tumor greater than
5mm or multifocal tumor regardless of size.

Keywords

Micropapillary thyroid cancer, tumor size, prognosis

Mikropapiller tiroid kanserlerinde tümör çapına ve tek odak-çoklu odak oluşuna göre operasyon bulgularının değerlendirilmesi

Abstract

Amaç:
Mikropapiller
kanserlere önerilen cerrahi şekli veya radyoaktif iyot (RAİ) verilip
verilmemesi konusunda görüş birliği yoktur. Bu çalışmadaki amaç, mikropapiller tiroid
kanserlerinde, tümör çapı ≤5 mm veya>5 mm olanlarda, ayrıca tek odak ve çok
odak varlığında öncelikle cerrahi bulguların ve 
patoloji sonuçlarının dökümante edilmesidir.

Gereç
ve yöntem: 2008-2012 yılları arasında Dışkapı Yıldırım Beyazıt
Eğitim ve Araştırma Hastanesi Endokrinoloji polikliğine başvuran toplam 209
mikropapiller tiroid kanserli hasta retrospektif olarak taranıp çalışmaya dahil
edildi. Hastalar öncelikle tümör çapı ≤5 mm ve >5 mm olacak şekilde gruplandırıldı,
ayrıca tümörün tek odak ya da çoklu odak oluşuna göre de sınıflandırıldı.

Bulgular:
209
hastadan 103 (13 erkek, 90 kadın) hastada 
tümör çapı ≤5 mm olup grup 1, 106 (12 erkek, 94 kadın) hastada tümör
çapı >5 mm olup grup 2 olarak sınıflandırıldı. Grup 1 için 20 (%22.2)
hastada santral lenf nodu diseksiyonu yapılırken, grup 2 için bu sayı 40
(%43.5) hastaydı (p=0.002). Kapsül invazyonu grup 1’de 6 (%6) hastada, grup
2’de 20 (%19.4) hastada tespit edildi (p=0.004). Çoklu odak varlığı açısından gruplar
arasında anlamlı farklıklık saptanmadı (grup 1’de 24 (%23.8), grup 2’de
33(%32);  p=0.18). Lenf nodu metastazı grup
1’de 4 (%4) hastada, grup 2’de 13 (%12.6) hastada mevcut olup iki grup arasında
anlamlı farklılık mevcuttu (p=0.027). Grup 1’de hiçbir hastada cerrahi sınırda
tümör tespit edilmemişken, grup 2’de 5 (%5.1) hastada cerrahi sınırda tümör
tespit edildi (p=0.025)

Sonuç:
Operasyon
ve patoloji sonuçları değerlendirildiğinde 1 cm’nin altındaki tümörler her ne
kadar mikropapiller kanserler başlığı altında tek olarak değerlendirilse de,tümör
boyutunun 5 mm’nin üzerinde olmasi veya tümör boyutundan bağımsız olarak
multifokal tümör varlığında daha sık rekürrens görülmektedir.

Keywords

Mikropapiller tiroid kanseri, tümör boyutu, prognoz

References

• 1. 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.
• 2. Mazzaferri EL. Managing small thyroid cancers. JAMA 2006; 295: 2179-82.
• 3. American Thyroid Association (ATA) Guidelines Task force on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-214.
• 4. Dietlein M, Luyken WA, Schicha H, Larena-Avellaneda A. Incidental multifocal papillary microcarcinomas of the thyroid: is subtotal thyroidectomy combined with radioiodineablation enough? NuclMedCommun 2005; 26: 3-8.
• 5. Lee HS, Park HS, Kim SW, Choi G, Park HS, Hong JC, Lee SG, Baek SM, Lee KD.Clinical characteristics of papillary thyroid microcarcinoma less than or equal to 5 mm on ultrasonography. .Eur Arch Otorhinolaryngol. 2013 Nov;270(11):2969-74.
• 6. Pyo JS, Sohn JH, Kang G. Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis. J Pathol Transl Med. 2016 Jul; 50(4) : 278-86.
• 7. Siddiqui S, White MG, Antic T, Grogan RH2, Angelos P, Kaplan EL, Cipriani NA. Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma. Thyroid. 2016 Jun;26(6):807-15.
• 8. John AM, Jacob PM, Oommen R, Nair S, Nair A, Rajaratnam S. Our experience with papillary thyroid microcancer. Indian J Endocrinol Metab. 2014 May;18(3):410-3.
• 9. Chang YW, Kim HS, Kim HY, Lee JB, Bae JW, Son GS. Should central lymph node dissection be considered for all papillary thyroid microcarcinoma? Asian J Surg. 2016 Oct;39(4):197-201.
• 10. Kim E, Choi JY, Koo do H, Lee KE, Youn YK. Differences in the characteristics of papillary thyroid microcarcinoma ≤ 5 mm and>5 mm in diameter. Head Neck. 2015 May;37(5):694-7.