Korean J Endocr Surg.  2011 Sep;11(3):152-157. 10.0000/kjes.2011.11.3.152.

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

• Oh SJ
• Ko JW
• Kim JS
• Moon DJ

• KMID: 2375375
• DOI: http://doi.org/10.0000/kjes.2011.11.3.152

Abstract

PURPOSE
Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma <10 mm in greatest dimension without palpation. In general, prognosis of PTMC is very favorable. PTMC can present with advanced features like papillary thyroid carcinoma >10 mm. Indication of FNAC based only on tumor size is still in debate. Some favor the criteria of a size <5 mm without FNAC and some argue for more study of the indication of FNAC according to tumor size. We analyzed the relationship of prognostic factors and number of FNACs prior to surgery for PTMC according to 5 mm size criterion.
METHODS
Three hundred seven patients diagnosed with PTMC after surgery were enrolled. Based on tumor size, patients were divided into group 1 (≤5 mm, n=151) and group 2 (>5 mm, n=156) and the prognostic factors and number of pre-surgical FNAC procedures were compared.
RESULTS
There were no significant differences in gender, age, site, accompanying benign disease, multifocality and bilaterality. Group 2 patients displayed more advanced features than group 1 patients concerning capsular invasion, lymph node metastasis and tumor stage. The number of FNAC procedures prior to the decision of surgery was not different in the two groups.
CONCLUSION
PTMC exceeding 5 mm in size showed advanced features than smaller tumors. Further study about the use of FNAC according only to the size of thyroid nodules is warranted.

Keyword

Thyroid; Papillary microcarcinoma; Prognosis; Fine-needle aspiration; Size

MeSH Terms

Biopsy, Fine-Needle*
Humans
Lymph Nodes
Neoplasm Metastasis
Palpation
Prognosis
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule

Reference

1.Wong CK., Wheeler MH. Thyroid nodules: rational management. World J Surg. 2000. 24:934–41.

2.Pitman MB., Abele J., Ali SZ., Duick D., Elsheikh TM., Jeffrey RB, et al. Techniques for thyroid FNA: a synopsis of the National Cancer Institute thyroid fine-needle aspiration state of the science conference. Diagn Cytopathol. 2008. 36:407–24.

3.Hedinger C., Williams ED., Sobin LH. Histological typing of thyroid tumours. World Health Organization International Histological Classification of Tumours. 2nd ed.Berlin: Springer-Verlag;1988.

4.Sakorafas GH., Giotakis J., Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev. 2005. 31:423–38.

5.Cooper DS., Doherty GM., Haugen BR., Kloos RT., Lee SL., Mandel SJ, et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009. 19:1167–214.

6.Hay ID., Grant CS., van Heerden JA., Goellner JR., Ebersold JR., Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery. 1992. 112:1139–46.

7.Bramley MD., Harrison BJ. Papillary microcarcinoma of the thyroid gland. Br J Surg. 1996. 83:1674–83.

8.Gharib H., Papini E., Paschke R., Duick DS., Valcavi R., Hegedüs L, et al. AACE/AME/ETA Task Force on Thyroid Nodules. American association of clinical endocrinologists, associazione medici endocrinologi, and European thyroid association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2010. 16(Suppl 1):1–43.

9.Camargo R., Corigliano S., Friguglietti C., Gauna A., Harach R., Munizaga F, et al. Latin American thyroid society. Latin American thyroid society recommendations for the management of thyroid nodules. Arq Bras Endocrinol Metabol. 2009. 53:1167–75.

10.Yi KH., Park YJ., Koong SS., Kim JH., Na DG., Ryu JS, et al. Revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer. J Korean Thyroid Assoc. 2010. 3:65–96.

11.Chung JH. Revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer - a physician's view. J Korean Thyroid Assoc. 2010. 3:97–101.

12.Chang HS. Surgeon's view for revised Korean thyroid association management guidelines for patients with thyroid nodules and thyroid cancer. J Korean Thyroid Assoc. 2010. 3:102–10.

13.Guidelines of the papanicolaou society of cytopathology for the examination of fine-needle aspiration specimens from thyroid nodules. The papanicolaou society of cytopathology task force on standards of practice. Diagn Cytopathol. 1996. 15:84–9.

14.Edge Stephen B., Byrd David R., Compton Carolyn C., Fritz April G., Greene Frederick L., Andy Trotti II. editors.AJCC Cancer Staging Manual. 7th ed. 2010.

15.Harach HR., Franssila KO., Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study. Cancer. 1985. 56:531–8.

16.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.

17.Kasai N., Sakamoto A. New subgrouping of small thyroid carcinomas. Cancer. 1987. 60:1767–70.

18.Chow SM., Law SC., Chan JK., Au SK., Yau S., Lau WH. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003. 98:31–40.

19.Cho YJ., Lee DH., Lee SC., Kim SJ., Kim JK., Ahn CJ, et al. Analysis of clinicopathologic features of papillary thyroid microcarcinoma according to cut-off of tumor size. Korean J Endocrine Surg. 2010. 10:152–6.

20.Appetecchia M., Scarcello G., Pucci E., Procaccini A. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res. 2002. 21:159–64.

21.Tae K., Chung JH., Lee YS., Choi YY., Park YS., Kim DS, et al. Characteristics of papillary thyroid microcarcinoma acoording to tumor size. J Korean Thyroid Assoc. 2008. 1:142–7.

22.Fink A., Tomlinson G., Freeman JL., Rosen IB., Asa SL. Occult micropapillary carcinoma associated with benign follicular thyroid disease and unrelated thyroid neoplasms. Mod Pathol. 1996. 9:816–20.

23.Ahn JH., Choi JY., Park WS., Song JY., Kim YH., Lee SM, et al. Clinical characteristics of papillary thyroid microcarcinoma (PTMC). Korean J Endocrine Surg. 2008. 8:101–5.

24.Yamashita H., Noguchi S., Murakami N., Toda M., Uchino S., Watanabe S, et al. Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer. 1999. 86:842–9.

25.Ryu HS., Ro HW., Cho JS., Park MH., Yoon JH., Jegal YJ. Predictive factors related to lymph node metastasis in patients with papillary thyroid microcarcinoma less than 5 mm in size. Korean J Endocrine Surg. 2007. 7:242–5.

26.Welker MJ., Orlov D. Thyroid nodules. Am Fam Physician. 2003. 67:559–66.

27.Sidawy MK., Del Vecchio DM., Knoll SM. Fine-needle aspiration of thyroid nodules: correlation between cytology and histology and evaluation of discrepant cases. Cancer. 1997. 81:253–9.

28.Oertel YC. Cytopathology reports from fine needle aspirations of the thyroid gland: can they be improved? Thyroid. 2007. 17:33–5.

29.Ali SZ., Cibas ES. The Bethesda system for reporting thyroid cytopa-thology. London: Springer;2010.

30.Lee K., Jung CK., Lee KY., Bae JS., Lim DJ., Jung SL. Application of bethesda system for reporting thyroid aspiration cytology. Korean J Pathol. 2010. 44:521–7.