The Surgical Management of Papillary Thyroid Microcarcinoma

Lim, Ra Joo; Lee, Sook Hyun; Yoon, Chan Seok; Ko, Seung Sang; Hur, Min Hee; Kang, Sung Soo; Lee, Hae Kyung

Abstract

PURPOSE
There has been a rapid rise in the incidence of thyroid cancer, particularly papillary thyroid microcarcinoma (PTMC). However, there is a lack of consensus of treatment guidelines or follow-up strategies.
METHODS
A retrospective analysis of 606 patients who underwent operation due to thyroid cancer from March 2000 to December 2008 was conducted. Of these patients, 587 with pure papillary carcinomas were studied, of whom 392 (67%) presented with PTMC.
RESULTS
Only 23% of patients were symptomatic, but 75% of patients were positive using the imaging techniques ultrasonography or positron emission tomography. When the microcarcinoma patient group (G1) was compared with the group of remaining patients (G2), less aggressive operations were chosen for G1. A lobectomy was performed in 63.8% of G1 versus in 14% of G2, and the central compartment neck dissection was omitted in 30% of G1 versus 16% of G2. During the follow-up period (mean 37.9±25.2 months), there were 11 recurrences. Two patients developed contralateral cancers 42 and 49 months after lobectomy. One patient had recurrences on central compartment lymph nodes 34 months post-operatively. Eight patients had lateral neck lymph nodes metastases 13~52 months postoperatively. Three of these eight patients had concomitant central neck lymph node metastases.
CONCLUSION
Less aggressive treatments can be chosen for PTMC patients compared to non-PTMC patients. To clarify these results, longer follow up and larger and multi-institutional data are needed.