Papillary microcarcinoma and papillary cancer of the thyroid ≤1cm

Summary

Aims: Major controversies exist regarding the treatment of papillary microcarcinoma of the thyroid (PMC). Prior to 2003 PMC was defined by the WHO as a papillary carcinoma of 1cm or less in diameter. In 2004 that definition changed, with the new classification requiring that the tumour also must be found incidentally. Patients, methods: In this study we reviewed the clinical records of 67 patients with papillary tumours of the thyroid ≤1 cm, taking into account the new WHO definition (54 pts. with incidentally found PMC, median age: 53 years, 13 pts. with suspicion of thyroid neoplasm before resection, median age: 38 years). Clinical presentation, surgical treatment, further therapy and follow-up are presented. Results: Median tumour size was 7 mm in both groups (1.10 mm). Multicentric tumours were found in 15 pts. (22%), 8 had more than one PMC on the same side, and 7 displayed PMC bilaterally. Eleven (16%) of the primary tumors had metastatic involvement of regional lymph nodes at the time of initial surgery or during follow-up. Two patients showed distant metastases. No correlation between tumour size and multifocality or the presence of lymph node metastases could be seen. The gender of patients was the only significant independent variable for all patients; age and lymph node involvement was significantly different between incidentally and non-incidentally found PMC. Conclusions: Despite the majority of patients with PMC having an excellent outcome, there are also cases showing an unfavorable course. Currently no predictive parameter exists to anticipate the course and long-term outcome for an individual patient. Until this problem is solved, each patient should have the option to decide for him or herself whether to be treated similarly or differently than for conventional thyroid cancer.

Zusammenfassung

Ziel: Hinsichtlich der Behandlung des papillaren Mikrokarzinoms der Schilddruse (PMC) bestehen nach wie vor grose Meinungsverschiedenheiten. Vor 2003 war das PMC von der WHO definiert als papillarer Tumor ≤1 cm. 2004 wurde diese Definition geandert, mit dem Zusatz, dass der Tumor zufallig gefunden werden muss. Patienten, Methoden: In dieser Studie untersuchten wir die Daten von 67 Patienten mit papillarem Tumor der Schilddruse .1 cm unter Berucksichtigung der aktuellen WHO-Definition (54 Patienten mit zufallig gefundenem PMC, medianes Alter: 53 Jahre, 13 Patienten mit Verdacht auf Schilddrusenkarzinom vor Operation, medianes Alter: 38 Jahre). Initiale Befunde, chirurgisches Vorgehen, weitere Behandlung und weiterer Krankheitsverlauf wurden ausgewertet. Ergebnisse: Die mediane Tumorgrose lag in beiden Gruppen bei 7 mm (1.10 mm). Multizentrische Tumore wurden bei 15 Patienten gefunden (22%), wobei sich bei acht Patienten mehr als ein Tumor auf derselben Seite befand, bei sieben Patienten auf beiden Seiten der Schilddruse. Elf (16%) Karzinome zeigten Lymphknotenmetastsen zum Zeitpunkt der Erstoperation oder im weiteren Verlauf. Zwei Patienten wiesen Fernmetastasen auf. Es gab keine Korrelation zwischen Tumorgrose und Multifokalitat oder dem Bestehen von Lymphknotenmetastasen. Das Geschlecht erwies sich als einzige unabhangige signifikante Variable; Alter und Lymphknotenbefall war signifikant unterschiedlich bzgl. zufallig und nicht zufallig gefundenem PMC. Schlussfolgerung: Trotz der Mehrzahl der Patienten mit PMC und exzellentem Verlauf, gibt es Patienten mit ungunstigem Verlauf. Derzeit existieren keine pradiktiven Parameter, die den individuellen Verlauf abschatzen lassen. Solange dies nicht gelost ist, sollte jeder Patient die Moglichkeit haben, selbst mit zu entscheiden, ob der Tumor wie ein konventionelles Schilddrusenkarzinom behandelt werden soll oder nicht.

Keywords

Thyroid cancer - papillary microcarcinoma - thyroid surgery - treatment guidelines

Schlüsselwörter

Schilddrüsenkarzinom - papilläres Mikrokarzinom - Schilddrüsenchirurgie - Therapieleitlinien

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