Download PDF
Nuklearmedizin 2008; 47(05): 188-193
DOI: 10.3413/nukmed-0147
Original Article
Schattauer GmbH

Risk-profile and outcome of small papillary and follicular thyroid carcinomas (≤1 cm)

Risikoprofil und Outcome bei kleinen follikulären und papillären Schilddrüsenkarzinomen (≤1 cm)
K. Rahbar
1   Departments of Nuclear Medicine, University Hospital Münster, Germany
,
V. Hutzenlaub
1   Departments of Nuclear Medicine, University Hospital Münster, Germany
,
R.-J. Fischer
2   Departments of Medical Informatics and Biomathematics, University Hospital Münster, Germany
,
O. Schober
1   Departments of Nuclear Medicine, University Hospital Münster, Germany
,
B. Riemann
1   Departments of Nuclear Medicine, University Hospital Münster, Germany
› Author Affiliations
Further Information

Publication History

Received: 29 August 2007

accepted in revised form: 28 April 2008

Publication Date:
05 January 2018 (online)

Also available at
    Permissions and Reprints

Summary

Aim: According to the procedure guidelines of the German Society of Nuclear Medicine no radioiodine ablation is necessary in patients with papillary microcarcinomas in case of limited surgical resection. Few data are available with respect to the optimal management of patients with small follicular thyroid carcinomas. It was the aim to compare risk-profile and outcome of patients with small papillary (PTC) and follicular thyroid carcinomas (FTC) ≤1 cm. Patients, methods: 1594 patients with thyroid cancer were attended at our department between 1995 and 2006. For the subgroup of 383 patients with small PTC and FTC ≤1 cm a comparative correlation of multifocality, extrathyroidal growth, lymph node spread, distant metastasis, local recurrence and survival was performed. Patients were monitored for a mean follow-up time of six years. Results: A total of 361 patients had PTC and 22 FTC ≤1 cm. At presentation the mean age of the 306 women and 77 men was 49 ± 13 years. An ablative radioiodine therapy was performed in 77% and 100% of patients with small PTC and FTC, respectively. Multifocality (14% vs. 9%), extrathyroidal growth (10% vs. 5%), lymph node spread (14% vs. 5%), local recurrence (0.5% vs. 0%) and progressive disease (1% vs. 0%) were more common in patients with small PTC than FTC, whereas the corresponding values for distant metastasis were 2% vs. 5%, respectively; however, these figures did not reach statistical significance. Eight patients with papillary microcarcinomas died because of nonthyroidal diseases. Conclusion: Our data show no statistically significant differences in the risk-profile and outcome of patients with small PTC and FTC ≤1 cm. Therefore, the decision for or against radioiodine ablation in patients with small differentiated thyroid carcinomas should be discussed individually.

Zusammenfassung

Nach den aktuellen Leitlinien der Deutschen Gesellschaft für Nuklearmedizin besteht bei Patienten mit einem papillären Mikrokarzinom nach eingeschränkter radikaler Operation unter Umständen keine Indikation zur Radioiodtherapie. Zurzeit liegen jedoch nur wenige Daten bezüglich der optimalen Behandlung vor. Ziel dieser retrospektiven Studie war, das Risikoprofil und Outcome bei Patienten mit kleinen papillären und follikulären Schilddrüsenkarzinomen ≤1 cm zu vergleichen. Patienten, Methode: Zwischen 1995 und 2006 wurden in unserer Klinik 1594 Patienten mit Schilddrüsenkarzinomen behandelt. Darunter waren 383 Patienten mit kleinen papillären und follikulären Karzinomen ≤1 cm. Diese wurden bezüglich Multifokalität, extrathyreoidalem Wachstum, Lymphknoten- und Fernmetastasierung, lokoregionaler Rezidive sowie überleben verglichen. Der mittlere Beobachtungszeitraum betrug sechs Jahre. Ergebnisse: 361 Patienten waren an papillären, 22 an follikulären Schilddrüsenkarzinomen ≤1 cm erkrankt. Bei ihrer Vorstellung betrug das Alter der 306 Frauen und 77 Männer 49 ± 13 Jahre. Eine ablative Radioiodtherapie erfolgte bei 77% bzw. 100% der Patienten mit kleinen Karzinomen. Verglichen mit den follikulären Schilddrüsenkarzinomen fanden sich bei den papillären Tumoren häufiger multifokales (14% vs. 9%) und extrathyroidales Wachstum (10 % vs. 5%), Lymphknotenmetastasen (14% vs. 9%), Lokalrezidive (0.5% vs. 0%) sowie Tumorprogression (1% vs. 0%), während die entsprechenden Werte bei den Fernmetastasen 2% bzw. 5% betrugen. Diese Werte erreichten allerdings nicht das Signifikanzniveau. Acht Patienten mit papillären Mikrokarzinomen starben wegen Erkrankungen nicht thyroidaler Genese. Schlussfolgerung: Unsere Daten zeigen keinen signifikanten Unterschied zwischen Risikoprofil und Outcome bei Patienten mit kleinen papillären und follikulären Schilddrüsenkarzinomen ≤1 cm. Daher sollte die Indikation zur Radioiodtherapie bei kleinen differenzierten Schilddrüsenkarzinomen individuell gestellt werden.

Keywords

Radioiodine ablation - papillary and follicular thyroid carcinoma - tumour size - extrathyroidal growth - lymph node metastasis - distant metastasis - recurrence

Schlüsselwörter

Radioiodablation - papilläres und follikuläres Schilddrüsenkarzinom - Tumordurchmesser - extrathyreoidales Wachstum - Lymphknotenmetastase - Fernmetastase - Rezidiv
 

  • References

  • 1 Appetecchia M, Scarcello G, Pucci E. et al. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res 2002; 21: 159-164.
    PubMedSearch in Google Scholar
  • 2 Baloch ZW, LiVolsi VA. Microcarcinoma of the thyroid. Adv Anat Pathol 2006; 13: 69-75.
    CrossrefPubMedSearch in Google Scholar
  • 3 Baudin E, Travagli JP, Ropers J. et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 1998; 83: 553-559.
    CrossrefPubMedSearch in Google Scholar
  • 4 Bergamaschi R, Becouarn G, Ronceray J. et al. Morbidity of thyroid surgery. Am J Surg 1998; 176: 71-75.
    CrossrefPubMedSearch in Google Scholar
  • 5 Biermann M, Pixberg MK, Dorr U. et al. Guidelines on radioiodine therapy for differentiated thyroid carcinoma: impact on clinical practice. Nuklearmedizin 2005; 44: 229-234. 236-237.
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Biermann M, Pixberg MK, Schuck A. et al. Multicenter study differentiated thyroid carcinoma (MSDS). Diminished acceptance of adjuvant external beam radiotherapy. Nuklearmedizin 2003; 42: 244-250.
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Biermann M, Schober O. Multizentrische Studie Differenziertes Schilddrusenkarzinom Studiengruppe. How many high-risk patients with differentiated thyroid cancer need a "Tumor Center" per year? Nuklearmedizin 2002; 41: 61-62.
    Search in Google Scholar
  • 8 Biondi B, Filetti S, Schlumberger M. Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab 2005; 1: 32-40.
    CrossrefPubMedSearch in Google Scholar
  • 9 Cappelli C, Castellano M, Braga M. et al. Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 2007; 95: 555-560.
    CrossrefPubMedSearch in Google Scholar
  • 10 Cappelli C, Pirola I, Braga M. et al. Prognostic factors in well-differentiated thyroid carcinoma in patients treated and followed in the same institution. Ann Ital Chir 2006; 77: 107-113.
    PubMedSearch in Google Scholar
  • 11 Cheema Y, Repplinger D, Elson D. et al. Is tumor size the best predictor of outcome for papillary thyroid cancer?. Ann Surg Oncol 2006; 13: 1524-1528.
    CrossrefPubMedSearch in Google Scholar
  • 12 Cooper DS, Doherty GM, Haugen BR. et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 109-142.
    CrossrefPubMedSearch in Google Scholar
  • 13 DeLellis RA, Lloyd RV, Heitz PU. et al. World Health Organisation Classification of Tumours. Pathology and Genetics ofTumours of Endocrine organs. Lyon: IARC Press; 2004
    Search in Google Scholar
  • 14 Dietlein M, Dressler J, Eschner W. et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3). Nuklearmedizin 2007; 46: 213-219.
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Dietlein M, Dressler J, Eschner W. et al. Procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer (version 3). Nuklearmedizin 2007; 46: 206-212.
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Dietlein M, Dressler J, Farahati J. et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 2). Nuklearmedizin 2004; 43: 115-120.
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Dralle H. Maligne Schilddrüsentumoren. für die Deutsche Krebsgesellschaft. Kurzgefasste interdisziplinäre Leitlinien 2006. Empfehlungen zur Diagnostik und Therapie maligner Erkrankungen. München: W Zuckschwerdt 2006; 53-61.
    Search in Google Scholar
  • 18 Dralle H, Sekulla C. Thyroid surgery: generalist or specialist?. ZentralblChir 2005; 130: 428-433.
    Search in Google Scholar
  • 19 Fink A, Tomlinson G, Freeman JL. et al. Occult micropapillary carcinoma associated with benign follicular thyroid disease and unrelated thyroid neoplasms. Mod Pathol 1996; 9: 816-820.
    PubMedSearch in Google Scholar
  • 20 Franzius C, Dietlein M, Biermann M. et al. Procedure guideline for radioiodine therapy and 131I whole-body scintigraphy in paediatric patients with differentiated thyroid cancer. Nuklearmedizin 2007; 46: 224-231.
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Friedrich T, Steinert M, Keitel R. et al. Incidence of damage to the recurrent laryngeal nerve in surgical therapy of various thyroid gland diseases: a retrospective study. Zentralbl Chir 1998; 123: 25-29.
    PubMedSearch in Google Scholar
  • 22 Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer 1985; 56: 531-538.
    PubMedSearch in Google Scholar
  • 23 Hay ID, Grant CS, van Heerden JA. et al. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 1992; 112: 1139-1147.
    PubMedSearch in Google Scholar
  • 24 Ito Y, Uruno T, Nakano K. et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003; 13: 381-387.
    CrossrefPubMedSearch in Google Scholar
  • 25 Khoo ML, Beasley NJ, Ezzat S. et al. Overexpression of cyclin D1 and underexpression of p27 predict lymph node metastases in papillary thyroid carcinoma. J Clin Endocrinol Metab 2002; 87: 1814-1818.
    CrossrefPubMedSearch in Google Scholar
  • 26 Khoo ML, Freeman JL, Witterick IJ. et al. Underexpression of p27/Kip in thyroid papillary micro- carcinomas with gross metastatic disease. Arch Otolaryngol Head Neck Surg 2002; 128: 253-257.
    CrossrefPubMedSearch in Google Scholar
  • 27 Kucuk NO, Tari P, Tokmak E. et al. Treatment for microcarcinoma of the thyroid--clinical experience. ClinNucl Med 2007; 32: 279-281.
    Search in Google Scholar
  • 28 Lerch H, Schober O, Kuwert T. et al. Survival of differentiated thyroid carcinoma studied in 500 patients. J Clin Oncol 1997; 15: 2067-2075.
    CrossrefPubMedSearch in Google Scholar
  • 29 Lin KD, Lin JD, Huang MJ. et al. Clinical presentations and predictive variables of thyroid micro-carcinoma with distant metastasis. Int Surg 1997; 82: 378-381.
    PubMedSearch in Google Scholar
  • 30 Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer 2005; 103: 2269-2273.
    CrossrefPubMedSearch in Google Scholar
  • 31 Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001; 86: 1447-1463.
    CrossrefPubMedSearch in Google Scholar
  • 32 Pacini F, Schlumberger M, Dralle H. et al. European consensus for the management of patients with differentiated thyroid carcinoma of the fol- licular epithelium. Eur J Endocrinol 2006; 154: 787-803.
    CrossrefPubMedSearch in Google Scholar
  • 33 Pellegriti G, Scollo C, Lumera G. et al. Clinicalbe- havior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab 2004; 89: 3713-3720.
    CrossrefPubMedSearch in Google Scholar
  • 34 Piersanti M, Ezzat S, Asa SL. Controversies in papillary microcarcinoma of the thyroid. Endocr Pathol 2003; 14: 183-191.
    CrossrefPubMedSearch in Google Scholar
  • 35 Prim MP, de Diego JI, Hardisson D. et al. Factors related to nerve injury and hypocalcemia in thyroid gland surgery. Otolaryngol Head Neck Surg 2001; 124: 111-114.
    CrossrefPubMedSearch in Google Scholar
  • 36 Riemann B, Schober O. Das kleine Schilddrüsenkarzinom. Nuklearmedizin 2007; 46: 113-114.
    Thieme ConnectSearch in Google Scholar
  • 37 Rosai J, LiVolsi VA, Sobrinho-Simoes M. et al. Renaming papillary microcarcinoma of the thyroid gland: the Porto proposal. Int J Surg Pathol 2003; 11: 249-251.
    CrossrefPubMedSearch in Google Scholar
  • 38 Roti E, Rossi R, Trasforini G. et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab 2006; 91: 2171-2178.
    CrossrefPubMedSearch in Google Scholar
  • 39 Satge D, Grob JC, Pusel J. et al. Thyroid microcarcinoma with a fatal outcome and 34 other unusually aggressive cases reported in the literature. Arch Anat Cytol Pathol 1990; 38: 143-151.
    PubMedSearch in Google Scholar
  • 40 Sawka AM, Thephamongkhol K, Brouwers M. et al. Clinical review 170: A systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab 2004; 89: 3668-3676.
    CrossrefPubMedSearch in Google Scholar
  • 41 Schonberger J, Marienhagen J, Agha A. et al. Papillary microcarcinoma and papillary cancer of the thyroid <1 cm: Modified definition of the WHO and the therapeutic dilemma. Nuklearmedizin 2007; 46: 115-120.
    Thieme ConnectPubMedSearch in Google Scholar
  • 42 Schuck A, Biermann M, Pixberg MK. et al. Acute toxicity of adjuvant radiotherapy in locally advanced differentiated thyroid carcinoma. First results of the multicenter study differentiated thyroid carcinoma (MSDS). Strahlenther Onkol 2003; 179: 832-839.
    CrossrefPubMedSearch in Google Scholar
  • 43 Shattuck TM, Westra WH, Ladenson PW. et al. Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma. N Engl J Med 2005; 352: 2406-2412.
    CrossrefPubMedSearch in Google Scholar
  • 44 Sherman SI. Thyroid carcinoma. Lancet 2003; 361: 501-511.
    CrossrefPubMedSearch in Google Scholar
  • 45 Wittekind C, Meyer HJ, Boots F. TNM classification of malignant tumors. Berlin: Springer; 2002
    Search in Google Scholar