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

K. Rahbar; V. Hutzenlaub; R.-J. Fischer; O. Schober; B. Riemann

doi:10.3413/nukmed-0147

Nuklearmedizin - NuclearMedicine, Table of Contents

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)

Authors

K. Rahbar

¹Departments of Nuclear Medicine, University Hospital Münster, Germany
V. Hutzenlaub

¹Departments of Nuclear Medicine, University Hospital Münster, Germany
R.-J. Fischer

²Departments of Medical Informatics and Biomathematics, University Hospital Münster, Germany
O. Schober

¹Departments of Nuclear Medicine, University Hospital Münster, Germany
B. Riemann

¹Departments of Nuclear Medicine, University Hospital Münster, Germany

Abstract

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

Full Text

References

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