Author:
Zhou Yi-Li,Gao Er-li,Zhang Wei,Yang Han,Guo Gui-Long,Zhang Xiao-Hua,Wang Ou-Chen
Abstract
Abstract
Background
The optimal resection extent for papillary thyroid microcarcinoma (PTMC) remains controversial. The objective of the study was to investigate risk factors of bilateral PTMC and central lymph node metastasis (CLNM) to guide surgical strategies for PTMC patients.
Methods
We retrospectively reviewed 211 PTMC patients who underwent total thyroidectomy (TT) and 122 clinical lymph node-negative (cN0) cases that underwent prophylactic central lymph node dissection (CLND) between 2010 and 2011. The frequency, pattern, and predictive factors for bilateral PTMC and CLNM in these patients were studied using univariate and multivariate analysis with respect to the following variables: age, gender, extrathyroidal extension (ETE), T stage, with Hashimoto thyroiditis (HT), tumor size and multifocality based on final pathology, and preoperative evaluation using ultrasonography (US).
Results
Fifty-four of 211 (25.6%) patients had bilateral PTMC. In multivariate analysis, multifocality (P < 0.001, OR = 23.900) and tumor size ≥7 mm (P = 0.014, OR = 2.398) based on US were independent predictive factors for bilateral PTMC which was also independently associated with multifocality (P < 0.001, OR = 29.657) and tumor size ≥7 mm (P = 0.005, OR = 2.863) based on final pathology. Among 122 cN0 patients who underwent prophylactic CLND, we found 49.2% of patients had CLNM. CLNM was independently associated with men, age <50 years and tumor size ≥7 mm based on final pathology or preoperative US.
Conclusions
TT should be considered for PTMC patients who are found multifocality and tumor size ≥7 mm based on preoperative US. CLND need be considered in cN0 patients who are men, aged <50 years or tumor size ≥7 mm based on preoperative US.
Publisher
Springer Science and Business Media LLC
Reference34 articles.
1. Sherman SI: Thyroid carcinoma. Lancet. 2003, 361: 501-511.
2. Zheng W, Zhang Z: An analysis of cancer incidence in 2005 in Lucheng District, Wenzhou City, Zhejiang Province. Bull Chin Cancer. 2007, 16: 306-308.
3. Davies L, Welch HG: Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006, 295: 2164-2167.
4. Shindo M, Wu JC, Park EE, Tanzella F: The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer. Arch Otolaryngol Head Neck Surg. 2006, 132: 650-654.
5. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma S, Kuma K, Miyauchi A: An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003, 13: 381-387.
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