title: Prognostic importance of histologic vascular invasion in papillary thyroid carcinoma.
abstract: OBJECTIVE
  To conduct a retrospective study of 39 patients with papillary carcinoma of the thyroid with histologic vascular invasion (VI+) and 361 patients without any sign of vascular invasion (VI-).
  
  
  BACKGROUND
  In the present study, we undertook a retrospective analysis of papillary carcinoma of the thyroid to assess whether histologically determined vascular invasion can be considered a predictive factor for prognosis.
  
  
  METHODS
  By means of a retrospective study, we evaluated the department's database of patients with papillary thyroid carcinoma who had undergone total thyroidectomy from January 1993 to December 1999.
  
  
  RESULTS
  Group I consisted of papillary carcinoma without any sign of vascular invasion (VI-) comprising 361 patients. Group II consisted of papillary carcinoma with vascular invasion (VI+) comprising 39 patients. At the time of diagnosis, we observed no metastases in patients with VI-, whereas a pulmonary metastasis was observed in 1 patient with VI+ (P = 0.0023). In 3.6% patients with VI- and in 20.5% patients with VI+, we observed recurrences in the regional lymph nodes (P < 0.001); we observed 6 (1.66%) distant metastases in patients with VI- and in the 12.8% patients with VI+ (P < 0.001). Three patients with VI+ (7.7%) and 2 patients with VI- (0.6%) died of tumor-related causes; these figures were found to be statistically significant (P < 0.001).
  
  
  CONCLUSIONS
  In papillary carcinoma, it should be noted that histologic vascular invasion may be considered as a sign of an increased tendency toward hematogenic invasion and consequent increase in the relative percentage of metastases; ultimately, this means a poorer prognosis. In the presence of risk factors indicating a possible increase in biologic aggressiveness, adequate postoperative treatment and close follow up become essential.
authors.affiliation: Division of General Surgery, Department of Surgical Sciences 3rd training program in General Surgery, La Sapienza, University of Rome, Italy. laurafalvo@mclink.it
authors.forename: Laura
authors.initials: L
authors.lastname: Falvo
authors.forename: Antonio
authors.initials: A
authors.lastname: Catania
authors.forename: Vito
authors.initials: V
authors.lastname: D'Andrea
authors.forename: Antonella
authors.initials: A
authors.lastname: Marzullo
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Giustiniani
authors.forename: Enrico
authors.initials: E
authors.lastname: De Antoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001707:Biopsy, Needle; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome