Incidental and nonincidental papillary thyroid microcarcinoma.
BACKGROUND
Subtotal thyroidectomy or lobectomy without radioactive iodide ((131)I) treatment is sufficient for postoperative treatment of incidental papillary thyroid microcarcinoma (PTMC). Aggressive surgical treatment with (131)I therapy is indicated for nonincidental PTMC.


METHODS
This is a retrospective analysis of 335 PTMC patients who received primary thyroid surgical treatment and long-term follow-up in a single medical center. All PTMC patients were categorized as incidental (group I) or nonincidental (group II). Group II patients (209 cases) were categorized as intrathyroid (group II A), neck lymph node or local regional soft-tissue invasion (group II B) and distant metastasis (group II C) groups.


RESULTS
In group I, 105 of 126 cases received only subtotal thyroidectomy or lobectomy. None died of thyroid cancer. Histological evaluation revealed multicentric PTMC in 12 (9.5%) and 52 (24.9%) cases (P < 0.05) in groups I and II, respectively. In group II, 55 of the 209 patients (26.3%) presented with extrathyroidal involvement. Two cases of relapse occurred in group I and 20 in group II by the end of follow-up. One patient in group II B and two patients in group II C died of thyroid cancer. Nine out of ten patients in group II C were diagnosed with distant metastases before primary thyroid surgical treatment.


CONCLUSIONS
Subtotal thyroidectomy is effective surgical treatment for incidental PTMC. For nonincidental cases, aggressive treatment is essential for reducing the risk of cancer relapse or mortality following surgery.
Lin
Jen-Der
JD
Department of Internal Medicine, CDivision of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Shin St Kweishan County, Taoyuan Hsien, Taiwan, ROC. einjd@adm.cgmh.org.tw
Kuo
Sheng-Fong
SF
Chao
Tzu-Chieh
TC
Hsueh
Chuen
C
D000328:Adult; D002291:Carcinoma, Papillary / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome