Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas.
BACKGROUND
Most papillary thyroid microcarcinomas (PTMCs; ≤ 1 cm diameter) are indolent low-risk tumors, but some cases behave more aggressively. Controversies have thus arisen over the optimum postoperative surveillance of PTMC patients.


OBJECTIVE
We tested the hypothesis that clinical criteria could be used to identify PTMC patients with very low mortality/recurrence risks and attempted to define the best strategy for their management and long-term surveillance.


METHODS
We retrospectively analyzed data from 312 consecutively diagnosed PTMC patients with T1N0M0 stage disease, no family history of thyroid cancer, no history of head-neck irradiation, unifocal PTMC, no extracapsular involvement, and classic papillary histotypes. Additional inclusion criteria were complete follow-up data from surgery to at least 5 yr after diagnosis. All 312 had undergone (near) total thyroidectomy [with radioactive iodine (RAI) remnant ablation in 137 (44%) - RAI group] and were followed up yearly with cervical ultrasonography and serum thyroglobulin, TSH, and thyroglobulin antibody assays.


RESULTS
During follow-up (5-23 yr, median 6.7 yr), there were no deaths due to thyroid cancer or reoperations. The first (6-12 months after surgery) and last postoperative cervical sonograms were negative in all cases. Final serum thyroglobulin levels were undetectable (<1 ng/ml) in all RAI patients and almost all (93%) of non-RAI patients.


CONCLUSIONS
Accurate risk stratification can allow safe follow-up of most PTMC patients with a less intensive, more cost-effective protocol. Cervical ultrasonography is the mainstay of this protocol, and negative findings at the first postoperative examination are highly predictive of positive outcomes.
Durante
Cosimo
C
Dipartimentos di Scienze Cliniche, Scienze Radiologiche, Dipartimento di Scienze Chirurgiche, and Chirurgia P. Valdoni, Università di Roma Sapienza, Roma, Italy.
Attard
Marco
M
Torlontano
Massimo
M
Ronga
Giuseppe
G
Monzani
Fabio
F
Costante
Giuseppe
G
Ferdeghini
Marco
M
Tumino
Salvatore
S
Meringolo
Domenico
D
Bruno
Rocco
R
De Toma
Giorgio
G
Crocetti
Umberto
U
Montesano
Teresa
T
Dardano
Angela
A
Lamartina
Livia
L
Maniglia
Adele
A
Giacomelli
Laura
L
Filetti
Sebastiano
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*