title: Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas.
abstract: 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.
authors.affiliation: Dipartimentos di Scienze Cliniche, Scienze Radiologiche, Dipartimento di Scienze Chirurgiche, and Chirurgia P. Valdoni, Università di Roma Sapienza, Roma, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Durante
authors.forename: Marco
authors.initials: M
authors.lastname: Attard
authors.forename: Massimo
authors.initials: M
authors.lastname: Torlontano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronga
authors.forename: Fabio
authors.initials: F
authors.lastname: Monzani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costante
authors.forename: Marco
authors.initials: M
authors.lastname: Ferdeghini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tumino
authors.forename: Domenico
authors.initials: D
authors.lastname: Meringolo
authors.forename: Rocco
authors.initials: R
authors.lastname: Bruno
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
authors.forename: Umberto
authors.initials: U
authors.lastname: Crocetti
authors.forename: Teresa
authors.initials: T
authors.lastname: Montesano
authors.forename: Angela
authors.initials: A
authors.lastname: Dardano
authors.forename: Livia
authors.initials: L
authors.lastname: Lamartina
authors.forename: Adele
authors.initials: A
authors.lastname: Maniglia
authors.forename: Laura
authors.initials: L
authors.lastname: Giacomelli
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
mesh_terms: 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*