title: Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients.
abstract: BACKGROUND
  There is debate concerning the clinical significance of papillary thyroid microcarcinoma (PTMC), and therefore, the rise in the incidence of PTMC creates management dilemmas. The purpose of this study was to analyse the clinicopathological characteristics of PTMC in an island region that has a high prevalence of goitre and to determine risk factors for the worst prognosis.
  
  
  METHODS
  Data from 1874 patients who underwent a total thyroidectomy between January 2002 and December 2008 were reviewed retrospectively. A total of 276 patients who were diagnosed with PTMC in a final pathology report were included in the study. A PTMC was defined as a papillary thyroid carcinoma with a diameter ≤ 10 mm. Clinicopathological features were evaluated by both univariate and multivariate analyses.
  
  
  RESULTS
  Of the 276 patients with PTMC, 219 patients (79·3%) were incidentally diagnosed. Two hundred and two patients had carcinomas of ≤ 5 mm, and 74 patients presented with carcinomas that ranged in size from 0·6 to 1·0 cm. Lymph node metastasis was diagnosed in 3·5% of patients with tumours ≤ 5 mm, and 21·6% of patients presented tumours > 5 mm. Upon multivariate analysis, clinically suspected diagnosis, a tumour size > 5 mm and an age over 45 years at diagnosis were independent risk factors for capsule invasion, while tumour multifocality, bilaterality, size of tumour > 5 mm and thyroid capsule invasion were independent risk factors for lymph node metastasis at diagnosis.
  
  
  CONCLUSIONS
  Patients presenting multifocal, bilateral PTMC with a maximum diameter > 5 mm and thyroid capsule invasion may have an increased risk of lymph node metastasis. These factors should be considered in the follow-up for these patients.
authors.affiliation: Department of Otolaryngology/Head and Neck surgery, Venizeleio-Pananeio General Hospital, Herakleion, Greece. j.vasileiadis@yahoo.gr
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vasileiadis
authors.forename: Efthimios
authors.initials: E
authors.lastname: Karakostas
authors.forename: Georgios
authors.initials: G
authors.lastname: Charitoudis
authors.forename: Anna
authors.initials: A
authors.lastname: Stavrianaki
authors.forename: Stylianos
authors.initials: S
authors.lastname: Kapetanakis
authors.forename: Gregory
authors.initials: G
authors.lastname: Kouraklis
authors.forename: Theodore
authors.initials: T
authors.lastname: Karatzas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D002291:Carcinoma, Papillary; D005260:Female; D006042:Goiter / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007455:Iodine / Q000172:deficiency; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000628:therapy; D013965:Thyroidectomy / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007455:Iodine