title: Encapsulation status of papillary thyroid microcarcinomas is associated with the risk of lymph node metastases and tumor multifocality.
abstract: The management of papillary microcarcinoma (PMC) of the thyroid is controversial, especially after partial thyroid resection for benign thyroid disease. In order to detect prognostic factors for PMC, we analyzed 116 patients with PMC for encapsulation status and lymph node metastases. Between 10/1992 and 12/2010, 116 patients with PMC have been operated in our department (87 females, 29 males, median age 49 years). Eighty per cent of PMCs were diagnosed postoperatively. Seventy-six patients (66%) received a more extended resection with either thyroidectomy, near total thyroidectomy, or Dunhill operation either primarily or after completion operation, whereas 40 patients (34%) had only partial resection. Fifty patients (43%) received radioiodine (RIA) ablation. Lymph node metastases were found in 21 patients (18%). Univariate analysis showed four risk factors to be significantly associated with the risk of lymph node metastasis (p<0.05): male gender, younger age, age group<50 years and nonencapsulation of the tumor. Multivariate analysis demonstrated statistical significance for gender and tumor capsulation status. The tumor capsulation status also correlated with tumor multifocality. Our data show that the risk of lymph node metastases is significantly higher in partially or nonencapsulated PMC than in encapsulated specimens. We therefore suggest that the WHO classification should be extended to a compulsory notification of the encapsulation status in PMC.
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Cupisti
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Lehwald
authors.affiliation: Institute of Pathology, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Anlauf
authors.affiliation: Institute of Pathology, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Riemer
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: T A
authors.initials: TA
authors.lastname: Werner
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Krieg
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Witte
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Chanab
authors.affiliation: Institute of Pathology, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: S E
authors.initials: SE
authors.lastname: Baldus
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Krausch
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Raffel
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Herdter
authors.affiliation: Department of Endocrinology, Rheumatology and Diabetes, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schott
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany.
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012307:Risk Factors; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf