title: Does extracapsular extension impact the prognosis of papillary thyroid microcarcinoma?
abstract: BACKGROUND
  Extracapsular (EC) extension is a pejorative factor in papillary thyroid carcinoma (PTC). However, the impact of EC extension in microcarcinoma (micro-pT3) remains controversial, and all pT3 patients are currently considered to be at high risk of recurrence.
  
  
  OBJECTIVE
  This study sought to determine the risk of recurrence in patients with micro-pT3 and to compare their outcomes with other pT3 (macro-pT3) and low-risk patients.
  
  
  METHODS
  All consecutive patients who received surgery for PTC in our department from January 1978 to December 2011 were included in this study. We compared three patient groups: micro-pT3 (≤10 mm with EC extension), macro-pT3, and low risk, including pT1a-b s N0-x, pT1a-b m N0-x, and pT2 N0-x. Total thyroidectomy was performed with lymph node (LN) dissection in most cases, and radioiodine therapy was administered as needed. The median follow-up period was 6.7 years.
  
  
  RESULTS
  A total of 2,482 patients were included in this study, including 178 micro-pT3 patients, 533 macro-pT3 patients, and 1,771 low-risk PTC patients. Recurrence was documented in 14 (7.9 %) micro-pT3 patients, 124 (23.3 %) macro-pT3 patients, and 36 (2 %) low-risk PTC patients. The micro-pT3 patients with LN metastases (N1) demonstrated a higher recurrence rate than the N0-x patients (14.8 vs. 4.8 %; p < 0.01), whereas the risk of recurrence among the T2 N0-x (5 %) and micro-pT3 N0-x (4.8 %) patients was similar (p = 0.95).
  
  
  CONCLUSIONS
  Micro-pT3 N1 patients are at high risk of recurrence and should be treated aggressively. Because the outcomes of the micro-pT3 N0-x patients were similar to those of the low-risk PTC patients (pT2 N0-x), we suggest that micro-pT3 N0-x should be treated in a similar manner, with low-dose iodine-131 and recombinant human thyrotropin.
authors.affiliation: Department of General and Endocrine Surgery, Hôpital de la Pitié Salpêtrière, APHP, Université Pierre et Marie Curie (Paris VI), Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chéreau
authors.forename: Camille
authors.initials: C
authors.lastname: Buffet
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.forename: Frederique
authors.initials: F
authors.lastname: Tissier
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Laurence
authors.initials: L
authors.lastname: Leenhardt
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes