Analysis of Clinicopathologic Factors Associated with Bilateral Thyroid Micro Papillary Carcinoma

Kwang-Min Kim M.D.; Joon-Beom Park M.D.; Keum- Seok Bae M.D.; Sung-Joon Kang M.D.

doi:10.16956/kjes.2011.11.1.18

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M.D., M.D., M.D., and M.D.: Analysis of Clinicopathologic Factors Associated with Bilateral Thyroid Micro Papillary Carcinoma

Review Article

Korean J Endocrine Surg 2011;11(1):18-21.

Published online: 18 March 2011

DOI: https://doi.org/10.16956/kjes.2011.11.1.18

Analysis of Clinicopathologic Factors Associated with Bilateral Thyroid Micro Papillary Carcinoma

Kwang-Min Kim M.D., Joon-Beom Park M.D., Keum- Seok Bae M.D., Sung-Joon Kang M.D.

Department of Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment.

Methods:

Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid mi-cropapillary cancer from January 1^st, 1994 to December 31^st, 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients’ gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed.

Results:

There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion.

Conclusion:

When we plan thyroidectomy for thyroid micro-papillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer pre-operative examination is thought to be required for such patients.

REFERENCES

1.Sebastian SO., Gonzalez JM., Paricio PP., Perez JS., Flores DP., Madrona AP, et al. Papillary thyroid carcinoma: prognostic index for survival including the histological variety. Arch Surg. 2000. 135:272–7.

2.Hundahl SA., Fleming ID., Fremgen AM., Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer. 1998. 83:2638–48.

3.Hedinger C., Williams ED., Sobin LH. The WHO histological classification of thyroid tumors: a commentary on the second edition. Cancer. 1989. 63:908–11.

4.Cross S., Wei JP., Kim S., Brams DM. Selective surgery and adjuvant therapy based on risk classifications of well-differentiated thyroid cancer. J Surg Oncol. 2006. 94:678–82.

5.Haigh PI., Urbach DR., Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol. 2005. 12:81–9.

6.Thompson NW., Olsen WR., Hoffman GL. The continuing development of the technique of thyroidectomy. Surgery. 1973. 73:913–27.

7.Rosen IB., Azadian A., Walfish PG. Adverse aspects of small thyroid cancer and need for treatment. Head Neck. 1995. 17:373–6.

8.Baudin E., Travagli JP., Ropers J., Mancusi F., Bruno-Bossio G., Caillou B, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer. 1998. 83:553–9.

9.Hay ID., Grant CS., van Heerden JA., Goellner JR., Ebersold JR., Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery. 1992. 112:1139–46. discussion 46-7.

10.Pasieka JL., Thompson NW., McLeod MK., Burney RE., Macha M. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg. 1992. 16:711–6. discussion 6-7.

11.Shin IY., Lee KJ., Kim HR., Kim SJ., Kim JG., Lee DH, et al. Analysis of the relationship between bilaterality and other clinicopathological factors in papillary thyroid carcinoma. Korean J Endocrine Surg. 2008. 8:123–7.

12.Kasai N., Sakamoto A. New subgrouping of small thyroid carcinomas. Cancer. 1987. 60:1767–70.

13.Choi SH., Woo SU., Kim DK., Kim JH., Nam SJ., Yand JH. Less than 0.5 cm papillary thyroid cancer. Korean J Endocrine Surg. 2004. 4:16–20.

14.Lin JD., Chao TC., Hsueh C., Kuo SF. High recurrent rate of multicentric papillary thyroid carcinoma. Ann Surg Oncol. 2009. 16:2609–16.

15.Carcangiu ML., Zampi G., Pupi A., Castagnoli A., Rosai J. Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer. 1985. 55:805–28.

16.Yamashita H., Noguchi S., Murakami N., Toda M., Uchino S., Watanabe S, et al. Extracapsular invasion of lymph node metastasis. A good indicator of disease recurrence and poor prognosis in patients with thyroid microcarcinoma. Cancer. 1999. 86:842–9.

17.Song DK., Choi YJ., Kang YJ., Park HW., Park JS., Joe BS, et al. Clinical Characteristics and Prognostic Factors of Papillary Microcarcinoma: Results from Retrospective Analysis of 176 Patients. Korean J Endocrine Surg. 2009. 9:79–84.

18.Kim JM., Kim TY., Kim WB., Gong G., Kim SC., Hong SJ, et al. Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma. Laryngoscope. 2006. 116:2081–5.

19.Lee HS., Kwak BS., Kim TD., Kim HY., Park TJ., Baik YH, et al. Bilaterality of papillary thyroid carcinoma: analysis of clinicopathologic factors and the value of preoperative ultrasonography. Korean J Endocrine Surg. 2009. 9:85–9.

20.Machens A., Holzhausen HJ., Dralle H. Skip metastases in thyroid cancer leaping the central lymph node compartment. Arch Surg. 2004. 139:43–5.

Table 1.

Clinicopathological information for 134 patients according to bilaterality

		Bilaterality (%)		Total	P-value
		Presence	Absence	Total	P-value
Sex	M (%)	3 (9.4)	11 (10.8)	14 (10.4)	0.820
	F (%)	29 (90.6)	91 (89.2)	120 (89.6)
Age	＜45	17 (53.1)	44 (43.1)	61 (45.5)	0.322
	≥45	15 (46.9)	58 (56.9)	73 (54.5)
Size	∗Group 1	7 (21.9)	27 (26.5)	34 (25.4)	0.602
	^†Group 2	25 (78.1)	75 (73.5)	100 (74.6)
Multifocality	Yes	23 (71.9)	16 (15.7)	39 (29.1)	＜0.001
	No	9 (28.1)	86 (84.3)	95 (70.9)
Capsule invasion	Yes	5 (15.6)	11 (10.8)	16 (11.9)	0.461
	No	27 (84.4)	91 (89.2)	118 (88.1)
Perithyroidal tissue invasion	Yes	14 (43.8)	23 (22.5)	37 (27.6)	0.019
	No	18 (56.3)	79 (77.5)	97 (72.4)
Lymphovascular invasion	Yes	4 (12.5)	3 (2.9)	7 (5.2)	0.034
	No	28 (87.5)	99 (97.1)	127 (94.8)
Central neck node metastasis	Yes	12 (37.5)	26 (25.5)	38 (28.4)	0.188
	No	20 (62.5)	76 (74.5)	96 (71.6)
Lateral neck node metastasis	Yes	2 (6.3)	1 (1.0)	3 (2.2)	0.079
	No	30 (93.8)	101 (99.0)	131 (97.8)

^∗ Group 1≤0.5 cm;

^† 0.5 cm＜group 2≤1.0 cm.

Table 2.

Multivariate analyses of factors associated with bilateral thyroid micro papillary carcinoma

	Multivariate	Hazard ratio (95% confidence intervals)
Multifocality	＜0.001	13.052 (4.989∼34.144)
Perithyroidal tissue invasion	0.092	2.389 (0.867∼6.578)
Lymphovascular invasion	0.297	2.692 (0.419∼17.300)

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