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Abstract
The incidence of PTMC (papillary thyroid microcarcinoma) has rapidly increased recently due to the application of ultrasonography to the thyroid. The good prognosis of PTMC is well known with a mortality rate of less than 1%. However, there is controversy about the surgical extent of thyroidectomy for PTMC patients between surgeons and endocrinologists due to differences in understanding the clinical properties of PTMC, while having a difference in basic concepts in the treatment and follow up strategy for PTMC patients. Total thyroidectomy is recommended for PTMC patients because there is no major difference in the rate of lymph node metastasis, extrathyroidal extension, multiplicity between the PTMC and PTC over 1 cm in size and although rare, occasional distant metastasis and mortality cases could be developed. However, there is no evidence of benefit of total thyroidectomy for the survival rate of PTMC patients. The microscopic lymph node metastasis and extrathyroidal extension are not prognostic factors for the survival or recurrence in PTMC. The clinical lateral neck lymph node metastasis and multiplicity has been proposed as valuable prognostic factors in micropapillary carcinoma and these factors could be assessed accurately by ultrasonography preoperatively. A decision on the proper extent of thyroidectomy could be possible in most PTMC patients. This article summarizes available data and concludes that routine total thyroidectomy for PTMC patients is not rational.
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Table 1.
Results of surgical treatment for PTMC patients at Noguchi Clinic and Mayo Clinic
Table 2.
Cervical lymph node recurrence according to central lymph node metastasis
Fig. 1
Lymph node recurrence free survival of the papillary thyroid cancer patients with central L-N metastasis and without central L-N metastasis.
Fig. 2
Lymph node recurrence free survival of the papillary thyroid cancer patients with microscopic central L-N metastasis and clinical central L-N metastasis.
Fig. 3
Lymph node recurrence free survival of the papillary thyroid cancer patients with microscopic central L-N metastasis and without central L-N metastasis.
Fig. 5
Disease free survival of PTMC patients with various extrathyroidal extension by gross findings.
Fig. 6
Disease free survival of PTMC patients without extrathyroidal extension by gross finding but pathdogially extrathyroidal extension positive and pathologically extrathyroidal extension negative.
Table 3.
Multifocality in PTMC patients
| Author | Frequency (%) |
|---|---|
| Baudin | 60∗ |
| Furlan | 31.9 |
| Chow | 31 |
| Pellegriti | 26.7 |
| Salvadori | 23.6 |
| Rassael | 23 |
| Lin | 19 |
Table 4.
Recurrence in remnant thyroid following lobectomy for PTMC patients
| Author | Frequency (%) |
|---|---|
| Hay | 10 |
| Baudin | 3.5 |
| 1.7 unifocal PTMC | |
| 8.0 multifocal PTMC | |
| Noguchi | 0.6 |
| Rassael | 0 |
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