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Papillary Thyroid Microcarcinoma : A Report of Impact of Initial Therapy in 2035 Patients. Jeonghun Lee, Su Han Seo , Euy Young Soh Department of Surgery, Ajou University. Introduction. Introduction Papillary thyroid carcinoma ① accounts for up to 80% of thyroid cancer

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papillary thyroid microcarcinoma a report of impact of initial therapy in 2035 patients

Papillary Thyroid Microcarcinoma: A Report of Impact of Initial Therapy in 2035 Patients

Jeonghun Lee, Su Han Seo,

Euy Young Soh

Department of Surgery, Ajou University

introduction
Introduction

Introduction

Papillary thyroid carcinoma

① accounts for up to 80% of thyroid cancer

② papillary microcarcinoma : 36~60% of papillary thyroid cancer

Discrepancy of treatment strategies

① geographical discrepancy

: Western vs. Japan

a. total thyroidectomy vs. lobectomy

b. therapeutic vs. prophylactic CCND

c. radioiodine therapy

② temporal discrepancy

: at Mayo Clinic (Hay et al)

a. 1940~54 - most lobectomy and no RAI

b. 1985~ - most total thyroidectomy and 50% RAI therapy

introduction1
Introduction

Prognostic factors for recurrence

- different among the institutions

  • Buffet et al ( Europ J endo 2012 )

: LN metastasis, multifocality, male, total size of multifocal tumor>20mm)

  • Kim TY et al ( BMC cancer 2008 )

: male, lateral cervical LN metastasis

  • Chow et al ( Cancer 2003 )

: multifocality, limited surgery

  • Hay et al ( Surgery 1992 )

: LN metastasis, limited surgery

purpose
Purpose

: To investigate the prognostic factors for recurrence in PTMC patients.

materials and methods
Materials and Methods

Periods : Jan.1994 ~ Oct. 2010

Patients : 2035 PTMC patients who underwent thyroidectomy at Ajou University Hospital

Inclusion criteria

① papillary thyroid microcarcinoma

② underwent primary surgical therapy at Ajou University Hospital

materials and methods1
Materials and Methods
  • Strategy for papillary thyroid cancer at Ajou University Hospital

① Lobectomy

: papillary thyroid caner < 1cm, no familial history,

no capsular invasion, no multifocality and no LN metastasis.

② Central compartment LN dissection(CCND)

: if malignancy on FNA cytology or frozen section biopsy

 prophylactic CCND was performed

③ Lateral compartment LN dissection

: therapeutic LN dissection

materials and methods2
Materials and Methods
  • Mean follow-up duration : 33.8 months

WIFTC : wide invasive FTC, MIFTC : minimal invasive FTC

MTC : medullary thyroid cancer, HCC : Hurthle cell cancer

summary
Summary
  • Prognostic factors for recurrence

① Extent of thyroidectomy : no significant factor

② RAI therapy : no significant factor in multivariate analysis

③ N stage : only significant factor for recurrence in multivariate analysis

- N1a : 2 riskier than N0 ( p= 0.01)

- N1b : 6.7 riskier than N0 (p< 0.01)

  • Complication

① postoperative hoarseness : 1.9%

② permanent hypoparathyroidism : 4.5% (2.7%*~12%#)

*Caliskan et al 2012 Endocrine J

#Mitra et al 2011 J LaryngolOtol

conclusion
Conclusion
  • Limited thyroidectomy

: maybe sufficient for initial surgery for PTMC patients

  • Prophylactic central LN dissection

: can be performed for PTMC patients for predicting prognosis accurately,

: however, performed by skilled surgeon because of higher incidence of permanent hypoparathyroidism

  • Limitation of study

: short-term follow-up duration

ad