Total Surface Area Is Useful for Differentiating between Aggressive and Favorable Multifocal Papillary Thyroid Carcinomas

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of the present study was to identify more useful parameters for predicting behaviors of multifocal papillary thyroid carcinoma (PTC). Materials and Methods: We investigated dominant tumor diameter (TD), total tumor diameter(TTD), and total surface area (TSA) in tumors from 588 patients and evaluated their usefulness as parameters for assessment of tumor behaviors in multifocal PTCs. Results: In 588 PTCs, tumor multifocality was found in 179 PTCs (30.4%). Multifocal tumors were significantly associated with extrathyroidal extension, lymph node metastasis, and higher tumor stage grouping (p<0.001, p<0.001, and p<0.001, respectively). The rates of nodal metastasis increased with greater TSA and TTD in PTCs. Multifocal papillary thyroid microcarcinomas (mPMCs) with TSA >3.14 cm2 had higher rates of nodal metastasis than mPMCs with TSA ≤3.14 cm2 (p=0.038); however, there was no significant difference between mPMCs with TTD >1.0 cm and with TTD ≤1.0 cm (p=0.325). In addition, nodal metastasis was more frequent in mPMCs with TSA >3.14 cm2 than in unifocal papillary thyroid microcarcinomas(uPMCs) (TD ≤1.0 cm) (p=0.002), but not overt unifocal PTCs (TD >1.0 cm) (p=0.244). Conclusion: Our results suggest that mPMCs with TSA >3.14 cm2 show more aggressive behavior than uPMCs and mPMCs with TSA ≤3.14 cm2. TSA could be useful in distinguishing aggressive mPMCs from favorable cases.

참고문헌 (Reference)

1 Page C, "‘Aggressive papillary’ thyroid microcarcinoma" 266 : 1959-1963, 2009

2 DeLellis RA, "World Health Organization Classification of Tumours. Pathology and genetics of tumours of endocrine organs" IARC Press 2004

3 Connor MP, "Variables predictive of bilateral occult papillary microcarcinoma following total thyroidectomy" 144 : 210-215, 2011

4 Siassakos D, "Thyroid microcarcinoma during thyroidectomy" 49 : 23-25, 2008

5 Machens A, "The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma" 103 : 2269-2273, 2005

6 Pyo JS, "The prognostic relevance of psammoma bodies and ultrasonographic intratumoral calcifications in papillary thyroid carcinoma" 37 : 2330-2335, 2013

7 American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer" 19 : 1167-1214, 2009

8 Kim HJ, "Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma" 78 : 614-620, 2013

9 Ghossein R, "Prognostic factors in papillary microcarcinoma with emphasis on histologic subtyping: a clinicopathologic study of 148 cases" 24 : 245-253, 2014

10 Mercante G, "Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients" 19 : 707-716, 2009

11 Andea AA, "Pathologic analysis of tumor size and lymph node status in multifocal/multicentric breast carcinoma" 94 : 1383-1390, 2002

12 Haymart MR, "Papillary thyroid microcarcinomas: big decisions for a small tumor" 16 : 3132-3139, 2009

13 Besic N, "Papillary thyroid microcarcinoma: prognostic factors and treatment" 97 : 221-225, 2008

14 Hay ID, "Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period" 144 : 980-987, 2008

15 Pelizzo MR, "Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients" 32 : 1144-1148, 2006

16 Chow SM, "Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality" 98 : 31-40, 2003

17 Appetecchia M, "Outcome after treatment of papillary thyroid microcarcinoma" 21 : 159-164, 2002

18 Ciuffreda L, "Our experience on surgical treatment of papillary thyroid microcarcinoma" 32 : 41-44, 2011

19 Pelizzo MR, "Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience" 25 : 547-552, 2004

20 Katoh R, "Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients" 70 : 1585-1590, 1992

21 Mazeh H, "Multifocality in well-differentiated thyroid carcinomas calls for total thyroidectomy" 201 : 770-775, 2011

22 Zhao Q, "Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma" 20 : 746-752, 2013

23 Rodríguez-Cuevas S, "Multifactorial analysis of survival and recurrences in differentiated thyroid cancer. Comparative evaluation of usefulness of AGES, MACIS, and risk group scores in Mexican population" 21 : 79-86, 2002

24 Shattuck TM, "Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma" 352 : 2406-2412, 2005

25 Ogilvie JB, "Impact of the 2009 American Thyroid Association guidelines on the choice of operation for well-differentiated thyroid microcarcinomas" 148 : 1222-1226, 2010

26 Lin JD, "High recurrent rate of multicentric papillary thyroid carcinoma" 16 : 2609-2616, 2009

27 Lee J, "Frequent, aggressive behaviors of thyroid microcarcinomas in Korean patients" 53 : 627-632, 2006

28 Andea AA, "Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentric breast carcinoma" 100 : 20-27, 2004

29 Lim YC, "Central lymph node metastases in unilateral papillary thyroid microcarcinoma" 96 : 253-257, 2009

30 Moon WJ, "Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study" 247 : 762-770, 2008

31 Park SY, "Analysis of differential BRAF(V600E) mutational status in multifocal papillary thyroid carcinoma: evidence of independent clonal origin in distinct tumor foci" 107 : 1831-1838, 2006

32 Voutilainen PE, "AMES, MACIS and TNM prognostic classifications in papillary thyroid carcinoma" 23 : 4283-4288, 2003

33 Edge SB, "AJCC Cancer Staging Manual" Springer-Verlag 87-100, 2009