Ito Yasuhiro, Miyauchi Akira
Kuma Hospital, Department of Surgery, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe 650-0011, Japan.
Expert Opin Pharmacother. 2007 Dec;8(18):3205-15. doi: 10.1517/14656566.8.18.3205.
Since the 1990 s, asymptomatic papillary microcarcinoma (PMC), papillary carcinoma measuring <or= 1.0 cm, has frequently been detected using ultrasonographic screening and diagnosed by ultrasonography-guided fineneedle aspiration biopsy. Thyroid carcinoma was detected in 3.5% of otherwise healthy women aged >or= 30 years of age and most of these patients had lesions measuring <or= 1.5 cm in diameter, which is not discrepant with previous autopsy findings that latent PMC showed a high incidence. A recent observation trial showed that only 6.7% of low-risk PMC definitely became enlarged during 5 years of follow up, indicating that observation is an attractive alternative to surgery for PMC. However, PMC with clinically apparent metastasis detected on imaging is likely to show a recurrence to the lymph node and careful neck dissection as well as total thyroidectomy may be required. If surgical treatment is performed for low-risk PMC, prophylactic modified radical neck dissection is not necessary and lobectomy (with isthmectomy) and central node dissection is adequate if the tumor is located only in one lobe.
自20世纪90年代以来，无症状性乳头状微小癌（PMC），即直径≤1.0 cm的乳头状癌，经常通过超声筛查被检测到，并通过超声引导下细针穿刺活检进行诊断。在年龄≥30岁的其他方面健康的女性中，3.5%被检测出患有甲状腺癌，这些患者中的大多数病变直径≤1.5 cm，这与之前尸检发现潜在PMC发病率高的结果并无差异。最近一项观察性试验表明，在5年的随访中，只有6.7%的低风险PMC确实增大了，这表明观察是PMC手术的一个有吸引力的替代方案。然而，影像学检查发现有临床明显转移的PMC可能会出现淋巴结复发，可能需要仔细的颈部清扫以及全甲状腺切除术。如果对低风险PMC进行手术治疗，预防性改良根治性颈部清扫术没有必要，如果肿瘤仅位于一个叶，则行叶切除术（加峡部切除术）和中央淋巴结清扫术就足够了。
