Division of Endocrine Surgery, Department of Surgery, Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L. go A. Gemelli 8, 00168, Rome, Italy.
World J Surg. 2010 Jun;34(6):1214-21. doi: 10.1007/s00268-009-0375-x.
Although papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency, the best therapeutic option and follow-up protocol have not been established yet, especially in the case of incidental diagnosis. We reviewed our series of patients with PTMC to determine risk factors for recurrence in an area where there is a high prevalence of goiter.
The medical records of all patients who underwent thyroidectomy with a final pathology report of PTMC between October 2002 and June 2007 were reviewed. PTMC was defined as a papillary thyroid carcinoma 10 mm or less in diameter. Follow-up evaluation was obtained by outpatient consultation and/or telephone interview.
In a series of 2,220 patients who underwent thyroidectomy for a thyroid carcinoma, 933 had a PTMC. Diagnosis was incidental in 704 patients (75.5%). Upon multivariate analysis, tumor size, nonincidental diagnosis, and neck node metastases at diagnosis were independent risk factors for extracapsular spread (ECS), while ECS, multifocal disease, and number of removed lymph nodes were independent risk factors for lymph node metastases at diagnosis. Follow-up evaluation was completed in 287 patients, 9 (3.1%) of whom experienced recurrence. The number of removed and metastasized nodes at first operation and the length of the follow-up were independent risk factors for recurrent disease.
Incidental diagnosis of PTMC is frequent in a high prevalence of goiter area. PTMC shows a variable degree of aggressiveness. Management protocols should be based on patient- and tumor-related prognostic factors, as for larger tumors.
尽管甲状腺微小乳头状癌（PTMC）的诊断率越来越高，但尚未确定最佳的治疗选择和随访方案，尤其是在偶然诊断的情况下。我们回顾了我们的一系列 PTMC 患者病例，以确定在甲状腺肿高发地区复发的危险因素。
回顾了 2002 年 10 月至 2007 年 6 月期间所有接受甲状腺切除术且最终病理报告为 PTMC 的患者的病历。PTMC 定义为直径 10 毫米或以下的甲状腺乳头状癌。通过门诊咨询和/或电话访谈获得随访评估。
在 2220 例接受甲状腺癌切除术的患者中，有 933 例患有 PTMC。704 例（75.5%）为偶然诊断。多因素分析显示，肿瘤大小、非偶然诊断和诊断时颈部淋巴结转移是包膜外扩散（ECS）的独立危险因素，而 ECS、多灶性疾病和切除的淋巴结数量是诊断时淋巴结转移的独立危险因素。对 287 例患者进行了随访评估，其中 9 例（3.1%）复发。首次手术切除和转移的淋巴结数量以及随访时间的长短是疾病复发的独立危险因素。
在甲状腺肿高发地区，PTMC 的偶然诊断较为常见。PTMC 具有不同程度的侵袭性。管理方案应基于患者和肿瘤相关的预后因素，与较大肿瘤的管理方案相同。
