Department of Surgery, Good Samaritan Hospital, Cincinnati, OH 45220, USA.
Am J Surg. 2012 Feb;203(2):140-4. doi: 10.1016/j.amjsurg.2010.12.008. Epub 2011 May 19.
The purpose of this study was to describe the incidence and clinical/pathologic characteristics of papillary thyroid microcarcinoma (PMC) in a community hospital setting and to evaluate the frequency and characteristics of these lesions when unsuspected preoperatively.
A total of 723 patients underwent a partial or total thyroidectomy. A retrospective review was performed.
A total of 194 of the 723 patients had a final diagnosis of papillary carcinoma. Ninety-six (49%) of these tumors were PMCs defined as being 1.0 cm or less in diameter. One third (32 of 96) of these lesions were multifocal and 16.7% (16 of 96) were found to have regional lymph node metastases. The majority (58%) of PMCs were found on final pathology and were clinically unsuspected (occult). Multifocality was found in 32.1% (18 of 56) of patients with clinically unsuspected PMC, with nodal metastases in 3.6% (2 of 56). The other 40 patients with PMC had surgeries performed for a clinical reason related to that pathologic lesion. This clinically suspected group was comparably multifocal (35%), but more likely to have cervical lymph node metastasis (35%). Sixty-six percent (37 of 56) diagnosed with a clinically unsuspected PMC underwent a partial thyroidectomy at the initial surgery.
The prevalence of clinically unsuspected PMC in our population undergoing thyroidectomy was 7.7% (56 of 723). In our institution, this is more than half of all PMCs. The incidence of cervical lymph node metastasis in clinically unsuspected PMC was only 3.6% compared with 35% in clinically suspected disease, suggesting that the biological behavior (and possibly treatment) may be different. Long-term follow-up evaluation is needed to better evaluate the significance of these differences.
本研究旨在描述社区医院环境中甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PMC）的发病率及临床/病理特征，并评估术前未怀疑时这些病变的频率和特征。
共 723 例患者接受了部分或全甲状腺切除术。对这些患者进行了回顾性分析。
723 例患者中，共有 194 例最终诊断为甲状腺癌。其中 96 例（49%）肿瘤为直径 1.0cm 或更小的 PMC。这些病变中有三分之一（32/96）为多灶性，16.7%（16/96）发现有区域淋巴结转移。大多数（58%）PMC 在最终病理中发现且术前临床未怀疑（隐匿性）。在临床未怀疑的隐匿性 PMC 患者中，32.1%（18/56）发现多灶性，3.6%（2/56）有淋巴结转移。其他 40 例患有 PMC 的患者因与该病理病变相关的临床原因而接受了手术。该临床疑似组同样具有多灶性（35%），但更可能发生颈部淋巴结转移（35%）。在临床未怀疑的 56 例 PMC 患者中，66%（37/56）在初次手术时接受了甲状腺部分切除术。
在接受甲状腺切除术的人群中，我们的研究人群中临床未怀疑的 PMC 患病率为 7.7%（723 例中的 56 例）。在我们的机构中，这超过了所有 PMC 的一半。临床未怀疑的 PMC 中颈部淋巴结转移的发生率仅为 3.6%，而临床疑似疾病中为 35%，这表明其生物学行为（可能还有治疗）可能不同。需要进行长期随访评估以更好地评估这些差异的意义。
