Lateral neck node metastasis in Papillary Thyroid UltraMicroCarcinoma(PTUMC); Are papillary thyroid carcinomas safe for ultra small size(?0.5cm)?

  • Background
    Thyroid nodule diagnostic fine needle aspiration(FNA) is not recommended for less than 1.0cm in 2015 ATA guidelines. In generally, Papillary thyroid ultramicrocarcinoma(PTUMC), defined as a tumor 0.5cm or less in size, can be consider as an active surveillance management. But there is also lateral neck node metastasis in PTUMC patients. The aim of this study is to evaluate clinicopathologic features of PTUMC and to comparison of the clinicopathologic characteristics of PTUMC with lateral neck metastasis and PTUMC without lateral neck node metastasis.
     
    Methods
    The study materials were patients treated at the Department of surgery in Gangnam Severance Hospital, from January 2009 and June 2013. 3,004 PTUMC patients were analyzed. Of these patients, 89(3.0%) patients had lateral neck node metastasis and 2,915(97.0%) patients didn’t have lateral neck node metastasis. The clinicopathologic characteristics including gender, age, size, operation type, tumor location, multiplicity, thyroiditis, microscopic extrathyroidal extension, and nodal status of the two groups were compared.
     
    Results
    The two groups were not different in regard to the age and tumor type. PTUMC with lateral neck node positive group presented with significantly male gender(p=0.014), microscopic ETE(p<0.001), multiplicity(p<0.001), upper pole lesion(p<0.001), psammomatous calcification and central node metastasis(p<0.001). A multivariate analysis revealed that microscopic ETE(p=0.003), upper pole lesion(p<0.001), psammomatous calcification(p=0.002) and central neck node metastasis(p<0.001).
     
    Conclusion
    Microscopic ETE, upper pole lesion, psammomatous calcification, and central node metastasis were associated with lateral neck node metastasis in PTUMC patients. Surgical treatment and lateral neck preoperative evaluation need be considered in PTUMC patients presenting with risk factors.

 

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