Identification and Optimal Postsurgical Follow-Up of Patients with Very Low-Risk Papillary Thyroid Microcarcinomas

被引:89
作者
Durante, Cosimo [1 ,2 ,3 ]
Attard, Marco [4 ]
Torlontano, Massimo [5 ]
Ronga, Giuseppe [1 ,2 ,3 ]
Monzani, Fabio [6 ]
Costante, Giuseppe [7 ]
Ferdeghini, Marco [8 ]
Tumino, Salvatore [9 ]
Meringolo, Domenico [10 ]
Bruno, Rocco [11 ]
De Toma, Giorgio [1 ,2 ,3 ]
Crocetti, Umberto [5 ]
Montesano, Teresa [1 ,2 ,3 ]
Dardano, Angela [6 ]
Lamartina, Livia [1 ,2 ,3 ]
Maniglia, Adele [4 ]
Giacomelli, Laura [1 ,2 ,3 ]
Filetti, Sebastiano [1 ,2 ,3 ]
机构
[1] Univ Roma Sapienza, Dipartimento Sci Clin, I-00161 Rome, Italy
[2] Univ Roma Sapienza, Dipartimento Sci Radiol, I-00161 Rome, Italy
[3] Univ Roma Sapienza, Dipartimento Sci Chirurg, I-00161 Rome, Italy
[4] Osped Riuniti Villa Sofia Cervello, Unita Operat Endocrinol, I-90146 Palermo, Italy
[5] Ist Ricovero & Cura Carattere Sci, Unita Operat Endocrinol, I-71013 San Giovanni Rotondo, Italy
[6] Univ Pisa, Dipartimento Med Interna, I-56126 Pisa, Italy
[7] Univ Catanzaro Magna Graecia, Dipartimento Med Sperimentale & Clin, I-88100 Catanzaro, Italy
[8] Univ Verona, Dipartimento Sci Morfol Biomed, I-37134 Verona, Italy
[9] Univ Catania, Dipartimento Sci Biomed, I-95123 Catania, Italy
[10] Osped Bentivoglio, Dipartimentale Endocrinol, Unita Operat Semplice, I-40010 Bologna, Italy
[11] Osped Tinchi Pisticci, Unita Endocrinol, I-75020 Matera, Italy
关键词
LYMPH-NODE METASTASIS; NECK ULTRASONOGRAPHY; SERUM THYROGLOBULIN; STIMULATED THYROGLOBULIN; DISTANT METASTASIS; PROGNOSTIC-FACTORS; GENETIC-ANALYSIS; CANCER PATIENTS; CARCINOMA; MANAGEMENT;
D O I
10.1210/jc.2010-0762
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Most papillary thyroid microcarcinomas (PTMCs; <= 1 cm diameter) are indolent low-risk tumors, but some cases behave more aggressively. Controversies have thus arisen over the optimum postoperative surveillance of PTMC patients. Objectives: We tested the hypothesis that clinical criteria could be used to identify PTMC patients with very low mortality/recurrence risks and attempted to define the best strategy for their management and long-term surveillance. Design: We retrospectively analyzed data from 312 consecutively diagnosed PTMC patients with T1N0M0 stage disease, no family history of thyroid cancer, no history of head-neck irradiation, unifocal PTMC, no extracapsular involvement, and classic papillary histotypes. Additional inclusion criteria were complete follow-up data from surgery to at least 5 yr after diagnosis. All 312 had undergone(near) total thyroidectomy [with radioactive iodine (RAI) remnant ablation in 137 (44%) - RAI group] and were followed up yearly with cervical ultrasonography and serum thyroglobulin, TSH, and thyroglobulin antibody assays. Results: During follow-up (5-23 yr, median 6.7 yr), there were no deaths due to thyroid cancer or reoperations. The first (6-12 months after surgery) and last postoperative cervical sonograms were negative in all cases. Final serum thyroglobulin levels were undetectable (<1 ng/ml) in all RAI patients and almost all (93%) of non-RAI patients. Conclusion: Accurate risk stratification can allow safe follow-up of most PTMC patients with a less intensive, more cost-effective protocol. Cervical ultrasonography is the mainstay of this protocol, and negative findings at the first postoperative examination are highly predictive of positive outcomes. (J Clin Endocrinol Metab 95: 4882-4888, 2010)
引用
收藏
页码:4882 / 4888
页数:7
相关论文
共 36 条
[1]   ROLE OF NECK ULTRASONOGRAPHY IN THE FOLLOW-UP OF PATIENTS OPERATED ON FOR THYROID-CANCER [J].
ANTONELLI, A ;
MICCOLI, P ;
FERDEGHINI, M ;
DICOSCIO, G ;
ALBERTI, B ;
IACCONI, P ;
BALDI, V ;
FALLAHI, P ;
BASCHIERI, L .
THYROID, 1995, 5 (01) :25-28
[2]   Papillary Thyroid Carcinoma and Microcarcinoma: Is There a Need to Distinguish the Two? [J].
Arora, Nimmi ;
Turbendian, Harma K. ;
Kato, Meredith A. ;
Moo, Tracy A. ;
Zarnegar, Rasa ;
Fahey, Thomas J., III .
THYROID, 2009, 19 (05) :473-477
[3]   Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes [J].
Arturi, F ;
Russo, D ;
Giuffrida, D ;
Ippolito, A ;
Perrotti, N ;
Vigneri, R ;
Filetti, S .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1997, 82 (05) :1638-1641
[4]   Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients [J].
Baudin, E ;
Do Cao, C ;
Cailleux, AF ;
Leboulleux, S ;
Travagli, JP ;
Schlumberger, M .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2003, 88 (03) :1107-1111
[5]   Thyroid-hormone therapy and thyroid cancer: a reassessment [J].
Biondi, B ;
Filetti, S ;
Schlumberger, M .
NATURE CLINICAL PRACTICE ENDOCRINOLOGY & METABOLISM, 2005, 1 (01) :32-40
[6]   Identification of a Neck Lump as a Lymph Node Metastasis from an Occult Contralateral Papillary Microcarcinoma of the Thyroid: Key Role of Thyroglobulin Assay in the Fine-Needle Aspirate [J].
Bruno, Rocco ;
Giannasio, Paolo ;
Chiarella, Rosarita ;
Capula, Carmelo ;
Russo, Diego ;
Filetti, Sebastiano ;
Costante, Giuseppe .
THYROID, 2009, 19 (05) :531-533
[7]   Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? [J].
Cailleux, AF ;
Baudin, E ;
Travagli, JP ;
Ricard, M ;
Schlumberger, M .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2000, 85 (01) :175-178
[8]   Papillary microcarcinoma of the thyroid - Prognostic significance of lymph node metastasis and multifocality [J].
Chow, SM ;
Law, SCK ;
Chan, JKC ;
Au, SK ;
Yau, S ;
Lau, WH .
CANCER, 2003, 98 (01) :31-40
[9]   Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer [J].
Cooper, David S. ;
Doherty, Gerard M. ;
Haugen, Bryan R. ;
Kloos, Richard T. ;
Lee, Stephanie L. ;
Mandel, Susan J. ;
Mazzaferri, Ernest L. ;
McIver, Bryan ;
Pacini, Furio ;
Schlumberger, Martin ;
Sherman, Steven I. ;
Steward, David L. ;
Tuttle, R. Michael .
THYROID, 2009, 19 (11) :1167-1214
[10]   Increasing incidence of thyroid cancer in the United States, 1973-2002 [J].
Davies, L ;
Welch, HG .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 295 (18) :2164-2167