A review of 227 cases of small papillary thyroid carcinoma

Aims: To review differences in biological aggressiveness, clinical behaviors or selected surgical treatments between the PMC and the slightly larger PTC of 1.0 < T <= 2.0 cm. Methods: Two hundred and twenty-seven cases of papillary thyroid carcinoma not larger than 2.0 cm, diagnosed and treated at the Kuma Hospital, Kobe, Japan, with a 10-year follow-up from 1992 to 2003, were reviewed. Results: The small PTCs demonstrated excellent outcomes, and persistent/recurrent disease was identified in only nine patients (4 %). None of the patients died of the disease. A multivariate analysis revealed that massive extrathyroidal extension at presentation was the only independent prognostic factor for locoregional recurrence. Subdivision into PMCs and slightly larger tumors (1 < T <= 2 cm) did not affect the excellent outcomes, but the patients in the latter subgroup received more lymph node surgery and displayed more aggressive clinico-histological features such as higher rates of extrathyroidal extension, lymph node metastasis, loss of polarity, invasive growth pattern and loss of cohesiveness. Conclusions: Small PTC not larger than 2.0 cm could be considered as favorable a prognosis as PMC. (c) 2006 Elsevier Ltd. All rights reserved.