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This Article Accepted manuscript (PDF) All Versions of this Article: ERC-08-0119v1 16/1/201    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Perrino, M. Articles by Fugazzola, L. Search for Related Content PubMed PubMed Citation Articles by Perrino, M. Articles by Fugazzola, L.

M Perrino, Department of Medical Sciences, University of Milan, Endocrine Unit Fondazione Policlinico IRCCS, Milan, Italy
G Vannucchi, Department of Medical Sciences, University of Milan, Endocrine Unit Fondazione Policlinico IRCCS, Milan, Italy
L Vicentini, Fondazione Policlinico IRCCS, Endocrine Surgery Unit, Milan, Italy
G Cantoni, Fondazione Policlinico IRCCS, Endocrine Surgery Unit, Milan, Italy
D Dazzi, Department of Medical Sciences, University of Milan, Endocrine Unit Fondazione Policlinico IRCCS, Milan, Italy
C Colombo, Department of Medical Sciences, University of Milan, Endocrine Unit Fondazione Policlinico IRCCS, Milan, Italy
M Rodari, Istituto Clinico Humanitas IRCCS, Nuclear Medicine Unit, Milan, Italy
A Chiti, Istituto Clinico Humanitas IRCCS, Nuclear Medicine Unit, Milan, Italy
P Beck-Peccoz, Department of Medical Sciences, University of Milan, Endocrine Unit Fondazione Policlinico IRCCS, Milan, Italy
L Fugazzola, Department of Medical Sciences, University of Milan, Endocrine Unit Fondazione Policlinico IRCCS, Milan, Italy

Correspondence: Laura Fugazzola, Email: l.fugazzola{at}policlinico.mi.it

Abstract

The incidence of papillary thyroid cancer (PTC) is rapidly growing, being the recorded increase mainly related to tumors 2 cm. The re-classification of tumors >1 and 2cm limited to the thyroid from the T2 to the T1 category, triggered some concerns about their best management. In order to identify possible predictors of disease outcome, several clinico-pathological features were analyzed by uni- and multivariate analyses in a retrospective consecutive series of 251 PTCs 2 cm. Moreover, since the 37% of cases were submitted to prophylactic central compartment node dissection (CLND, VI-VII levels) and radioiodine ablation was performed only when the tumor had an extrathyroidal extension, the impact of these therapeutic tools on the final outcome was evaluated. Among all outcome predictors analyzed, only lymph-node metastases and extracapsular invasion were strongly associated with persistence/recurrence. It is worth noting that neither age, nor tumor size were significant indicators of the outcome. Interestingly, as far as the therapeutic interventions are concerned, CLND was strongly associated with remission, whereas radioiodine ablation did not influence the outcome. In conclusion, present results confirm the prognostic influence of node metastases and extrathyroidal invasion indicating the need for aggressive treatment in tumors extending beyond the capsule. On the contrary, all pT1N0 tumors, regardless of the diameter, the number of intrathyroidal foci and the age can be effectively treated only by surgery. The major impact of prophylactic CLND on prognosis, suggests to routinely associate it to total thyroidectomy in cases with a preoperative diagnosis of malignancy.