Endocrine Abstracts

Introduction: Papillary thyroid micro-carcinoma (PTMC) is a well-differentiated thyroid cancer ≤10 mm in diameter. The recent higher prevalence of PTMC is due to the frequent detection of micro-carcinomas as an incidental finding in surgical specimens, but especially during routine imaging of the neck with highly sensitive techniques.

Aim: To review the clinical course of PTMC so to reach its optimal management by adapting therapy and follow-up schemes to the risk of persistent or recurrent disease.

Methods: We selected 160 PTMC patients and retrospectively analyzed their case history, surgical therapy [total thyroidectomy (TT), lymphnode dissection (LL), near-total thyroidectomy (NT), partial thyroidectomy (PT)], ¹³¹I-remnant ablation (¹³¹I-RMT), post-surgical follow-up (serum thyroglobulin evaluation, neck ultrasonography, ¹³¹I-WBS, other radiological test results).

Results: Out of 160 pts, 143 were affected by sporadic PTMC (sPTMC),11 by familial neoplasia (fPTMC). Mean follow-up time: 6yrs.

83 sPTM (group A) were incidentalomas, identified during thyroidectomy for nodular goiter, and 60 sPTM (group B) were preoperatively identified with FNA.

In group A (67 pts underwent NT and 16 pts PT) 4 cases had a loco-regional relapse. In group B, among 28 subjects who underwent TT+LL+¹³¹I-RMT, 5 presented loco-regional and mediastinal secondary localizations and 1 pt died of distant metastases. 32 pts of group B underwent TT±¹³¹I-RMT and 2 of them showed local recurrence and distant metastases.

3 out of 11 pts affected by fPTMC underwent NT: 1 died of pulmonary metastases, 1 had cervical lymphnodal metastases and 1 had a good clinical course. 1 pt who underwent PT developed loco-regional recurrence, 3 pts who underwent TT±¹³¹I-RMT had a good clinical course, 1 out of 4 pts treated with TT+LL+¹³¹I-RMT showed loco-regional recurrence.

Conclusions: Our observations suggest that prognosis is less favourable in subjects with locoregional metastases at the baseline control and in those with fPMTC; a more careful management and accurate follow-up are suggested in high risk patients.