Papillary Thyroid Carcinoma

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Endocrine Surgery Comprehensive Board Exam Guide
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Abstract

Papillary thyroid cancer is the most common thyroid cancer. The incidence of small papillary cancers has increased since the 1990s, leading to changes in treatment options and recommendations. Patients should be carefully examined and included explicitly in treatment discussions. Small low-risk PTC may be suitable for observation or hemithyroidectomy. High-risk patients require total thyroidectomy and adjuvant RAI. For patients who lie between these extremes, factors relating to the patient, their tumor, and the chance of treatment side effects should be balanced to optimize oncological and functional outcomes in the long term.

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References

  1. Kim J, Gosnell JE, Roman SA. Geographic influences in the global rise of thyroid cancer. Nat Rev Endocrinol. 2020;16(1):17–29.

    Article  PubMed  Google Scholar 

  2. Li M, Dal Maso L, Vaccarella S. Global trends in thyroid cancer incidence and the impact of overdiagnosis. Lancet Diabetes Endocrinol. 2020;8(6):468–70.

    Article  PubMed  Google Scholar 

  3. Sanabria A, Kowalski LP, Shah JP, Nixon IJ, Angelos P, Williams MD, et al. Growing incidence of thyroid carcinoma in recent years: factors underlying overdiagnosis. Head Neck. 2018;40(4):855–66.

    Article  PubMed  Google Scholar 

  4. Davies L, Morris LG, Haymart M, Chen AY, Goldenberg D, Morris J, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: the increasing incidence of thyroid cancer. Endocr Pract. 2015;21(6):686–96.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Davies L, Ouellette M, Hunter M, Welch HG. The increasing incidence of small thyroid cancers: where are the cases coming from? Laryngoscope. 2010;120(12):2446–51.

    Article  PubMed  Google Scholar 

  6. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164–7.

    Article  CAS  PubMed  Google Scholar 

  7. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009;115(16):3801–7.

    Article  PubMed  Google Scholar 

  8. Malone MK, Zagzag J, Ogilvie JB, Patel KN, Heller KS. Thyroid cancers detected by imaging are not necessarily small or early stage. Thyroid. 2014;24(2):314–8.

    Article  PubMed  Google Scholar 

  9. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531–8.

    Article  CAS  PubMed  Google Scholar 

  10. Furuya-Kanamori L, Bell KJ, Clark J, Glasziou P, Doi SA. Prevalence of differentiated thyroid cancer in autopsy studies over six decades: a meta-analysis. J Clin Oncol. 2016;34(30):3672–9.

    Article  PubMed  Google Scholar 

  11. Wang LY, Nixon IJ, Patel SG, Palmer FL, Tuttle RM, Shaha A, et al. Operative management of locally advanced, differentiated thyroid cancer. Surgery. 2016;160(3):738–46.

    Article  PubMed  Google Scholar 

  12. Efanov AA, Brenner AV, Bogdanova TI, Kelly LM, Liu P, Little MP, et al. Investigation of the relationship between radiation dose and gene mutations and fusions in post-Chernobyl thyroid cancer. J Natl Cancer Inst. 2018;110(4):371–8.

    Article  CAS  PubMed  Google Scholar 

  13. Reiners C, Biko J, Haenscheid H, Hebestreit H, Kirinjuk S, Baranowski O, et al. Twenty-five years after Chernobyl: outcome of radioiodine treatment in children and adolescents with very high-risk radiation-induced differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2013;98(7):3039–48.

    Article  CAS  PubMed  Google Scholar 

  14. Furukawa K, Preston D, Funamoto S, Yonehara S, Ito M, Tokuoka S, et al. Long-term trend of thyroid cancer risk among Japanese atomic-bomb survivors: 60 years after exposure. Int J Cancer. 2013;132(5):1222–6.

    Article  CAS  PubMed  Google Scholar 

  15. Shaha MA, Wang LY, Migliacci JC, Palmer FL, Nixon IJ, Tuttle RM, et al. Previous external beam radiation treatment exposure does not confer worse outcome for patients with differentiated thyroid cancer. Thyroid. 2017;27(3):412–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nixon IJ, Suarez C, Simo R, Sanabria A, Angelos P, Rinaldo A, et al. The impact of family history on non-medullary thyroid cancer. Eur J Surg Oncol. 2016;42(10):1455–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Nose V. Familial thyroid cancer: a review. Mod Pathol. 2011;24(Suppl 2):S19–33.

    Article  CAS  PubMed  Google Scholar 

  18. Hughes DT, Haymart MR, Miller BS, Gauger PG, Doherty GM. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid. 2011;21(3):231–6.

    Article  PubMed  Google Scholar 

  19. Ahn HS, Kim HJ, Kim KH, Lee YS, Han SJ, Kim Y, et al. Thyroid cancer screening in South Korea increases detection of papillary cancers with no impact on other subtypes or thyroid cancer mortality. Thyroid. 2016;26(11):1535–40.

    Article  PubMed  Google Scholar 

  20. Davies L, Welch HG. Thyroid cancer survival in the United States: observational data from 1973 to 2005. Arch Otolaryngol Head Neck Surg. 2010;136(5):440–4.

    Article  PubMed  Google Scholar 

  21. Tuttle RM, Fagin JA, Minkowitz G, Wong RJ, Roman B, Patel S, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg. 2017;143(10):1015–20.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Miyauchi A, Kudo T, Ito Y, Oda H, Sasai H, Higashiyama T, et al. Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance. Surgery. 2018;163(1):48–52.

    Article  PubMed  Google Scholar 

  23. Hartl DM, Leboulleux S, Al Ghuzlan A, Baudin E, Chami L, Schlumberger M, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg. 2012;255(4):777–83.

    Article  PubMed  Google Scholar 

  24. Nixon IJ, Wang LY, Ganly I, Patel SG, Morris LG, Migliacci JC, et al. Outcomes for patients with papillary thyroid cancer who do not undergo prophylactic central neck dissection. Br J Surg. 2016;103(3):218–25.

    Article  CAS  PubMed  Google Scholar 

  25. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sampson RJ, Oka H, Key CR, Buncher CR, Iijima S. Metastases from occult thyroid carcinoma. An autopsy study from Hiroshima and Nagasaki, Japan. Cancer. 1970;25(4):803–11.

    Article  CAS  PubMed  Google Scholar 

  27. Ottino A, Pianzola HM, Castelletto RH. Occult papillary thyroid carcinoma at autopsy in La Plata, Argentina. Cancer. 1989;64(2):547–51.

    Article  CAS  PubMed  Google Scholar 

  28. Nixon IJ, Ganly I, Palmer FL, Whitcher MM, Patel SG, Tuttle RM, et al. Disease-related death in patients who were considered free of macroscopic disease after initial treatment of well-differentiated thyroid carcinoma. Thyroid. 2011;21(5):501–4.

    Article  PubMed  Google Scholar 

  29. Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, et al. ACR thyroid imaging, reporting and data system (TI-RADS): white paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14(5):587–95.

    Article  PubMed  Google Scholar 

  30. Middleton WD, Teefey SA, Reading CC, Langer JE, Beland MD, Szabunio MM, et al. Comparison of performance characteristics of American College of Radiology TI-RADS, Korean Society of Thyroid Radiology TIRADS, and American Thyroid Association guidelines. AJR Am J Roentgenol. 2018;210(5):1148–54.

    Article  PubMed  Google Scholar 

  31. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19(11):1159–65.

    Article  PubMed  Google Scholar 

  32. Carling T, Carty SE, Ciarleglio MM, Cooper DS, Doherty G, Kim LT, et al. American Thyroid Association (ATA) - design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22(3):237–44.

    Article  PubMed  Google Scholar 

  33. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.

    Article  PubMed  Google Scholar 

  34. Haugen BRM, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Byar DP, Green SB, Dor P, Williams ED, Colon J, van Gilse HA, et al. A prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. Thyroid Cancer Cooperative Group. Eur J Cancer. 1979;15(8):1033–41.

    Article  CAS  Google Scholar 

  36. Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114(6):1050–7; discussion 7–8.

    CAS  PubMed  Google Scholar 

  37. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102(6):1088–95.

    CAS  PubMed  Google Scholar 

  38. Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988;104(6):947–53.

    Article  CAS  PubMed  Google Scholar 

  39. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992;164(6):658–61.

    Article  CAS  PubMed  Google Scholar 

  40. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC staging manual. Springer; 2017. 1024 p

    Book  Google Scholar 

  41. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.

    Article  CAS  PubMed  Google Scholar 

  42. Scharpf J, Tuttle M, Wong R, Ridge D, Smith R, Hartl D, et al. Comprehensive management of recurrent thyroid cancer: an American Head and Neck Society consensus statement: AHNS consensus statement. Head Neck. 2016;38(12):1862–9.

    Article  PubMed  Google Scholar 

  43. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol. 2014;81(Suppl 1):1–122.

    Article  CAS  Google Scholar 

  44. Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014;21(12):3844–52.

    Article  PubMed  Google Scholar 

  45. Meltzer C, Hull M, Sundang A, Adams JL. Association between annual surgeon total thyroidectomy volume and transient and permanent complications. JAMA Otolaryngol Head Neck Surg. 2019;145(9):830.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Adam MA, Thomas S, Youngwirth L, Hyslop T, Reed SD, Scheri RP, et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg. 2017;265(2):402–7.

    Article  PubMed  Google Scholar 

  47. Chadwick D, Kinsman R, Walton P. The British Association of Endocrine and Thyroid Surgeons: fifth national audit report. Dendrite Clinical Systems Ltd; 2017. 196 p

    Google Scholar 

  48. Francis DO, Pearce EC, Ni S, Garrett CG, Penson DF. Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a Medicare population. Otolaryngol Head Neck Surg. 2014;150(4):548–57.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Oda H, Miauchi A, Ito Y, Yoshioka K, Nakayama A, Sasai H, Masuoka H, Yabuta T, Fukushima M, Higashiyama T, Kihara M, Kobayashi K, Miya A. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 2016;26(1):150–5.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sawant R, Hulse K, Sohrabi S, Yeo JCL, Pal K, Gibb FW, et al. The impact of completion thyroidectomy. Eur J Surg Oncol. 2019;45(7):1171–4.

    Article  CAS  PubMed  Google Scholar 

  51. Kiess AP, Agrawal N, Brierley JD, Duvvuri U, Ferris RL, Genden E, et al. External-beam radiotherapy for differentiated thyroid cancer locoregional control: a statement of the American Head and Neck Society. Head Neck. 2016;38(4):493–8.

    Article  PubMed  Google Scholar 

  52. Ito Y, Miyauchi A, Inoue H, Fukushima M, Kihara M, Higashiyama T, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34(1):28–35.

    Article  PubMed  Google Scholar 

  53. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13(4):381–7.

    Article  PubMed  Google Scholar 

  54. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26(1):144–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sugitani I, Fujimoto Y, Yamada K. Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J Surg. 2014;38(3):673–8.

    Article  PubMed  Google Scholar 

  56. Smulever A, Pitoia F. Active surveillance in papillary thyroid carcinoma: not easily accepted but possible in Latin America. Arch Endocrinol Metab. 2019;63(5):462–9.

    PubMed  Google Scholar 

  57. Sanabria A. Experience with active surveillance of thyroid low-risk carcinoma in a develo** country. Thyroid. 2020;30(7):985–91.

    Article  CAS  PubMed  Google Scholar 

  58. Sakai T, Sugitani I, Ebina A, Fukuoka O, Toda K, Mitani H, et al. Active surveillance for T1bN0M0 papillary thyroid carcinoma. Thyroid. 2019;29(1):59–63.

    Article  PubMed  Google Scholar 

  59. Ohtsuru A, Midorikawa S, Ohira T, Suzuki S, Takahashi H, Murakami M, Shimura H, Matsuzuka T, Yasumura S, Suzuki S, Yokoya S, Hashimoto Y, Sakai A, Ohto H, Yamashita S, Tanigawa K, Kamiya K. Incidence of Thyroid Cancer among children and young adults in Fukushima, Japan, screened with 2 rounds of ultrasonography within 5 years of the 2011 Fukushima Daiichi nuclear power station accident. JAMA Otolaryngol Head Neck Surg. 2019;145(1):4–11.

    Article  PubMed  Google Scholar 

  60. Oh HS, Ha J, Kim HI, Kim TH, Kim WG, Lim DJ, et al. Active surveillance of low-risk papillary thyroid microcarcinoma: a multi-center cohort study in Korea. Thyroid. 2018;28(12):1587–94.

    Article  PubMed  Google Scholar 

  61. Molinaro E, Campopiano MC, Pieruzzi L, Matrone A, Agate L, Bottici V, et al. Active surveillance in papillary thyroid microcarcinomas is feasible and safe: experience at a Single Italian Center. J Clin Endocrinol Metab. 2020;105(3):e172.

    Article  Google Scholar 

  62. Kwon H, Oh HS, Kim M, Park S, Jeon MJ, Kim WG, et al. Active surveillance for patients with papillary thyroid microcarcinoma: a single center’s experience in Korea. J Clin Endocrinol Metab. 2017;102(6):1917–25.

    Article  PubMed  Google Scholar 

  63. Tuttle RM, Alzahrani AS. Risk stratification in differentiated thyroid cancer: from detection to final follow-up. J Clin Endocrinol Metab. 2019;104(9):4087–100.

    Article  PubMed Central  Google Scholar 

  64. Pitoia F, Jerkovich F. Dynamic risk assessment in patients with differentiated thyroid cancer. Endocr Relat Cancer. 2019;26(10):R553–R66.

    Article  CAS  PubMed  Google Scholar 

  65. Momesso DP, Vaisman F, Yang SP, Bulzico DA, Corbo R, Vaisman M, et al. Dynamic risk stratification in differentiated thyroid cancer patients treated without radioactive iodine. J Clin Endocrinol Metab. 2016;101(7):2692–700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605–13.

    Article  PubMed  Google Scholar 

  67. Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985;312(25):1604–8.

    Article  CAS  PubMed  Google Scholar 

  68. Black WC, Welch HG. Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy. N Engl J Med. 1993;328(17):1237–43.

    Article  CAS  PubMed  Google Scholar 

  69. Black WC, Ling A. Is earlier diagnosis really better? The misleading effects of lead time and length biases. AJR Am J Roentgenol. 1990;155(3):625–30.

    Article  CAS  PubMed  Google Scholar 

  70. Hay ID, Johnson TR, Kaggal S, Reinalda MS, Iniguez-Ariza NM, Grant CS, et al. Papillary thyroid carcinoma (PTC) in children and adults: comparison of initial presentation and long-term postoperative outcome in 4432 patients consecutively treated at the Mayo Clinic during eight decades (1936-2015). World J Surg. 2018;42(2):329–42.

    Article  PubMed  Google Scholar 

  71. Chereau N, Buffet C, Tresallet C, Tissier F, Leenhardt L, Menegaux F. Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: predictive factors and operative management. Surgery. 2016;159(3):755–62.

    Article  PubMed  Google Scholar 

  72. Tufano RP, Clayman G, Heller KS, Inabnet WB, Kebebew E, Shaha A, et al. Management of recurrent/persistent nodal disease in patients with differentiated thyroid cancer: a critical review of the risks and benefits of surgical intervention versus active surveillance. Thyroid. 2015;25(1):15–27.

    Article  PubMed  Google Scholar 

  73. Sanabria A, Rojas A, Arevalo J, Kowalski LP, Nixon I. Microscopically positive surgical margins and local recurrence in thyroid cancer. A meta-analysis. Eur J Surg Oncol. 2019;45(8):1310–6.

    Article  PubMed  Google Scholar 

  74. Oda H, Miyauchi A, Ito Y, Yoshioka K, Nakayama A, Sasai H, et al. Incidences of unfavorable events in the management of low-risk papillary microcarcinoma of the thyroid by active surveillance versus immediate surgery. Thyroid. 2016;26(1):150–5.

    Article  PubMed  PubMed Central  Google Scholar 

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Nixon, I., Davies, L. (2021). Papillary Thyroid Carcinoma. In: Shifrin, A.L., Raffaelli, M., Randolph, G.W., Gimm, O. (eds) Endocrine Surgery Comprehensive Board Exam Guide. Springer, Cham. https://doi.org/10.1007/978-3-030-84737-1_5

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