[Management of the papillary microcarcinoma of the thyroid gland]. / Microcarcinomes papillaires de la thyroïde: quelle attitude thérapeutique?

ABSTRACT

OBJECTIVES: To study the management and treatment of papillary microcarcinoma of the thyroid. MATERIAL AND METHODS: Retrospective study of 57 patients operated on their thyroid gland between 1995 and 2004. All patients had a frozen section of the specimen. Procedure varied according to histology results and presence of adenopathy. RESULTS: Procedure planned initially was a total thyroidectomy in 75% of patients (the other 25% were planned as hemi-thyroidectomy). Frozen section was positive in 46% of patients. We proceeded with 16 selective neck dissections (levels 2-3-4) and 10 bilateral "level 6" . Microcarcinomas were unique in 77% of cases. Extra-capsular spreading was noted in 39% of cases. Adjuvant Iodine 131 was administered to 36 patients (63%). Follow-up included clinic visits, ultra-sound and Tg levels. With a follow-up of 3 to 12 years, no recurrence or metastasis has been identified. CONCLUSION: Treatment of papillary microcarcinomas of the thyroid is controversial. If surgery is chosen as treatment, the extent both regarding the thyroid itself and the cervical nodes is debated. Because of the excellent prognosis, some authors have recommended, when risk factors are absent, to limit the treatment to the thyroidectomy. Others, because of the risk of local recurrence and distal metastasis, have recommended a very aggressive approach.