Advertisement

Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4187–4192 | Cite as

Pediatric Thyroid Microcarcinoma

  • Jonathan Lerner
  • Melanie Goldfarb
Endocrine Tumors

Abstract

Background

Thyroid microcarcinomas (TMCs) are increasing in the general population, most commonly in older individuals; however, the incidence, characteristics, and outcomes of TMCs in pediatric patients has not been studied.

Methods

All patients ≤19 years of age with differentiated thyroid carcinoma (DTC) were identified from the surveillance, epidemiology, and end results registry from 1988 to 2009. Patients were divided into two groups based on tumor siz e: TMCs (≤1 cm) and tumors >1 cm. Demographic, tumor, and treatment characteristics, as well as overall survival (OS) and disease-specific survival (DSS), were compared between the two groups. The TMC group was analyzed separately for predictors of overall and disease-specific death.

Results

Of 1825 pediatric DTC patients, 8.4 % had a TMC, and, over the past decade, the incidence has decreased (6.5 vs 14.5 %; p < 0.001). Compared to patients with DTCs >1 cm, TMCs were more likely to have papillary histology, negative lymph nodes, be treated with a partial thyroidectomy [odds ratio (OR) 3.46, CI 2.02–5.93] and not receive radioiodine (OR 1.77, CI 1.10–2.83). Neither OS (TMC: 253.59 months; DTC >1 cm: 257.97 months) nor DSS (TMC: 256.38 months; DTC >1 cm: 260.77 months) differed between groups. Predictors of decreased OS in the entire cohort included secondary malignancy status (p = 0.001), black race (p = 0.006) and follicular or Hurthle histology (p = 0.001). In patients with primary TMC, only follicular or Hurthle histology (p = 0.001) predicted decreased OS.

Conclusions

TMCs in patients ≤19 years of age are declining and comprise <10 % of pediatric thyroid malignancies. TMCs are most commonly treated with a partial thyroidectomy not followed by radioiodine, and have an excellent OS and DSS.

Keywords

Overall Survival Differentiate Thyroid Carcinoma Extrathyroidal Extension Differentiate Thyroid Carcinoma Patient Partial Thyroidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Jonathan Lerner and Melanie Goldfarb have no conflicts of interest to declare, nor any financial disclosures to report.

References

  1. 1.
    Londero SC, Krogdahl A, Bastholt L, et al. Papillary thyroid microcarcinoma in Denmark 1996-2008: a national study of epidemiology and clinical significance. Thyroid. 2013;23(9):1159–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Hughes DT, Haymart MR, Miller BS, et al. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009;115(16):3801–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Li N, Du XL, Reitzel LR, et al. Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end results registry, 1980-2008. Thyroid. 2013;23(1):103–10.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Morris LG, Myssiorek D. Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am J Surg. 2010;200(4):454–61.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Morris LG, Sikora AG, Tosteson TD, et al. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid. 2013;23(7):885–91.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.CrossRefPubMedGoogle Scholar
  9. 9.
    Ito Y, Miyauchi A, Inoue H, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34(1):28–35.CrossRefPubMedGoogle Scholar
  10. 10.
    Yu XM, Wan Y, Sippel RS, et al. Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg. 2011;254(4):653–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Park YJ, Kim YA, Lee YJ, et al. Papillary microcarcinoma in comparison with larger papillary thyroid carcinoma in BRAF(V600E) mutation, clinicopathological features, and immunohistochemical findings. Head Neck. 2010;32(1):38–45.PubMedGoogle Scholar
  12. 12.
    Pellegriti G, Scollo C, Lumera G, et al. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab. 2004;89(8):3713–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Mehanna H, Al-Maqbili T, Carter B, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab. 2014;99(8):2834–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg. 2010;34(6):1222–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Wartofsky L. Management of papillary microcarcinoma: primum non nocere? J Clin Endocrinol Metab. 2012;97(4):1169–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Mehanna H, Al-Maqbili T, Carter B, et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metab. 2014;99(8):2834–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Pellegriti G, De Vathaire F, Scollo C, et al. Papillary thyroid cancer incidence in the volcanic area of Sicily. J Natl Cancer Inst. 2009;101(22):1575–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Gaur P, Leary C, Yao JC. Thymic neuroendocrine tumors: a SEER database analysis of 160 patients. Ann Surg. 2010;251(6):1117–21.CrossRefPubMedGoogle Scholar
  19. 19.
    Nathan H, Pawlik TM. Limitations of claims and registry data in surgical oncology research. Ann Surg Oncol. 2008;15(2):415–23.CrossRefPubMedGoogle Scholar
  20. 20.
    Overview of the SEER Program. http://seer.cancer.gov/about/overview.html. Accessed 18 Feb 2014.
  21. 21.
    Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Pellegriti G, Frasca F, Regalbuto C, et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Horn-Ross PL, Lichtensztajn DY, Clarke CA, et al. Continued rapid increase in thyroid cancer incidence in california: trends by patient, tumor, and neighborhood characteristics. Cancer Epidemiol Biomarkers Prev. 2014;23(6):1067–79.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid. 2009;19(7):707–16.CrossRefPubMedGoogle Scholar
  25. 25.
    Besic N, Zgajnar J, Hocevar M, et al. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. Ann Surg Oncol. 2009;16(4):920–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Podda MG, Terenziani M, Gandola L, et al. Thyroid carcinoma after treatment for malignancies in childhood and adolescence: from diagnosis through follow-up. Med Oncol. 2014;31(8):121.CrossRefPubMedGoogle Scholar
  27. 27.
    Grigsby PW, Gal-or A, Michalski JM, et al. Childhood and adolescent thyroid carcinoma. Cancer. 2002;95(4):724–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Enomoto Y, Enomoto K, Uchino S, et al. Clinical features, treatment, and long-term outcome of papillary thyroid cancer in children and adolescents without radiation exposure. World J Surg. 2012;36(6):1241–6.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  1. 1.University of Southern California Keck School of MedicineLos AngelesUSA
  2. 2.Endocrine Tumor ProgramJohn Wayne Cancer Institute at Providence St. John’s Health CenterSanta MonicaUSA

Personalised recommendations