| Identification and optimal postsurgical follow-up of patients with very low-risk papillary thyroid microcarcinomas. | |
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MedLine Citation:
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PMID: 20660054 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Most papillary thyroid microcarcinomas (PTMCs; ≤ 1 cm diameter) are indolent low-risk tumors, but some cases behave more aggressively. Controversies have thus arisen over the optimum postoperative surveillance of PTMC patients. OBJECTIVES: We tested the hypothesis that clinical criteria could be used to identify PTMC patients with very low mortality/recurrence risks and attempted to define the best strategy for their management and long-term surveillance. DESIGN: We retrospectively analyzed data from 312 consecutively diagnosed PTMC patients with T1N0M0 stage disease, no family history of thyroid cancer, no history of head-neck irradiation, unifocal PTMC, no extracapsular involvement, and classic papillary histotypes. Additional inclusion criteria were complete follow-up data from surgery to at least 5 yr after diagnosis. All 312 had undergone (near) total thyroidectomy [with radioactive iodine (RAI) remnant ablation in 137 (44%) - RAI group] and were followed up yearly with cervical ultrasonography and serum thyroglobulin, TSH, and thyroglobulin antibody assays. RESULTS: During follow-up (5-23 yr, median 6.7 yr), there were no deaths due to thyroid cancer or reoperations. The first (6-12 months after surgery) and last postoperative cervical sonograms were negative in all cases. Final serum thyroglobulin levels were undetectable (<1 ng/ml) in all RAI patients and almost all (93%) of non-RAI patients. CONCLUSION: Accurate risk stratification can allow safe follow-up of most PTMC patients with a less intensive, more cost-effective protocol. Cervical ultrasonography is the mainstay of this protocol, and negative findings at the first postoperative examination are highly predictive of positive outcomes. |
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Authors:
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Cosimo Durante; Marco Attard; Massimo Torlontano; Giuseppe Ronga; Fabio Monzani; Giuseppe Costante; Marco Ferdeghini; Salvatore Tumino; Domenico Meringolo; Rocco Bruno; Giorgio De Toma; Umberto Crocetti; Teresa Montesano; Angela Dardano; Livia Lamartina; Adele Maniglia; Laura Giacomelli; Sebastiano Filetti; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-07-21 |
Journal Detail:
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Title: The Journal of clinical endocrinology and metabolism Volume: 95 ISSN: 1945-7197 ISO Abbreviation: J. Clin. Endocrinol. Metab. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-05 Completed Date: 2010-12-10 Revised Date: 2012-04-24 |
Medline Journal Info:
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Nlm Unique ID: 0375362 Medline TA: J Clin Endocrinol Metab Country: United States |
Other Details:
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Languages: eng Pagination: 4882-8 Citation Subset: AIM; IM |
Affiliation:
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Dipartimentos di Scienze Cliniche, Scienze Radiologiche, Dipartimento di Scienze Chirurgiche, and Chirurgia P. Valdoni, Università di Roma Sapienza, Roma, Italy. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Carcinoma, Papillary / diagnosis, surgery* Female Follow-Up Studies Humans Male Middle Aged Postoperative Care / methods* Postoperative Period Prognosis Retrospective Studies Thyroid Gland / pathology, surgery Thyroid Neoplasms / diagnosis, surgery* |
| Investigator | |
Investigator/Affiliation:
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Maria Calvo / ; Sandro La Vignera / ; Carmelo Capula / ; Barbara Fruci / ; Girolamo D'Azzò / ; Giuseppe Termine / ; Mario Stella / ; Antonio Polini / ; Alessandra Paciaroni / ; Francesco Cava / ; Marco Ammendola / ; Maria Toteda / ; Rosaria D'Apollo / ; Giuseppe Cavallaro / ; Carlo Chiesa / ; Andrea Esposito / ; Michela Massa / ; Nazario Bonfitto / ; Franca Dicembrino / ; Antonio Varraso / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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