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나병곤,배학연,조현진,김권천 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.3
Purpose: Papillary thyroid microcarcinoma (PTMC) is increasing in incidence because of ultrasound-guided fine-needle aspiration cyology (FNA). According to WHO, PTMC is defined as a papillary thyroid cancer of 1 cm or less in diameter. Within the group of patients with PTMC, prognosis is known to be very favorable. This study was carried out to evaluate the clinicohistological characteristics of PTMC and to determine a reasonable extent of surgery for them. Methods: From Mar. 2002 to Dec. 2007, 610 patients with thyroid diseases underwent thyroidectomy at Chosun University hospital. Among these patients, 205 patients (33%) had a thyroid papillary carcinoma less than or equal to 1 cm in great diameter. The clinicopathologic features and treatment outcome of these patients were evaluated retrospectively. Results: In the period 2002-2007, PTMC incidence rate in our institution increased from 10% to 20%. There were 19 men and 186 women with a median age of 46 years (range; 16-74). PTMC diameter ranged from 0.1 to 1 cm. (mean 0.54 cm) 15.7% of patients with PTMC presented with preoperative symptoms (palpable mass, fatigue, pain, hoarseness). Preoperatively 84.3% of these 205 cases were diagnosed by ultrasonography. We performed unilateral lobectomy (41%), near total thyroidectomy (44%), and total thyroidectomy (11%) with or without central compartment neck node dissection. During a mean follow-up of 36 months, 5 patients (2.4%) developed locoregional recurrence with no distant metastasis. There were no significant difference on recurrence rate by size, capsular invasion. But multiplicity of primary tumor has a higher locoregional recurrence rate (p= 0.04). The detection rate of PTMC is increasing due to FNA technique in our hospital. This study shows that PTMC may have capsular invasion, lymph node involvement, multiplicity and locoregional recurrence likely to larger (>1 cm) papillary carcinoma. Conclusion: We suggest that total or near total thyroidectomy with central compartment neck dissection is proper therapeutic operation for PTMC and modified neck dissection shoud be performed if lateral neck lymph node are enlarged or diagnosed as metastatic tumor.