Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus

Abstract

Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985 - 2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1) ; two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a suf fi cient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.