Document Type : Review Article
Authors
1 Dept. of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Thrombosis Hemostasis Research Center, Tehran University of Medical Sciences, Tehran, Iran
3 Dept. of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
4 Central Library, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Thyroid carcinoma is the most common malignancy of the endocrine system. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for 70–90% of well-differentiated thyroid malignancies. Thyroid papillary microcarcinoma is a subtype of papillary carcinoma that included tumors with less than 10mm diameter. As a result of diagnostic methods improvement, prevalence of this tumor is increasing. In this study we reviewed different characteristics of tumor. Methods: We searched various factors about this tumor in different databases (PubMed, Ovid, Google scholar, Iran medex and SID databases,July 2012 till August 2013), after that the articles were classified. Data of each article were extracted and sorted in tables.Data of each factor in different articles were summarized. Results:Etiology, clinical presentation, prognosis, histopathology, follow-up, diagnosis and also age, gender, tumor size and treatment were factors about this tumor described in details here. Conclusion: Awareness and better understanding of the characteristics of this tumor and manage it as an individual and valuable tumor can take an effective step in promoting public health practice.
Keywords
Goldman L, Ausiello DA. Cecil Medicine. 23rd ed. Saunders Elsevier Publishers; 2007.
Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill Publishers; 2012.
Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, et al. Papillary Thyroid Microcarcinoma: Extrathyroidal Extension, Lymph Node Metastases, and Risk Factors for Recurrence in a High Prevalence of Goiter Area. World J Surg 2010: 34: 1214-21.
Yang GCH, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: Fine-needle aspiration diagnosis and histologic follow-up. IJSP 2002: 10: 133-9.
Wang Y, Li L, Wang YX, Feng XL, Zhao F, Zou SM, et al. Ultrasound findings of papillary thyroid microcarcinoma: A review of 113 consecutive cases with histopathologic correlation. Ultrasound Med Biol 2012 Oct;38(10):1681-8.
Moon HJ, Son E, Kim EK, Yoon JH, Kwak JY. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol 2012: 19: 52-9.
Page C, Biet A, Boute P, Cuvelier Ph, Strunski V. Aggressive papillary’ thyroid microcarcinoma. Eur Arch Otorhinolaryngol 2009 Dec;266(12):1959-63.
Novosel T, Ritter HE, Gupta M, Harvey A, Mitchell J, Berber E, et al. Detection of circulating thyroid cancer cells in patients with thyroid microcarcinomas. Surgery 2009: 146: 1081-9.
Goldust M, Samankan S, Sokouti M, Fakhrjoo A. A clinical epidemiologic study of thyroid carcinoma in patients under 25 years old in Tabriz, Iran (1995-2010). JPMA 2012: 62: 1265.
Larijani B, Aghakhani S, Haghpanah V, Mosavi-Jarrahi A, Bastanhagh MH. Review in thyroid cancer in Iran. Austral-Asian J Cancer 2005: 4(4): 199-203.
Arora N, Turbendian HK, Kato MA, Moo TA, Zarnegar R, Fahey TJ. Papillary Thyroid Carcinoma and Microcarcinoma: Is There a Need to Distinguish the Two? Thyroid 2009: 19(5): 473-77.
Törüner FB, Altinova AE, Taneri F, Aktürk M, Atasever T, Poyraz A, et al. Management of Papillary Thyroid Microcarcinomas: Our Clinical Experience. Turk Jem 2006: 3: 53-6.
Yun M, Noh TW, Cho A, Choi YJ, Hong SW, Park CS, et al. Visually discernible (18F)fluorodeoxyglucose uptake in papillary thyroid microcarcinoma: A potential new risk factor. J Clin Endocrinol Metab 2010: 95: 3182-8.
Lim YC, Choi EC, Yoon YH, Kim EH, Koo BS. Central lymph node metastases in unilateral papillary thyroid microcarcinoma. Br J Surg 2009 Mar;96(3):253-7.
Zafon C, Baena JA, Castellví J, Obiols G, Monroy G, Mesa J.Differences in the Form of Presentation between Papillary Microcarcinomas and Papillary Carcinomas of Larger Size. J Thyroid Res 2010 Dec 14;2011:639156.
Page C, Biet A, Boute P, Cuvelier Ph, Strunski V.Aggressive papillary’ thyroid microcarcinoma. Eur Arch Otorhinolaryngol 2009: 266: 1959-63.
Tzvetov G, Hirsch D, Slutzky IS, Weinstein R, Manistersky Y, Kalmanovich R, et al. Well-differentiated thyroid carcinoma: comparison of microscopic and macroscopic disease. Thyroid 2009: 19(5):487-94.
Kim YW, Wang SG, Lee JC, Lee BJ, Lee JW, Kim YK, et al. Clinically Related Factors and Features of Central Compartment Neck Lymph Nodes in Thyroid Micropapillary Carcinoma. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:232-6.
Chung YS, Kim JY, Bae JS, Song BJ, Kim JS, Jeon HM, et al.Lateral Lymph Node Metastasis in Papillary Thyroid Carcinoma: Results of Therapeutic Lymph Node Dissection. Thyroid 2009: 19: 241-6.
Garrel R, Tripodi C, Cartier C, Makeieff M, Crampette L, Guerrier B.Cervical lymphadenopathies signaling thyroid microcarcinoma. Case study and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2011 Jun;128(3):115-9.
Koo BS, Lim HS, Lim YC, Yoon YH, Kim YM, Park YH, et al. Occult Contralateral Carcinoma in Patients with Unilateral Papillary Thyroid Microcarcinoma. Ann Surg Oncol 2010: 17: 1101-5.
Kim HS, Choi YJ, Yun JS. Features of Papillary Thyroid Microcarcinoma in the Presence and Absence of Lymphocytic Thyroiditis. Endocr Pathol 2010 Sep;21(3):149-53.
Gerschpacher M, Göbl C, Anderwald C, Gessl A, Krebs M. Thyrotropin Serum Concentrations in Patients with Papillary Thyroid Microcancers. Thyroid 2010: 20: 389-92.
Bayraktaroglu T, Boztepe H, Kapran Y, Tanakol R, Alagöl F. Fas Ligand (FasL, Apo-1L / CD95L) Expression and Clinical Outcome in Papillary Microcarcinoma and Papillary Thyroid Carcinomas with Diameter Smaller than 1.5 Centimeters. Exp Clin Endocrinol Diabetes 2010 Aug;118(8):537-43.
Zheng X, Wei S, Han Y, Li Y, Yu Y, Yun X, et al. Papillary Microcarcinoma of the Thyroid: Clinical Characteristics and BRAFV600E Mutational Status of 977 Cases. Ann Surg Oncol 2013: 20: 2266-73.
Yang GCH, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: Fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol 2002 Apr;10(2):133-9.
Wang Y, Li L, Wang YXJ, Feng XL, Zhao F, Zou SM, et al.Ultrasound findings of papillary thyroid microcarcinoma: A review of 113 consecutive cases with histopathologic correlation. Ultrasound Med Biol 2012 Oct;38(10):1681-8.
Lin JD, Huang BY, Chang HY. Clinical experience in the diagnosis of 127 papillary thyroid microcarcinomas. Endocr Relat Cancer1998: 5: 239-45.
Tanriover O, Comunoglu N, Eren B, Comunoglu C, Turkmen N, Dogan M, et al. Occult papillary thyroid carcinoma: prevalence at autopsy in Turkish people. Eur J Cancer Prev 2011 Jul;20(4):308-12.
Moon HJ, Son E, Kim EK, Yoon JH, Kwak JY. The diagnostic values of ultrasound and ultrasound-guided fine needle aspiration in subcentimeter-sized thyroid nodules. Ann Surg Oncol 2012: 19: 52-9.
Marchetti I, Iervasi G, Mazzanti CM, Lessi F, Tomei S, Naccarato AG, et al. Detection of the BRAFV600E Mutation in Fine Needle Aspiration Cytology of Thyroid Papillary Microcarcinoma Cells Selected by Manual Macrodissection: An Easy Tool to Improve the Preoperative Diagnosis. Thyroid 2012: 22(3): 292-8.
Zafon C, Baena JA, Castellvi J, Obiols G, Monroy G, Mesa J. Differences in the Form of Presentation between Papillary Microcarcinomas and Papillary Carcinomas of Larger Size. J Thyroid Res. 2010;2011:639156.
Törüner FB, Altinova AE, Taneri F, Aktürk M, Atasever T, Poyraz A., et al.Management of Papillary Thyroid Microcarcinomas: Our Clinical Experience. Turk Jem 2006: 3: 53-6.
Tong J1, Wang Y, Da JP.Usefulness of CK19, HBME-1 and galectin-3 expressions in differential diagnosis of thyroid papillary microcarcinoma from benign lesions. Zhonghua Zhong Liu Za Zhi 2011 Aug;33(8):599-604.
Batistatou A, Charalabopoulos K, Nakanishi Y, Vagianos C, Hirohashi S, Agnantis NJ, et al. Differential Expression of Dysadherin in Papillary Thyroid Carcinoma and Microcarcinoma: Correlation with E-cadherin. Endocr Pathol 2008: 19: 197-202.
Lee NS, Bae JS, Jeong SR, Jung CK, Lim DJ, Park WC, et al. Risk Factors of Lymph Node Metastasis in Papillary Thyroid Microcarcinoma. J Korean Surg Soc 2010: 78: 82-6.
Pisello F, Geraci G, Sciumè C, Li Volsi F, Modica G.Total thyroidectomy of choice: papillary microcarcinoma. G Chir 2007 Jan-Feb;28(1-2):13-9.
Xu YN, Wang JD. Surgical treatment of incidental and non-incidental papillary thyroid microcarcinoma. G Chir 2010: 31: 205-9.
Sorrentino F, Atzeni J, Romano G, Buscemi G, Romano M. Differentiated microcarcinoma of the thyroid gland. G Chir 2010: 31: 277-8.
Novosel T, Ritter HE, Gupta M, Harvey A, Mitchell J, Berber E, et al. Detection of circulating thyroid cancer cells in patients with thyroid microcarcinomas. Surgery 2009: 146: 1081-9.
Hayashi Y, Lagarde F, Tsuda N, Funamoto S, Preston DL, Koyama K, et al. Papillary Microcarcinoma of the Thyroid Among Atomic Bomb Survivors. Cancer 2010: 116: 1646-55.
Corvi R, Alfaro MM, Harach HR, Zini M, Papotti M, Romeo G. Frequent RET Rearrangements in Thyroid Papillary Microcarcinoma Detected by Interphase Fluorescence In Situ Hybridization. Lab Invest 2001: 81: 1639-45.
Kovács GL, Gonda G, Vadász G, Ludmány É, Uhrin K, Görömbey Z, et al.Epidemiology of Thyroid Microcarcinoma Found in Autopsy Series Conducted in Areas of Different Iodine Intake. Thyroid 2005: 15:152-7.
Virk RK, Van Dyke AL, Finkelstein A, Prasad A, Gibson J, Hui P,et al. BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation. Mod Pathol 2013 Jan;26(1):62-70.
Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three Distinctly Different Kinds of Papillary Thyroid Microcarcinoma should be Recognized: Our Treatment Strategies and Outcomes. World J Surg 2010: 34: 1222-31.
Lin JD, Kuo SF, Chao TC, Hsueh C.Incidental and Nonincidental Papillary Thyroid Microcarcinoma. Ann Surg Oncol 2008 Aug;15(8):2287-92.
Besic N, Zgajnar J, Hocevar M, Petric R. Extent of Thyroidectomy and Lymphadenectomy in 254 Patients With Papillary Thyroid Microcarcinoma: A Single-Institution Experience. Ann Surg Oncol 2009: 16: 920-8.
Zhou YL, Gao EL, Zhang W, Yang H, Guo GL, Zhang XH,et al. Factors predictive of papillary thyroid micro-carcinoma with bilateral involvement and central lymph node metastasis: a retrospective study. World J Surg Oncol 2012 May 19;10:67.
Durante C, Attard M, Torlontano M, Ronga G, Monzani F, Costante G, et al. Identification and Optimal Postsurgical Follow-Up of Patients with Very Low-Risk Papillary Thyroid Microcarcinomas. J Clin Endocrinol Metab 2010: 95: 4882-88.
Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S, et al. Patients with papillary microcarcinoma that extends into soft tissues or is metastatic to locoregional lymph nodes are at high risk for persistent or recurrent disease. Thyroid 2009: 19: 1-10.
Creach KM, Siegel BA, Nussenbaum B, Grigsby PW.Radioactive iodine therapy decreases recurrence in thyroid papillary microcarcinoma. ISRN Endocrinol 2012;2012:816386.
Ross DS, Litofsky D, Ain KB, Bigos T, Brierley JD, Cooper DS, et al.Recurrence after treatment of micropapillary thyroid cancer. Thyroid 2009: 19: 1043-8.
Haymart MR, Cayo M, Chen H. Papillary thyroid microcarcinomas: Big decisions for a small tumor. Ann Surg Oncol 2009: 16: 3132-9.
Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S, 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: 707-6.
Dănilă R, Grigorovici A, Ionescu L, Popovici R, Huţanu I, Ungureanu MC, et al. Thyroid Papillary Microcarcinoma Incidentally Found Following Thyroidectomies for Benignant Diseases. Chirurgia 2008: 4: 273-80.
Buffet C, Golmard JL, Hoang C, Trésallet C, Du Pasquier Fédiaevsky L, Fierrard H,et al. Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma. Eur J Endocrinol 2012 Aug;167(2):267-75.
Vlassopoulou B, Vryonidou A, Ioannidis D, Koletti A, Klonaris N, Katsoulis C, et al. Long term follow-up and outcome in thyroid papillary microcarcinoma. Endocrine Abstracts 2011: 26: 477.
Kim HJ, Kim NK, Choi JH, Kim SW, Jin SM, Suh S, et al. Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma. Clin Endocrinol 2013: 78: 614-20.
So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: Influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery 2012: 151: 192-8.
Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al.Clinical Significance of Metastasis to the Central Compartment from Papillary Microcarcinoma of the Thyroid. World J Surg 2006: 30: 91-9.
Londero SC, Krogdahl A, Bastholt L, Overgaard J, Trolle W, Pedersen HB, et al. Papillary Thyroid Microcarcinoma in Denmark 1996–2008: A National Study of Epidemiology and Clinical Significance. Thyroid 2013: 23: 1159-64.
Pennelli N, Pennelli G, Merante Boschin I, Pelizzo MR. Thyroid intrafollicular neoplasia (TIN) as a precursor of papillary microcarcinoma. Ann Ital Chir. 2005 May-Jun;76(3):219-24.
Friguglietti CU, Dutenhefner SE, Brandão LG, Kulcsar MA.Classification of papillary thyroid microcarcinoma according to size and fine-needle aspiration cytology: behavior and therapeutic implications. Head Neck 2011 May;33(5):696-701.
Pakdaman MN, Rochon L, Gologan O, Tamilia M, Garfield N, Hier MP,et al.Incidence and histopathological behavior of papillary microcarcinomas: Study of 429 cases. Otolaryngol Head Neck Surg 2008 Nov;139(5):718-22.
Koperek O, Asari R, Niederle B, Kaserer K.Desmoplastic stromal reaction in papillary thyroid microcarcinoma. Histopathology 2011 May;58(6):919-24.
Cvejic D, Selemetjev S, Savin S, Paunovic I, Petrovic I, Tatic S. Apoptosis and proliferation related molecules (Bcl-2, Bax, p53, PCNA) in papillary microcarcinoma versus papillary carcinoma of the thyroid. Pathology 2008: 40: 475-80.
Corapcioglu D, Sak SD, Delibasi T, Tonyukuk V, Kamel N, Uysal AR, Kocak S, et al.Papillary microcarcinomas of the thyroide gland and immunohistochemical analysis of expression of p53 protein in papillary microcarcinomas. J Transl Med 2006 Jul 5;4:28.
Akin S, Akin S, Aksoy DY, Bayraktar M. clinicopathological characteristics of patients with thyroid papillary microcarcinoma: preliminary results. Endocrine Abstracts 2012: 29: 1766.
Yang GC, LiVolsi VA, Baloch ZW. Thyroid microcarcinoma: fine-needle aspiration diagnosis and histologic follow-up. Int J Surg Pathol 2002: 10: 133-9.
Siassakos D, Gourgiotis S, Moustafellos P, Dimopoulos N, Hadjiyannakis E.Thyroid microcarcinoma during thyroidectomy. Singapore Med J. 2008 Jan;49(1):23-5.
Fardella C, Jiménez M, González H, León A, Goñi I, Cruz F, et al. Pathological characteristics of thyroid microcarcinoma. A review of 402 biopsies. Rev Méd Chile 2005: 133: 1305-10.
Lin KL, Wang OC, Zhang XH, Dai XX, Hu XQ, Qu JM. The BRAF mutation is predictive of aggressive clinicopathological characteristics in papillary thyroid microcarcinoma. Ann Surg Oncol 2010: 17: 3294-3300.
Neuhold N, Schultheis A, Hermann M, Krotla G, Koperek O, Birner P. Incidental papillary microcarcinoma of the thyroid-further evidence of a very low malignant potential: A retrospective clinicopathological study with up to 30 years of follow-up.Ann Surg Oncol 2011: 18: 3430-6.
Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M, et al. Papillary Thyroid Microcarcinoma: Extrathyroidal Extension, Lymph Node Metastases, and Risk Factors for Recurrence in a High Prevalence of Goiter Area. World J Surg 2010: 34: 1214-21.
Roh JL, Kim JM, Park CI.Central Cervical Nodal Metastasis from Papillary Thyroid Microcarcinoma: Pattern and Factors Predictive of Nodal Metastasis. Ann Surg Oncol 2008 Sep;15(9):2482-6.
Moon HJ, Kim EK, Yoon JH, Kwak JY. Clinical Implication of Elastography as a Prognostic Factor of Papillary Thyroid Microcarcinoma. Ann Surg Oncol 2012: 19: 2279-87.
Lee SH, Lee SS, Jin SM, Kim JH, Rho YS. Predictive Factors for Central Compartment Lymph Node Metastasis in Thyroid Papillary Microcarcinoma. Laryngoscope 2008: 118: 659-62.
Min HS, Choe G, Kim SW, Park YJ, Park do J, Youn YK, et al.S100A4 expression is associated with lymph node metastasis in papillary microcarcinoma of the thyroid. Mod Pathol 2008 Jun;21(6):748-55.
Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY. Minimal extrathyroidal extension in patients with papillary thyroid microcarcinomas: Is it a real prognostic factor?. Ann Surg Oncol 2011: 18: 1916-23.
Kim BY, Jung CH, Kim JW, Lee SW, Kim CH, Kang SK, et al. Impact of Clinicopathologic Factors on Subclinical Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma. Yonsei Med J 2012: 53(5): 924-30.
Connor MP, Wells D, Schmalbach CE.Variables Predictive of Bilateral Occult Papillary Microcarcinoma Following Total Thyroidectomy. Otolaryngol Head Neck Surg 2011 Feb;144(2):210-5.
Ardito G, Revelli L, Giustozzi E, Salvatori M, Fadda G, Ardito F, et al. Aggressive papillary thyroid microcarcinoma: prognostic factors and therapeutic strategy. Clin Nucl Med 2013: 38: 25-8.
Czarniecka A, Wloch J, Lange D.Clinical picture of differentiated thyroid carcinoma in the T1 stage. Wiad Lek 2001: 54: 225-33.
Byun BH, Jeong UG, Hong SP, Min JJ, Chong A, Song HC, et al. Prediction of central lymph node metastasis from papillary thyroid microcarcinoma by 18F-fluorodeoxyglucose PET/CT and ultrasonography. Ann Nucl Med 2012: 26: 471-7.
Bo YH, Ahn HY, Lee YH, Lee YJ, Kim JH, Ohn JH, et al. Malignancy Rate in Sonographically Suspicious Thyroid Nodules of Less than a Centimeter in Size Does Not Decrease with Decreasing Size. J Korean Med Sci 2011: 26: 237-42.
Pelizzo MR, Boschin IM, Toniato A, Piotto A, Bernante P, Pagetta C, et al. Papillary thyroid microcarcinoma (PTMC): Prognostic factors, management and outcome in 403 patient. EJSO 2006: 32: 1144-8.
Kuo SF, Chao TC, Chang HY, Hsueh C, Yang CH, Lin JD. Prognostic Evaluation of Patients With Multicentric Papillary Thyroid Microcarcinoma. J Formos Med Assoc 2011: 110(8): 511-7.
Giordano D, Gradoni P, Oretti G, Molina E, Ferri T. Treatment and prognostic factors of papillary thyroid microcarcinoma. Clin Otolaryngol 2010: 35: 118-24.
Sethom A, Riahi I, Riahi K, Akkari K, Benzarti S, Miled I, et al. Care of thyroid microcarcinoma. About 13 cases. La Tunisie Medicale 2011: 89: 23-5.
Kwak JY, Kim EK, Chung WY, Moon HJ, Kim MJ, Choi JR.. Association of BRAFV600E Mutation with Poor Clinical Prognostic Factors and US Features in Korean Patients with Papillary Thyroid Microcarcinoma. Radiology 2009: 253(3): 854-60.
Kim TY, Hong SJ, Kim JM, Kim WG, Gong G, Ryu JS, et al.Prognostic parameters for recurrence of papillary thyroid microcarcinoma. BMC Cancer 2008: 8: 296.
Antonaci A, Consorti F, Mardente S, Natalizi S, Giovannone G, Della Rocca C.Survivin and cyclin D1 are jointly expressed in thyroid papillary carcinoma and microcarcinoma. Oncol Rep 2008 Jul;20(1):63-7.
Friguglietti CUM, Kulcsar MAV. Thyroid Microcarcinoma: Experience and Management in Private Clinic. Arq Bras Endocrinol Metab 2007: 51(5): 774-82.
Caliskan M, Park JH, Jeong JS, Lee CR, Park SK, Kang SW,et al.Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma. Endocr J 2012;59(4):305-11.
Kwak JY, Kim EK, Kim MJ, Son EJ, Chung WY, Park CS, et al. Papillary Microcarcinoma of the Thyroid: Predicting Factors of Lateral Neck Node Metastasis. Ann Surg Oncol 2009: 16: 1348-55.
Kim KE, Kim EK, Yoon JH, Han KH, Moon HJ, Kwak JY. Preoperative Prediction of Central Lymph Node Metastasis in Thyroid Papillary Microcarcinoma Using Clinicopathologic and Sonographic Features. World J Surg 2013: 37: 385-91.
Zhao Q, Ming J, Liu C, Shi L, Xu X, Nie X, et al. Multifocality and Total Tumor Diameter Predict Central Neck Lymph Node Metastases in Papillary Thyroid Microcarcinoma. Ann Surg Oncol 2013: 20: 746-52.
Rossi ED, Martini M, Capodimonti S, Lombardi CP, Pontecorvi A, Vellone VG, et al. BRAF (V600E) Mutation Analysis on Liquid-Based Cytology-Processed Aspiration Biopsies Predicts Bilaterality and Lymph Node Involvement in Papillary Thyroid Microcarcinoma. Cancer Cytopathol 2013 Jun;121(6):291-7.
Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient Age Is Significantly Related to the Progression of Papillary Microcarcinoma of the Thyroid Under Observation. Thyroid 2013: 24(1): 27-34.
)