Surgical treatment of papillary thyroid carcinoma.

Papillary carcinoma accounts for 85% of differentiated thyroid cancers. We witness a yearly increased incidence and this is may be, in part, due to the increasing use of neck ultrasonography. Certain histologic subtypes of papillary carcinoma have a worse prognosis related to vascular invasion, invasion into extrathyroidal tissues, extensive tumor necrosis and/or mitoses. Adequate surgery is the most important treatment variable influencing prognosis, while radioactive iodine treatment, TSH suppression, and external beam irradiation each play adjunctive roles in at least some patients. Numerous schemes have been developed in an effort to achieve more accurate risk factor stratification. Each of the schemes allows accurate identification of the majority (70-85%) of patients at low risk of mortality (T1-3, M0 patients), allowing the follow-up and management of these patients to be less intensive than the higher-risk minority (T4 and M1 patients), who may benefit from a more aggressive management strategy. Overall 5- and 20-year survival in the low-risk group was 100% and 99% respectively. However, the survival in the high-risk group dropped to almost 72% and 57% respectively.