eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Thyroid, Papillary Carcinoma, Early: Workup

Author: Eric J Lentsch, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina College of Medicine
Coauthor(s): M Boyd Gillespie, MD, MS, FACS, Associate Professor, Department of Otolaryngology, Associate Member of College of Graduate Studies, Medical University of South Carolina; Director, Medical University of South Carolina Snoring Clinics; Surgical Consultant, Medical University of South Carolina Sleep Disorders Center; John C Goddard, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina; Christina ST Wilhoit, EMT, CCRP, Program Coordinator for Head and Neck Surgery Clinical Trials, Department of Otolaryngology, Hollings Cancer Center, Medical University of South Carolina; Zoran Rumboldt, MD, Associate Professor, Department of Radiology, Medical University of South Carolina; Rana S Hoda, MD, FIAC, Professor of Pathology, Attending Pathologist and Director of Cytopathology, University of Rochester Medical Center; Allen O Mitchell, MD, Chairman, Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth; Kenneth M Spicer, MD, PhD, Professor of Radiology with Tenure, Director of Nuclear Medicine Residency, Medical Director of Radiology Informatics, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Apr 24, 2009

Workup

Laboratory Studies

  • Fine-needle aspiration is one of the mainstays of preoperative diagnosis of papillary carcinoma of the thyroid. The use of fine-needle aspiration cytology can increase the diagnostic accuracy of thyroid malignancy cases to 92%.
  • Serum thyroglobulin level can be used as a postoperative tumor marker for well-differentiated thyroid cancer (ie, papillary, follicular).
  • Two-dimensional gel electrophoresis has also been used as a diagnostic tool to identify tumor-specific proteins from well-differentiated thyroid cancers, but this technique is still being investigated.

Imaging Studies

  • Ultrasonography: Cervical ultrasonography with fine needle aspiration cytology is the mainstay of the preoperative diagnosis of carcinoma of the thyroid.
  • Iodine-131 scans and CT scans occasionally reveal cold thyroid nodules, requiring a follow up ultrasound and fine-needle aspiration. Similarly,18 F-fluorodeoxyglucose (FDG) avid nodules incidentally found on PET scans are occurring with increasing frequency and may require similar clarification.
  • PET with FDG depicts many malignancies, including thyroid cancers.6 The role of FDG-PET scanning in differentiated thyroid cancer has been well described.7 Efforts to distinguish benign from malignant nodules remain controversial, and its expense precludes routine use when malignancy is first diagnosed.8,9
  • Undifferentiated thyroid carcinomas and recurrent or metastatic thyroid cancer my have decreased iodine-131 avidity and consequently present a diagnostic and therapeutic dilemma. In the setting of elevated thyroglobulins and a negative iodine-131 scan, FDG PET/CT offers improved sensitivity, frequently revealing abnormal, FDG avid lesions. Use of FDG-PET/CT during surgical planning for non-iodine avid recurrent disease has been shown significant benefit, especially when ultrasound is equivocal.
  • PET and PET/CT: In addition to data in the literature demonstrating accurate detection of thyroid cancer by PET, one study has hinted that PET may play a role in the management of patients with inconclusive cytologic diagnosis of a thyroid nodule. In this study, PET reduced the number of negative hemithyroidectomies by 66%. Whether the sensitivity of PET and its cost outweighs the costs and risks associated with thyroid surgery have yet to be determined.

Histologic Findings

See Pathophysiology.

Staging

Tumor, node, and metastasis (TNM) for papillary carcinoma of the thyroid are classified as follows:

  • Primary tumor (T)
    • TX: Primary tumor cannot be assessed.
    • T0: No evidence of primary tumor is found.
    • T1: Tumor size is 2 cm or less in greatest dimension and is limited to the thyroid.
    • T2: Tumor size is greater than 2 cm but less than 4 cm, and tumor is limited to the thyroid.
    • T3: Tumor size is greater than 4 cm, and tumor is limited to the thyroid or any tumor with minimal extrathyroidal extension (extension to sternothyroid muscle of perithyroid soft tissues).
    • T4a: Tumor extends beyond the thyroid capsule and invades any of the following: subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve.
    • T4b: Tumor invades prevertebral fascia, mediastinal vessels, or encases the carotid artery.
  • Regional lymph nodes (N)
    • NX: Regional nodes cannot be assessed.
    • N0: No regional node metastasis is found.
    • N1a: Metastasis is found in level VI (pretracheal and paratracheal, including prelaryngeal and Delphian) lymph nodes.
    • N1b: Metastasis is found in unilateral, bilateral, or contralateral cervical or upper/superior mediastinal lymph nodes.
  • Distant metastasis (M)
    • MX: Distant metastasis cannot be assessed.
    • M0: No distant metastasis is found.
    • M1: Distant metastasis is present.

Stages of Papillary Carcinoma of the Thyroid

Open table in new window

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Table
 Younger Than 45 YearsAge 45 Years and Older
Stage IAny T, Any N, M0T1, N0, M0
Stage IIAny T, Any N, M1T2, N0, M0
Stage III T3, N0, M0, T1, T2, T3, N1a, M0
Stage IVa T1, T2, T3, N1b, M0, T4a, N0, N1, M0
Stage IVb T4b, any N, M0
Stage IVc Any T, any N, M1
 Younger Than 45 YearsAge 45 Years and Older
Stage IAny T, Any N, M0T1, N0, M0
Stage IIAny T, Any N, M1T2, N0, M0
Stage III T3, N0, M0, T1, T2, T3, N1a, M0
Stage IVa T1, T2, T3, N1b, M0, T4a, N0, N1, M0
Stage IVb T4b, any N, M0
Stage IVc Any T, any N, M1


More on Thyroid, Papillary Carcinoma, Early

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Workup: Thyroid, Papillary Carcinoma, Early
Treatment: Thyroid, Papillary Carcinoma, Early
Follow-up: Thyroid, Papillary Carcinoma, Early
Multimedia: Thyroid, Papillary Carcinoma, Early
References
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Further Reading

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Keywords

papillary carcinoma, thyroid carcinoma, thyroid carcinomas, papillary carcinomas, thyroid cancer, thyroid neoplasia, thyroid neoplasias, papillary and follicular carcinoma, thyroid tumor, thyroid tumors, diffuse sclerosing variant, Hürthle cell, oxyphilic cell, tall-cell carcinoma, columnar cell carcinoma, thyroid mass, thyroid masses, hemithyroidectomy, near-total thyroidectomy, thyroidectomy, modified radical neck dissection, ipsilateral radical neck dissection, psammoma bodies

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Contributor Information and Disclosures

Author

Eric J Lentsch, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina College of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

M Boyd Gillespie, MD, MS, FACS, Associate Professor, Department of Otolaryngology, Associate Member of College of Graduate Studies, Medical University of South Carolina; Director, Medical University of South Carolina Snoring Clinics; Surgical Consultant, Medical University of South Carolina Sleep Disorders Center
M Boyd Gillespie, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American College of Surgeons, American Head and Neck Society, American Medical Association, Johns Hopkins Medical and Surgical Association, Phi Beta Kappa, and South Carolina Medical Association
Disclosure: Nothing to disclose.

John C Goddard, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina
John C Goddard, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Christina ST Wilhoit, EMT, CCRP, Program Coordinator for Head and Neck Surgery Clinical Trials, Department of Otolaryngology, Hollings Cancer Center, Medical University of South Carolina
Disclosure: Nothing to disclose.

Zoran Rumboldt, MD, Associate Professor, Department of Radiology, Medical University of South Carolina
Zoran Rumboldt, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Bracco Grant/research funds Other

Rana S Hoda, MD, FIAC, Professor of Pathology, Attending Pathologist and Director of Cytopathology, University of Rochester Medical Center
Rana S Hoda, MD, FIAC is a member of the following medical societies: American Society for Clinical Pathology, American Society of Cytopathology, College of American Pathologists, College of American Pathologists, International Academy of Cytology, South Carolina Medical Association, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Allen O Mitchell, MD, Chairman, Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth
Allen O Mitchell, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Kenneth M Spicer, MD, PhD, Professor of Radiology with Tenure, Director of Nuclear Medicine Residency, Medical Director of Radiology Informatics, Medical University of South Carolina
Kenneth M Spicer, MD, PhD is a member of the following medical societies: American College of Nuclear Medicine, American College of Nuclear Physicians, American College of Radiology, Association of University Radiologists, Radiological Society of North America, Society of Nuclear Medicine, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

David J Terris, MD, FACS, Porubsky Professor and Chairman, Department of Otolaryngology, Medical College of Georgia
David J Terris, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, Federation of American Societies for Experimental Biology, International Association of Endocrine Surgeons, Phi Beta Kappa, Radiation Research Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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Disclosure: eMedicine Salary Employment

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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