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It is estimated that there will be 23,600 new cases of thyroid cancer in the United States in 2004, and 1,460 thyroid cancer deaths (1). Papillary thyroid cancer accounts for approximately 85% of thyroid tumors in the United States and other iodine-sufficient countries (2). The U.S. incidence of papillary thyroid cancers overall has increased over the past several decades (3). It is estimated that in recent years, as the use of thyroid ultrasound and other neck imaging modalities has increased, nodules too small to be palpated are more often discovered, and papillary thyroid microcarcinomas, defined by the World Health Organization as less than 1.0 cm in size (4), are being identified with greater frequency (5, 6). Papillary thyroid microcarcinomas are also frequently identified incidentally at surgery for benign thyroid disorders.

Overall, clinical outcomes for patients with papillary thyroid carcinoma are excellent. Although autopsy studies have shown that occult papillary thyroid carcinoma is present in 1–36% of patients (7), thyroid cancer accounts for only 0.3% of cancer deaths in the United States annually (1), and the cause-specific 10-yr survival rate for papillary thyroid carcinoma is 93% (8). However, papillary thyroid carcinoma remains the cause of mortality or substantial morbidity in a small subset of patients. Various staging systems have been designed to try to identify the patients with papillary carcinoma who are most likely to have poor outcomes (9). Tumor size has traditionally been viewed as an important prognostic factor, with papillary carcinomas less than 1–2 cm in size considered to be associated with lower risk. Within the group of patients with papillary microcarcinoma, prognostic factors have not been well defined.

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