Classification of papillary thyroid microcarcinoma according to size and fine‐needle aspiration cytology: Behavior and therapeutic implications

Friguglietti, Celso U. M.; Dutenhefner, Simone Elisa; Brandão, Lenine Garcia; Kulcsar, Marco Aurélio Vamondes

doi:10.1002/hed.21517

Cited by 26 publications

(20 citation statements)

References 36 publications

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“…Several authors have reported that PTMCs that have >5 mm in size had a higher incidence of lymph node involvement, capsule invasion and multifocality, compared with those ≤5 mm [29,36], whereas other studies have shown no differences [37]. In our study we demonstrated that tumor size (< or ≥5 mm) was an independent risk factor for extrathyroidal extension.…”

Section: Discussioncontrasting

confidence: 44%

“…The increasing number of thyroid echography, more or less controlled, the increasing number of total thyroidectomies performed for multinodular goiter and a more careful sampling of the thyroid specimens are among the most important factors to be considered [2,5,[7][8][9]. Population-level data supports this hypothesis, by correlating the increasing thyroid cancer incidence to the increasing use of thyroid ultrasound and fine needle aspiration (FNA), that were introduced in the early 1980s for thyroid cancer diagnosis [2,4,36]. Udelsman et al have showed that 57% and 49% of the variability in the USA state-level incidence of thyroid cancer for males and females, respectively, can be explained by the regional variation in the density of endocrinologists, general surgeons and employment of cervical ultrasonography [10].…”

Section: Discussionmentioning

confidence: 99%

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Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan

Boilă

Paşcanu

et al. 2016

Acta Medica Marisiensis

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Background: Papillary thyroid microcarcinoma (PTMC) defines a group of papillary thyroid carcinomas, incidentally discovered, measuring 1 cm or less. The aim of our study was to evaluate the incidence and the pathological characteristics of PTMCs in our institution in the last 25 years, with special emphasis on the prognostic factors related to PTMCs. Material and methods: We performed a retrospective, cohort study on 255 PTMCs, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and 2014. Results: A significant increase in the incidence of PTMCs was observed in the 2004-2014 period, compared to 1990-2003 (7.6%, 229 PTMCs/3005 thyroid specimens vs. 1.2%, 23 PTMCs/1885 thyroid specimens). Conventional PTMCs accounted for most of PTMC cases (n=123 cases, 48.2%), followed by the follicular variant of PTC (n=117 cases, 45.9%). The increasing incidence of PTMCs was associated with a significant increase in the routine number of blocks sampled per case over the study period (R2 =0.72, p < 0.001). By means of the univariate and multivariate analysis, three risk factors were predictive for extrathyroidal extension in PTMCs: multifocality (Odds ratio [OR] 4.97, p-0.002), tumor size ≥ 5mm (OR 8.97, p-0.008) and lymph node involvement (OR 17.66 p<0.005). Conclusion: The incidence of PTMCs has revealed a significant increasing trend in our institution over the last 25 years. Multifocality, lymph node involvement and tumor size ≥ 5mm were found to be risk factors for extrathyroidal extension. These prognostic factors must be evaluated and clearly mentioned in the pathological report, to help a correct estimation of biological potential of the lesion and an appropriate postoperative management.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan

Boilă

Paşcanu

et al. 2016

Acta Medica Marisiensis

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“…In a previous study of mPTC tumors, multifocality was found in 15% to 16% of tumors (23). In our study, we found multifocality in 35% of mFVPTC tumors and 32% of mPTC tumors.…”

Section: Discussionmentioning

confidence: 87%

Distinguishing classical papillary thyroid microcancers from follicular-variant microcancers

Singhal

Sippel

Chen

2014

Journal of Surgical Research

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Background Papillary thyroid microcarcinomas (mPTC), tumors less than or equal to 1 centimeter, have been considered the same clinical entity as follicular-variant thyroid microcarcinomas (mFVPTC). The purpose of this study was to use population-level data to characterize differences between mFVPTC and mPTC. Materials & Methods We identified adult patients diagnosed with mFVPTC or mPTC between 1998 and 2010 in the Surveillance, Epidemiology, and End Results (SEER) database. Binary comparisons were made with the student’s t-test and chi-squared test. Multivariate logistic regression was used to further analyze lymph node metastases and multifocality. Results Of the 30,926 cases, 8,697 (28.1%) were mFVPTC. Multifocal tumors occurred with greater frequency in the mFVPTC group compared to the mPTC group (35.4% vs. 31.7%, p<0.01). Multivariate logistic regression indicated that patients with mFVPTC had a 26% increased risk of multifocality (OR = 1.26, 95% CI 1.2–1.4, P<0.01). In contrast, lymph node metastases were nearly twice as common in the mPTC group compared to the mFVPTC group (6.8% vs. 3.6%, p<0.01). Multivariate logistic regression confirmed that patients with mPTC had a 69% increased risk of lymph node metastases compared to patients with mFVPTC (OR 1.69, 95% CI 1.4–2.0, p<0.01). Conclusions Multifocality is not unique to classical mPTC and occurs more often in mFVPTC. The risk of lymph node metastases is greater for mPTC than mFVPTC. The surgeon should be aware of these features as they may influence the treatment for these microcarcinomas.

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“…As ultrasound-guided FNA has been widely accepted as a diagnostic modality for small thyroid nodules, the incidence of PMC has increased steadily [31]. However, PMC could be a confusing factor in thyroid FNA.…”

Section: Discussionmentioning

confidence: 99%

Reclassifying Formerly Indeterminate Thyroid FNAs Using the Bethesda System Reduces the Number of Inconclusive Cases

Song

Chu²,

Kim³

et al. 2012

Acta Cytologica

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Objective: To evaluate the effectiveness of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and to analyze the causes of unclear diagnoses following BSRTC adoption. Study Design: According to the BSRTC, we reclassified cytologic samples originally diagnosed as ‘indeterminate’ with sequential surgical resection. Then, we analyzed the causes of cases, which were recategorized as ‘atypia undetermined significance/follicular lesion of undetermined significance (AUS/FLUS)’. Results: According to the BSRTC, 154 ‘indeterminate’ cases were reclassified as follows: unsatisfactory, n = 5 (3.2%); benign, n = 43 (27.9%); AUS/FLUS, n = 77 (50.0%); suspicious for a follicular neoplasm, n = 7 (7.1%); suspicious for a Hürthle cell neoplasm, n = 4 (2.6%); suspicious for malignancy, n = 15 (9.7%), and malignancy, n = 3 (1.9%). Then, the AUS/FLUS group was analyzed according to the scenarios proposed by the BSRTC. Fifty-nine (58.9%) cases of AUS/FLUS were due to suboptimal preparation. In addition, papillary microcarcinoma and coexisting Hashimoto’s thyroiditis caused inconclusive diagnoses. Conclusion: The BSRTC can be easily applied to thyroid fine-needle aspiration. We were able to reclassify indeterminate thyroid nodules into more detailed categories and thus reduce the number of cases classified as indeterminate. However, suboptimal preparation, papillary microcarcinoma, and coexisting Hashimoto’s thyroiditis precluded cytopathologists from making definitive diagnoses.

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Classification of papillary thyroid microcarcinoma according to size and fine‐needle aspiration cytology: Behavior and therapeutic implications

Abstract: The diagnosis of papillary carcinoma using the preoperative biopsy enables a more precise oncological procedure with greater chance of biological cure.

Cited by 26 publications

References 36 publications

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Distinguishing classical papillary thyroid microcancers from follicular-variant microcancers

Reclassifying Formerly Indeterminate Thyroid FNAs Using the Bethesda System Reduces the Number of Inconclusive Cases

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