Management of incidental and non-incidental papillary thyroid microcarcinoma

Elliott, Michael; Gao, Kan; Gupta, Ruta; Chua, Elizabeth L.; Gargya, Ash; Clark, Jonathan R.

doi:10.1017/s0022215113000455

Cited by 19 publications

(23 citation statements)

References 25 publications

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“…Because we did not biopsy all small nodules with suspicious US features, we had detected fewer nonincidental TMC than the Ha et al reported. In the study of Elliott et al, supporting our results, ITMC was half of all TMC . Vasileiadis et al suspected clinically only 81 of 339 patients with TMC .…”

Section: Discussionsupporting

confidence: 86%

A cancer of undetermined significance: Incidental thyroid carcinoma

Evranos¹,

Polat

Cuhaci

et al. 2018

Diagnostic Cytopathology

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Introduction The incidence of thyroid cancer is increasing which can be attributed in part to improved ultrasonography (US) methods and increased detection of incidental thyroid carcinomas (ITC). We aimed to compare ITC with nonincidental thyroid carcinomas (NITC) in this study. Methods Retrospective analyses of 906 individual patients who were operated for benign and malignant thyroid disease and had a final histopathological diagnosis of thyroid carcinoma were enrolled in this study. Preoperative US examination and fine needle aspiration (FNA) biopsy results were evaluated. The tumor foci in thyroidectomy specimens that were not represented in preoperative US or FNA reports were classified as ITC. The tumor foci that match with the lesions defined in US or FNA results were classified as NITC. Results Final histology revealed ITC in 326 patients (36%) and NITC in 580 patients (64% Mean age was 51.7 ± 11.11 in ITC group and 48.15 ± 13.1 in NITC group (P < .001). In NITC group 322 (55.5%) of the patients were operated for suspicious cytology while only 29 (8.9%) of the patients in the ITC group were operated because of this indication (P < .001). There were 1301 cancer foci in histopathology specimens. Among all these cancer foci, 434 (33.3%) were detected incidentally and 867 (66.7%) were detected non‐incidentally. About 779 (89.9%) of nonincidental cancer foci were papillary cancer (PTC), while all of the incidental cancer foci were PTC. Mean size was 13 mm in NITC group and it was 3 mm in the ITC group and differed significantly between the groups (P < .001). Tumor size was ≤1 cm in 35.2% of the patients with NITC while 98.5% of patients with ITC had tumor ≤1 cm. The occurrence of multinodularity was higher in ITC than the NITC group (P < 001). Median TSH level was higher in patients with NITC than ITC while both were in the reference range (1.53 vs 1.03 μIU/mL, P < .001). The frequency of thyroiditis detected by US, and thyroid peroxidase antibody and thyroglobulin antibody positivities were similar in patients with ITC and NITC (P = .2, P = .86, and P = .26, respectively). The frequencies of capsular invasion (29.1% vs 7.9%), extrathyroidal extension (13% vs 4.2%), multifocality (35.8% vs 24.2%), non‐complete resection (9.2% vs 1.8%), and lymph node metastasis (9.5% vs 1.8%) were significantly higher in the NITC group (P < .001, for each). Persistent/recurrent disease in patients with NITC was more frequent than patients with ITC (P = .004). This outcome was similar for cancers measuring ≤1 cm (P = .001). Conclusion ITC is often encountered in older patients and frequently determined in early stages with more favorable histopathological features and better prognosis.

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Section: Discussionsupporting

confidence: 86%

A cancer of undetermined significance: Incidental thyroid carcinoma

Evranos¹,

Polat

Cuhaci

et al. 2018

Diagnostic Cytopathology

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“…The prevalence of thyroid cancer (TC) is rising (1). In Poland in 2000, the number of new cases of this malignancy amounted to 1,457 individuals, while in 2010, this number was 2,192 individuals (1,808 women and 384 men).…”

Section: Introductionmentioning

confidence: 99%

“…According to the World Health Organization, TMC is defined as TC measuring ≤10 mm at its greatest dimension (1). The clinical and pathological significance of TMC is widely debated.…”

Section: Introductionmentioning

confidence: 99%

Incidental and non-incidental thyroid microcarcinoma

et al. 2016

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Abstract. There is no clear therapeutic approach for thyroid microcarcinoma (TMC). This may be as a consequence of recent observations that have reported biologically different types of TMC, which should be treated differently. The objective of the present study was to compare incidental TMC (ITMC) and non-incidental TMC (NITMC) in order to assess the differences in the incidence, diagnostic results, clinicopathological characteristics and surgical treatment. The study consisted of a retrospective chart review of 3,218 patients consecutively admitted and surgically treated in a single institution due to thyroid pathology. A total of 246 (7.64%) patients presented with a thyroid malignancy, and 97 (39.43%) of these individuals were diagnosed with TMC; 37 (38.14%) patients exhibited ITMC and 60 (61.86%) exhibited NITMC. All 37 (100.00%) patients with ITMC exhibited a papillary type of cancer. In the NITMC group, 1 (1.67%) patient presented with follicular microcarcinoma, 1 (1.67%) individual with papillary-and follicular-type microcarcinoma, 1 (1.67%) individual with medullary microcarcinoma, and the remaining 57 (95.00%) patients presented with papillary microcarcinoma. The number of younger patients (<45 years old) was higher in the NITMC group, but this difference was not significant (P=0.205). In all patients with ITMC, ultrasound-guided fine-needle aspiration biopsy did not reveal malignant processes. In the NITMC group, the number of larger tumors (>5 mm) was significantly higher compared with that in the ITMC group (P<0.001). ITMC was significantly associated with multinodular goiter (MNG) (P<0.001). Amongst the NITMC group, 18.33% of patients presented with cervical lymph node involvement (P<0.001). Overall, the incidence of TMC is high, and consists of ITMC and NITMC, although the prevalence of NITMC is higher than that of ITMC. The majority of ITMCs and NITMCs are composed of a papillary type of cancer. The majority of ITMCs have dimensions ≤5 mm in diameter and are significantly associated with MNG. In comparison with ITMC, NITMC more often presents with aggressive features such as cervical lymph node metastases, so the surgical approach to this tumor should be more radical.

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“…The prevalence of thyroid cancer (TC) is rising. 6 Papillary thyroid carcinoma (PTC) is the most common thyroid cancer, it presents relatively as a low-grade malignancy with good prognosis, and a 10-year survival rate of over 90%. However, the clinical behaviors of this cancer are complex.…”

Section: Introductionmentioning

confidence: 99%

“…According to the World Health Organization, TMC is defined as TC measuring ≤10mm at its greatest dimension. 6 The clinical and pathological significance of TMC is widely debated. This supports the hypothesis that the incidence of TC depends on the geographical region.…”

Section: Introductionmentioning

confidence: 99%

5-year analysis of thyroidectomies; a retrospective clinicopathological assessment of papillary carcinoma of thyroid in a coastal urban area

et al. 2018

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INTRODUCTIONThyroid surgery was pioneered by surgeons such as Billroth, Kocher, Crile, Lahey and Dunhill.1 Kocher performed 5,000 operations with a mortality rate of 0.5%. 2The main complications associated with thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve. The prevalence of thyroid nodules varies from 4-8% in adults by palpation. Autopsy studies have shown a prevalence of thyroid nodules in 50 %. 3,4 The prevalence increases in endemic areas, women and with increase of age. Only five percent of thyroid nodules will have cancer. 5 The risk of malignancy does not differ either in solitary nodule or multinodular goiter. The prevalence of thyroid cancer (TC) is rising.6 Papillary thyroid carcinoma (PTC) is the most common thyroid cancer, it presents relatively as a low-grade malignancy with good prognosis, and a 10-year survival rate of over 90%. However, the clinical behaviors of this cancer are complex.Department of General Surgery, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Received: 10 January 2018 Accepted: 15 January 2018 *Correspondence: Dr. Ahmed Pervez, E-mail: dr_ahmed_pervez@yahoo.co.in Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background:The aim of our study was to analyse thyroidectomies done past 5 years on a clinico pathological basis. Additionally, we also wanted to study the presence and characteristics of papillary carcinoma of thyroid. Methods: Retrospective analysis of 57 patients who underwent thyroidectomy from 2012 to 2017 performed by Department of General Surgery of Sri Ramachandra Medical College (Chennai, India) was done and checked for statistical significance. Results: In this 5-year study of 57 thyroidectomies, 17 patients had papillary carcinoma of thyroid, 1 patient had anaplastic carcinoma and another patient had a thyroid metastasis with unknown primary. The nonmalignant 38 patients were studied separately. Regarding malignancy, 29.4% had micro carcinoma. 35.3% were in Stage I. 94.1% were in Grade I, 94.1% had no angioinvasion. 15 patients (88.2%) had negative capsule invasion and negative lympho vascular invasion. 4 patients (23.5%) had extra thyroid extension. The observed difference in the characteristics were statistically not significant (p>0.05). The odds ratio for micro carcinoma of thyroid was 0.364. Most common clinical diagnosis among patients with benign disease was multinodular goiter and 16 (40%) patients had total thyroidectomy. 82.5% of patients had microscopic nodules on histopathology. The association between the surgery type and clinical diagnosis was statistically significant (p<0.001). Conclusions: Statistical significance was noted between surgery type and clinical diagnosis. Papillary carcinoma of thyroid is not rare even in non endemic...

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Management of incidental and non-incidental papillary thyroid microcarcinoma

Abstract: Papillary thyroid microcarcinomas present both incidentally and non-incidentally, with equal prevalence. Non-incidental tumours not infrequently present with cervical lymph node disease. The patient outcome is generally excellent.

Cited by 19 publications

References 25 publications

A cancer of undetermined significance: Incidental thyroid carcinoma

A cancer of undetermined significance: Incidental thyroid carcinoma

Incidental and non-incidental thyroid microcarcinoma

5-year analysis of thyroidectomies; a retrospective clinicopathological assessment of papillary carcinoma of thyroid in a coastal urban area

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