Microscopic papillary thyroid cancer as an incidental finding in patients treated surgically for presumably benign thyroid disease

Abstract

Background: Papillary thyroid microcarcinoma (PTMC) is a relatively common entity in the general population. Aim: To present our experience with papillary thyroid microcarcinoma of the thyroid as an incidental finding in patients treated surgically for presumably benign thyroid disease. Settings and Design: Histology reports of patients treated surgically with a preoperative diagnosis of benign thyroid disease were reviewed to identify patients with PTMC. Patients with a preoperative diagnosis of thyroid cancer were excluded from this study. Materials and Methods: The files of 380 patients who underwent surgery for presumably benign thyroid disease in our hospital from 1990 to 2002 were reviewed. Data regarding patient's demographics, pathology findings, management and outcomes, were retrieved. Statistical Analysis Used: The findings are expressed as absolute numbers and as percentages (with reference to the total number of patients of this study). Results: Twenty-seven patients with PTMC diagnosed incidentally following thyroid surgery for presumably benign thyroid disease (27/380 or 7.1%) (multinodular goiter = 20 patients, follicular adenoma = 6 patients, diffuse hyperplasia of the thyroid = 1 patient) are presented. Mean diameter of PTMC was 4.4 mm. In 11 patients (40.7%) the tumor was multifocal and in about half of them tumor foci were found in both thyroid lobes. In two patients the tumor infiltrated the thyroid capsule. Total/near-total thyroidectomy was performed in all these patients (in three as completion thyroidectomy). All patients received suppression therapy and 20 of them underwent adjuvant radioiodine therapy. Follow-up (mean 4.56 years, range 1-12 years) was completed in 25 patients; all these patients were alive and disease-free. Conclusions: PTMC is not an uncommon incidental finding after surgery for presumably benign thyroid disease (7.1% in our series). The possibility of an underlying PTMC should be taken into account in the management of patients with nodular thyroid disease; total/near total thyroidectomy should be considered, at least in selected patients with presumably benign nodular thyroid disease.

Incidental Finding of Papillary Thyroid Carcinoma in the Patients with Primary Hyperparathyroidism

“…Particularly, incidental finding of papillary microcarcinoma has been reported in a large number of patients undergoing thyroidectomy for benign thyroid disease, reaching up to 24% [15]. Likewise, papillary microcarcinoma was the most commonly seen pathology in the present study.…”

Thyroid papillary microcarcinoma: a descriptive and meta-analysis study

“…Another study reported that either suppressive or substitutive L-T 4 therapy was recommended for an unknown period of time and later substitutive therapy only (42). Finally, substitutive L-T 4 therapy was the treatment of choice in some patients with PTMC (26,27,42).…”

“…Total/near total thyroidectomy was carried out in 100% of the cases in 17 (11,12,14,15,18,24,26,27,39,46,49,52,97,104,106,117,150) out of 44 studies that reported the type of surgery (4-6, 8, 11, 12, 14-18, 20, 23-27, 30-32, 34, 38-40, 42, 45, 46, 48-50, 58, 97, 98, 104-106, 114, 117, 121, 123, 124, 143, 148, 150). Combining the results of different studies that clearly reported the extent of surgery in 9259 patients with PTMC, total/near total thyroidectomy was performed in the 72%, subtotal thyroidectomy in the 11% and lobectomy in the 17% of the cases (4-6, 8, 11, 12, 14-18, 20, 23-27, 30-32, 34, 38-40, 42, 45, 46, 48-50, 58, 97, 98, 104-106, 114, 117, 121, 123, 124, 143, 148, 150).…”

Clinical Features and Prognosis of Patients with Benign Thyroid Disease Accompanied by an Incidental Papillary Carcinoma

“…Therefore, the central lymph node intraoperative exploration is enough for incidental PTC, the central lymph node dissection is only needed for lymphadenectasis. Sakorafas et al (2007) recommended the total or neartotal thyroidectomy of incidental PTC under a microscope, which can avoids the risk of reoperation and have the possibility of better monitoring of treated patients by DOI:http://dx.doi.org/10.7314/APJCP.2013.14.2…”

“…Arora et al (2009) believed there exist some differences between the occasional thyroid microcarcinoma and tiny carcinoma from clinical findings, the invasiveness of the latter is higher. Incidental thyroid carcinoma should recieve a clinical close follow-up or positive surgical (total thyroidectomy + neck lymph node dissection) or other treatments, there has not been determined (Ito et al, 2007;Sakorafas et al, 2007;Dralle et al, 2009;Pisanu et al, 2009;Lombardi et al, 2010;Papini et al, 2011). Sokal (1957) suggest that the incidence of carcinoma in non-toxic thyroid nodules is low and patients can be followed up safely for up to 15 years.…”