Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

Gao, Rui; Jia, Xi; Liang, Yiqian; Fan, Kun; Wang, Xiaoxiao; Wang, Yuanbo; Yang, Aimin; Zhang, Guangjian

doi:10.3389/fendo.2019.00074

Cited by 14 publications

(14 citation statements)

References 47 publications

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“…Our results showed that large diameter (≥ 5 mm), multifocality, and extracapsular invasion were correlated with an increased risk of positive lymph nodes, which is another important factor of aggressiveness. Other markers of aggressiveness, such as lymphatic emboli, vascular invasion, and perineural invasion, were also present in 9.0%, 0.7%, and 5.6% of our cases, comparable with the results of previous studies [22].…”

Section: Discussionsupporting

confidence: 92%

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

et al. 2020

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Papillary thyroid microcarcinoma (PTMC) is a common malignant disease of the endocrine system, which has rapidly increased in incidence and prevalence in recent decades. The aim of our paper was to identify correlations between pathological and clinical features of cases of PTMC. A total of 612 patients of both genders, who were operated on for benign thyroid diseases in the 3rd Surgical Unit of St. Spiridon University Hospital of Iasi, were monitored for a period of 2 years. According to pathological reports, PTMC was diagnosed in 144 cases. Of those cases, 81.2% were female and 18.8% were male, with an overall mean age of 54.77 ± 11.9 years. The mean diameter of tumors was 3.04 ± 2.2 mm (75.7% were under 5 mm), and 35.4% were multifocal tumors. Of all tumors studied, 76.4% were the follicular variant, 13.2% were conventional, and 10.4% of cases included tall cell, hobnail, or columnar variants. The underlying diseases were multinodular goiters (73.6%), adenomas (25%), Hashimoto thyroiditis (17.4%), Basedow’s disease, and other types of hyperthyroidism (4.9%), primarily hyperparathyroidism (7.6%), with a small percentage presenting a combination thereof. Extracapsular invasion was present in 14.6% while 5.6% presented perineural invasion and 0.7% of cases had vascular invasion. Lymphatic emboli were found in 9% of cases and lymph node metastasis in 5.6% of cases. PTMC is not as innocent as believed, and further studies, performed on larger batches, would be necessary in order to identify high oncological risk cases and to determine when a more aggressive surgical approach is indicated.

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Section: Discussionsupporting

confidence: 92%

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

et al. 2020

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“…[ 1 2 17 ] Furthermore, the multifocal disease was present in about 41% of our patients, which is slightly higher than the reported rates in other studies (20.6 to 38%). [ 2 13 14 ] Like other studies, most of our patients had a low-risk ATA classification. [ 1 13 ]…”

Section: Discussionmentioning

confidence: 54%

“…In the present study, LNM was reported in 16.6% of the patients, which lies within the 5–38% prevalence documented in the literature. [ 1 2 14 ] This wide range of nodal involvement could be attributed to the heterogeneity of the studied cohorts and the indication and extent of surgery. We found that younger age, tumor size (>0.5 cm), ATA intermediate or high-risk category, and the extent of surgery were independent predictors of LNM.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies on PTMC characteristics and management outcomes were conducted in countries outside the Middle East and North Africa region. [ 1 2 12 13 14 ] Data from our group showed that from 2008 to 2018, there was a significant decline in RAI therapy, but not in surgery, in a wider cohort of thyroid cancer in the United Arab Emirates (UAE). [ 15 ] Scoping of the current practice in PTMC management is crucial in light of an expected rise in the number of such patients in the future, especially in the absence of regional guidelines on the management of thyroid cancer.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and Management of Papillary Thyroid Microcarcinoma in the United Arab Emirates

Aldahmani

Malik

Aziz

et al. 2022

Saudi Journal of Medicine &Amp; Medical Sciences

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Background: Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking. Objectives: To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE). Patients and Methods: This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables. Results: A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5–10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence. Conclusions: The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.

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“…Although overall prognosis seems to be excellent after lobectomy, some patients that appear to be at low risk, in fact, have high intrinsic risk for poor prognosis and should benefit from an aggressive treatment. Even in papillary thyroid microcarcinoma, cases evaluated as having a low risk of recurrence preoperatively showed intermediate to high-risk disease post-surgery, leading to a higher rate of radioiodine therapy ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics-Assisted Risk Stratification for Extent of Thyroidectomy in Patients With 1–4 cm Solitary Intrathyroidal Differentiated Thyroid Cancer

et al. 2022

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BackgroundDifferentiated thyroid cancer (DTC) is the most common type of thyroid cancer. The 2015 American Thyroid Association (ATA) guidelines recommend that lobectomy is suitable for solitary intrathyroidal DTC (SI-DTC) of 1–4 cm. However, some SI-DTC patients with other high-risk characteristics still have poor prognosis and require more aggressive surgical methods. This study aimed to explore the clinical characteristics that are important for the identification and treatment of high-risk patients with SI-DTC of 1–4 cm.MethodsThe study cohort was obtained from the SEER database, consisting of data between 2004 and 2013. The outcome measures were thyroid carcinoma-specific mortality (CSM) and all-cause mortality (ACM). Patient survival curves were examined using Kaplan–Meier analyses with log-rank tests and Cox proportional hazards regression analyses. Hazard ratios (HRs) were used to show the magnitude of the effect of disease stage on DTC-specific patient mortality.ResultsThe study included 55,947 patients with SI-DTC of 1–4 cm and 4,765 patients with DTC >4 cm. Tumor size, surgical approach, age, sex, race, and radiation exposure were independent risk factors for CSM and ACM. SI-DTC patients with female, age ≤45, and 1 cm< tumor size ≤2 cm were at low risk of CSM [HR = 0.014 (0.002–0.115)] and ACM [HR = 0.115 (0.077–0.171)] when stratified by age, sex, and tumor size. Compared to T3 patients, CSM was not significantly different in male patients, age >45, 2 cm< tumor size ≤3 cm [HR = 0.839 (0.414–1.700)] and male patients, age >45, 1 cm< tumor size ≤2 cm [HR = 0.751 (0.410–1.377)]. Furthermore, compared to T3 patients without extrathyroidal extension (ETE) and lymph node metastasis (LNM), more subgroups of SI-DTC of 1–4 cm had a similar prognosis. In addition, patients with SI-DTC of 1–4 cm showed similar rates of CSM and ACM to T3 patients without ETE, LNM, and distant metastasis (DM). Similar results were obtained when we set the age cut-off value as 55 years, according to the 8th edition of AJCC TNM system.ConclusionsOur study demonstrated that sex, age, and tumor size clearly differentiate SI-DTC of 1–4 cm into low-and high-risk categories. Survival rates were significantly lower in subgroups containing old males with larger tumors compared to younger females with small tumors. Total thyroidectomy may be favored in these high-risk subgroup patients.

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Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

Cited by 14 publications

References 47 publications

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Characteristics and Management of Papillary Thyroid Microcarcinoma in the United Arab Emirates

Clinical Characteristics-Assisted Risk Stratification for Extent of Thyroidectomy in Patients With 1–4 cm Solitary Intrathyroidal Differentiated Thyroid Cancer

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