Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience
Papillary thyroid microcarcinoma (PTMC) represents 35–40% of all papillary cancers; it is defined as a nodule ≤ 10 mm at the time of histological diagnosis. The clinical significance of PTMC is still controversial, and it may be discovered in two settings: incidental PTMC (iPTMC), in which it is ide...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/31/2/70 |
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| author | Giorgio Lucandri Giulia Fiori Francesco Falbo Vito Pende Massimo Farina Paolo Mazzocchi Assunta Santonati Daniela Bosco Antonio Spada Emanuele Santoro |
| author_facet | Giorgio Lucandri Giulia Fiori Francesco Falbo Vito Pende Massimo Farina Paolo Mazzocchi Assunta Santonati Daniela Bosco Antonio Spada Emanuele Santoro |
| author_sort | Giorgio Lucandri |
| collection | DOAJ |
| description | Papillary thyroid microcarcinoma (PTMC) represents 35–40% of all papillary cancers; it is defined as a nodule ≤ 10 mm at the time of histological diagnosis. The clinical significance of PTMC is still controversial, and it may be discovered in two settings: incidental PTMC (iPTMC), in which it is identified postoperatively upon histological examination of thyroid specimens following thyroid surgery for benign disease, and nonincidental PTMC (niPTMC), in which it is diagnosed before surgery. While iPTMC appears to be related to mild behavior and favorable clinical outcomes, niPTMC may exhibit markers of aggressiveness. We retrospectively review our experience, selecting 54 PTMCs: 28 classified as niPTMC (52%) and 26 classified as iPTMC (48%). Patients with niPTMC showed significant differences, such as younger age at diagnosis (<i>p</i> < 0.001); a lower male/female ratio (<i>p</i> < 0.01); a larger mean nodule diameter (<i>p</i> < 0.001); and a higher rate of aggressive pathological findings, such as multifocality, capsular invasion and/or lymphovascular invasion (<i>p</i> = 0.035). Other differences found in the niPTMC subgroup included a higher preoperative serum TSH level, higher hospital morbidity and a greater need for postoperative iodine ablation therapy (<i>p</i> < 0.05), while disease-free long-term survival did not differ between subgroups (<i>p</i> = 0.331) after a mean follow-up (FU) of 87 months, with one nodal recurrence among niPTMCs. The differences between iPTMC and niPTMC were consistent: patients operated on for total thyroidectomy and showing iPTMC can be considered healed after surgery, and follow-up should be designed to properly calibrate hormonal supplementation; conversely, niPTMC may sometimes exhibit aggressive behavior, and so the FU regimen should be closer and aimed at early detection of cancer recurrence. |
| first_indexed | 2024-03-07T22:36:20Z |
| format | Article |
| id | doaj.art-33892c2b25bd480cb4d1d50376f3d09a |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-07T22:36:20Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-33892c2b25bd480cb4d1d50376f3d09a2024-02-23T15:13:26ZengMDPI AGCurrent Oncology1198-00521718-77292024-02-0131294195110.3390/curroncol31020070Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal ExperienceGiorgio Lucandri0Giulia Fiori1Francesco Falbo2Vito Pende3Massimo Farina4Paolo Mazzocchi5Assunta Santonati6Daniela Bosco7Antonio Spada8Emanuele Santoro9Department of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyDepartment of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyDepartment of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyDepartment of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyDepartment of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyDepartment of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyEndocrinologic and Metabolic Departmental Ward Unit, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyEndocrinologic and Metabolic Departmental Ward Unit, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyEndocrinologic and Metabolic Departmental Ward Unit, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyDepartment of Surgical Oncology, San Giovanni-Addolorata Hospital, Via Dell’Amba Aradam 9, 00184 Rome, ItalyPapillary thyroid microcarcinoma (PTMC) represents 35–40% of all papillary cancers; it is defined as a nodule ≤ 10 mm at the time of histological diagnosis. The clinical significance of PTMC is still controversial, and it may be discovered in two settings: incidental PTMC (iPTMC), in which it is identified postoperatively upon histological examination of thyroid specimens following thyroid surgery for benign disease, and nonincidental PTMC (niPTMC), in which it is diagnosed before surgery. While iPTMC appears to be related to mild behavior and favorable clinical outcomes, niPTMC may exhibit markers of aggressiveness. We retrospectively review our experience, selecting 54 PTMCs: 28 classified as niPTMC (52%) and 26 classified as iPTMC (48%). Patients with niPTMC showed significant differences, such as younger age at diagnosis (<i>p</i> < 0.001); a lower male/female ratio (<i>p</i> < 0.01); a larger mean nodule diameter (<i>p</i> < 0.001); and a higher rate of aggressive pathological findings, such as multifocality, capsular invasion and/or lymphovascular invasion (<i>p</i> = 0.035). Other differences found in the niPTMC subgroup included a higher preoperative serum TSH level, higher hospital morbidity and a greater need for postoperative iodine ablation therapy (<i>p</i> < 0.05), while disease-free long-term survival did not differ between subgroups (<i>p</i> = 0.331) after a mean follow-up (FU) of 87 months, with one nodal recurrence among niPTMCs. The differences between iPTMC and niPTMC were consistent: patients operated on for total thyroidectomy and showing iPTMC can be considered healed after surgery, and follow-up should be designed to properly calibrate hormonal supplementation; conversely, niPTMC may sometimes exhibit aggressive behavior, and so the FU regimen should be closer and aimed at early detection of cancer recurrence.https://www.mdpi.com/1718-7729/31/2/70thyroidmicrocarcinomaincidentalnonincidentalcancerultrasound |
| spellingShingle | Giorgio Lucandri Giulia Fiori Francesco Falbo Vito Pende Massimo Farina Paolo Mazzocchi Assunta Santonati Daniela Bosco Antonio Spada Emanuele Santoro Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience Current Oncology thyroid microcarcinoma incidental nonincidental cancer ultrasound |
| title | Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience |
| title_full | Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience |
| title_fullStr | Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience |
| title_full_unstemmed | Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience |
| title_short | Papillary Thyroid Microcarcinoma: Differences between Lesions in Incidental and Nonincidental Settings—Considerations on These Clinical Entities and Personal Experience |
| title_sort | papillary thyroid microcarcinoma differences between lesions in incidental and nonincidental settings considerations on these clinical entities and personal experience |
| topic | thyroid microcarcinoma incidental nonincidental cancer ultrasound |
| url | https://www.mdpi.com/1718-7729/31/2/70 |
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