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Published on: December 19, 2019
Prognostic factors in papillary microcarcinoma with emphasis on histologic subtyping: a clinicopathologic study of
Ronald Ghossein1, Ian Ganly, Agnese Biagini
11 Department of Pathology, Memorial Sloan-Kettering Cancer Center , New York, New York.
Background:
There continues to be controversy regarding which clinicopathological features confer a higher risk of adverse outcome in papillary microcarcinomas (PMC). The aim of this study was to assess the prognostic value of a meticulous histologic examination in PMC.
Method:
All papillary thyroid carcinoma <1 cm in size without associated larger thyroid carcinomas, identified between 1977 and 2002, were categorized as PMC and subjected to a meticulous histopathologic examination by 2 thyroid pathologists.
Results:
148 PMC patients fulfilled the inclusion criteria. Within PMC, young age, male sex, tumor multicentricity, extrathyroidal extension, and infiltrative and larger tumor (≥0.5 cm) correlated with the presence of >1 cm metastatic node (MN) or >3 MN at presentation (p<0.05). With a median follow-up of 9.9 years, only 1 (0.7%) of 134 PMC patients died of thyroid carcinomas and 3 (2.2%) had recurrences in the neck. The patient who died had harbored a poorly differentiated carcinoma in his MN. The presence of MN and especially a large MN (>1 cm) correlated with worse recurrence-free survival (p=0.005 and p<0.0001, respectively). Except for one, all individuals with clinically adverse outcomes had >1 cm MN. Patients whose MNs were predominantly composed of poorly differentiated carcinoma or tall cell variant papillary thyroid carcinoma had a significant shorter recurrence-free survival (p<0.0001). Only 1 of 80 radioactive iodine-naïve PMC patients with absent or small MN (≤1 cm) had recurrence with a median follow-up of 9.2 years.
Conclusions:
(i) The size and histotype of the MN are predictors of outcome in PMC and should be recorded. (ii) The very rare PMC patients who suffer recurrence or even die of disease have usually aggressive histopathologic features at presentation. (iii) PMC patients with nodal disease that is small or absent at presentation are at a very low risk of recurrence and may be spared radioactive iodine therapy.
Insights
Papillary microcarcinomas (PMC) with large or aggressive metastatic nodes have a higher risk of recurrence. Small or absent nodes indicate a very low risk, potentially sparing patients radioactive iodine therapy.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Controversy exists regarding risk factors for adverse outcomes in papillary microcarcinomas (PMC).
- Meticulous histopathologic examination is crucial for assessing prognostic features in PMC.
Purpose of the Study:
- To evaluate the prognostic significance of detailed histopathologic findings in PMC.
- To identify clinicopathological features associated with adverse outcomes in PMC.
Main Methods:
- A cohort of 148 PMC patients (thyroid carcinoma <1 cm) identified between 1977-2002 were analyzed.
- Two thyroid pathologists performed meticulous histopathologic examinations on all cases.
Main Results:
- Young age, male sex, multicentricity, extrathyroidal extension, and larger tumor size (≥0.5 cm) correlated with metastatic nodes (MN).
- Large MN (>1 cm) and aggressive histotypes (poorly differentiated carcinoma, tall cell variant) in MNs predicted worse recurrence-free survival.
- Only 0.7% of patients died of disease, and 2.2% had recurrences, with aggressive features present in those with adverse outcomes.
Conclusions:
- Metastatic node size and histotype are key predictors of outcome in PMC.
- Aggressive histopathologic features at presentation are associated with the rare cases of recurrence or death in PMC.
- PMC patients with small or absent nodes have a very low recurrence risk and may not require radioactive iodine therapy.