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The non-interventional approach to papillary thyroid microcarcinomas. An "active surveillance" dilemma
Rodis D Paparodis1, Dimitra Bantouna2, Shahnawaz Imam3
1Private Practice, Patras, Greece; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism and Center for Diabetes and Endocrine Research (CeDER), College of Medicine and Life Sciences (formerly Medical College of Ohio), University of Toledo, Toledo, OH, USA.
Background:
Recent studies suggest that papillary-thyroid-microcarcinomas (PTMi) and follicular-variant-papillary-thyroid-cancers (FVPTC) are less aggressive overall. Our observations argue against.
Objectives:
To assess whether PTMi and FVPTC are indeed low-risk and could be safely followed without intervention.
Methods:
We prospectively collected data of subjects with PTC on pathology post-thyroidectomy. Odds ratios (OR) were calculated with Fisher's exact test and differences between means were calculated using Mann Whitney's test.
Results:
696 met inclusion-criteria; 436 had macrocarcinomas (PTMa) and 260 had PTMi. PTMa were statistically significantly more likely to present multifocal [44.0% vs.28.1%], with extrathyroidal extension [22.1% vs.3.4%], lymph nodes involvement [25.5% vs.8.8%] and local invasion [3.1% vs.0.4%] (p < 0.05 for all), but not with distant metastasis [3.4% vs.1.3%, p > 0.05]. Therefore, PTMi measuring down to 0.01 cm, harbored aggressive features. We also identified 174 cases with FVPTC and 522 subjects with non-FVPTC. FVPTC had lower incidence of multifocality [40.1%, vs.60.9%], extrathyroidal extension [8.6% vs.17.4%] and lymphatic involvement [5.2% vs.24.0%], but not distant metastasis or local invasion [p > 0.05 for all]. Therefore, FVPTC measuring down to 0.5 cm, also harbored aggressive features.
Conclusions:
PTMi and FVPTC aggressive features are substantial enough to require careful evaluation, independent of their original tumor size before defaulting to just "active surveillance."
Insights
Papillary thyroid microcarcinomas (PTMi) and follicular-variant papillary thyroid cancers (FVPTC) show aggressive features, challenging the notion they are low-risk. Careful evaluation is necessary, not just active surveillance, regardless of initial tumor size.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Recent literature suggests papillary-thyroid-microcarcinomas (PTMi) and follicular-variant-papillary-thyroid-cancers (FVPTC) have a less aggressive nature.
- This study challenges that assumption, presenting observational data that argues against this classification.
Purpose of the Study:
- To investigate the risk stratification of PTMi and FVPTC.
- To determine if these thyroid cancer subtypes can be safely managed with active surveillance without immediate intervention.
Main Methods:
- Prospective data collection from patients with papillary thyroid cancer (PTC) post-thyroidectomy.
- Statistical analysis using Fisher's exact test for odds ratios and Mann Whitney's test for differences in means.
Main Results:
- PTMi (n=260) exhibited aggressive features, including multifocality (28.1%), extrathyroidal extension (3.4%), and lymph node involvement (8.8%), even at sizes down to 0.01 cm.
- FVPTC (n=174) also demonstrated aggressive characteristics, with lower but significant rates of multifocality (40.1%) and extrathyroidal extension (8.6%), irrespective of size (down to 0.5 cm).
- Compared to PTMa (n=436), PTMi showed significantly lower rates of multifocality, extrathyroidal extension, lymph node involvement, and local invasion.
Conclusions:
- PTMi and FVPTC possess substantial aggressive features that warrant thorough evaluation.
- Tumor size alone is insufficient for classifying these subtypes; active surveillance may not be appropriate for all cases.