Abstract
Clinical and pathological characteristics of incidental papillary thyroid microcancer cases, surgical, medical, and nuclear treatment methods, and patients' outcome were studied during follow-up period of 102 months. We studied 37 patients with incidental papillary thyroid microcancer (I-PTM). The surgical procedure was total thyroidectomy in 29 and hemithyroidectomy in 8 patients. Size, multifocality, and bilateralism of PTM foci, thyroid capsule invasion, and presence of lymphovascular invasion were histopathological parameters. We analysed adjuvant medical and nuclear treatment and patients' outcome during follow-up period of 102 (61–144) months. The prevalence rates of I-PTM were 9.4% in 395 thyroidectomy cases. Histopathological examination reported unifocal disease in 30 and multifocal disease in 7 (18%) patients. Multifocal disease was bilateral in 6 (20.1%) patients. The mean size of the PTM foci was 4.88 mm. The rate of thyroid capsule invasion was 5.4%. All patients received a suppressive dose of LT4 to achieve a low serum TSH level. Adjuvant surgical and nuclear treatment was not performed in our cases. We did not find any negative changes in blood chemistry and ultrasound imaging, and any unfavourable events as locoregional and systemic recurrence. In conclusion, diagnosis of I-PTM is common that multifocality and bilateralism appear as pathologic features. The prognosis is excellent after surgical treatment and TSH suppression. Routine adjuvant nuclear treatment is unnecessary in majority of patients.
Highlights
The incidence of well-differentiated thyroid carcinoma, papillary cancer, has been increasing since the last 20–30 years
A total of 37 patients with papillary thyroid microcarcinoma (PTM) incidentally diagnosed on postoperative histopathological examination of the excised thyroid tissue were analysed for assessing the rate of incidental diagnosis of PTM and their demographic features and the surgical procedures used for their treatment
Incidental PTM (I-PTM) was diagnosed on histopathological examination in 37 (9.4%) of the 395 patients
Summary
The incidence of well-differentiated thyroid carcinoma, papillary cancer, has been increasing since the last 20–30 years. An important contributing factor for the increased incidence of such well-differentiated cancers is the increasing diagnostic rates of papillary thyroid microcarcinoma (PTM). Other factors such as iodination programmes in low iodine intake areas, detailed histopathological examination of the excised thyroid tissue, and the increase in bilateral total excision of the thyroid gland during thyroid surgery have been attributed to the increasing rates of large (>10 mm) and micropapillary carcinoma [2,3,4,5]. Incidental PTM (I-PTM) is a tumour focus that is clinically unsuspected before thyroid surgery and is identified in the final pathological examination of a thyroidectomy specimen. Several controversies regarding the need for completion surgery for excision of the remaining thyroid tissue and lymph nodes exist
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