Overdiagnosis and overtreatment of papillary thyroid carcinoma

Abstract

ABSTRACT Objectives: Thyroid cancer is one of the most common cancers and its incidence continues to grow in high-income countries. Combined with an excellent survival and stable mortality rate, this increase in incidence is due to overdiagnosis, particularly with the wide use of ultrasonography and other imaging modalities. This study aims to address the issue of thyroid cancer overdiagnosis, and how the recent guidelines can reduce the burden of diagnosis of incidental and indolent lesions, as well as de-escalating the treatment. Materials and Methods: All thyroid cancer cases diagnosed at King Salman Armed Forces Hospital from 2012 to 2020 were reviewed. A descriptive analysis was performed on the clinicopathologic relevant variables, including age, gender, tumor type, pathologic variant type, tumor size, stage, papillary micro-carcinoma, extra-thyroid extension, tumor focality, lymphovascular invasion, recurrence, and baseline thyroglobulin. We excluded subjects with nay (not applicable or missing) data points to get accurate statistical results and were left with pure papillary carcinoma cases Results: Of the cases of papillary thyroid carcinoma, a significant proportion of which (23%) are microcarcinoma (≤1 cm), a tumor usually found incidentally and rarely causes clinical symptoms. Only two cases out of the microcarcinomas have shown regional lymph node metastasis (4%). No distant metastasis or tumor-related death is encountered. A similar proportion of our cases is the previously called noninvasive follicular variant of papillary thyroid carcinoma encapsulated follicular variant papillary thyroid carcinomas (PTC). Conclusions: Awareness of thyroid cancer overdiagnosis is important to reduce the unnecessary surgical interventions, patient psychological distress, and postoperative complications.