Abstract
BackgroundPapillary thyroid microcarcinoma (PTMC) generally is a cancer with excellent prognosis, but the term “cancer” sounds severe and harsh, which can elicit emotional and physical responses from patients. To eliminate the word “cancer,” the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced. However, not all PTMCs can be classified as NIFTP. Sometimes, very aggressive PTMC cases might be observed. Some authors suggest that one of the risk factors for poor prognosis is lymph node metastasis. The aim of the study was to evaluate some clinicopathological features of PTMC as the risk factors for lymph node metastasis.Material and methodsWe performed a retrospective chart review and selected 177 patients with PTMC. To analyze the cases with potentially aggressive behavior, we enrolled PTMC patients with lymph node metastases (pN1, central, and/or lateral) and evaluated some of their clinicopathological features.ResultsThe logistic regression analysis results demonstrated significantly higher rates of multifocal or bilateral tumor occurrence in the PTMC patients with pN1 than in the patients with pN0 (P < 0.0001 for both). In addition, the occurrence of thyroid tumors with sizes above 0.5 cm was a significant risk factor for lymph node metastasis (P < 0.0001). The results of the ROC analyses showed that the presence of multifocal or bilateral tumors and tumor sizes above 0.5 cm were significant predictors of lymph node metastasis (P < 0.0001 for all).ConclusionsMultifocal and bilateral PTMC tumors with diameters above 0.5 cm should be treated aggressively as “true cancer” and might benefit from lymph node dissection. Unifocal PTMC tumors with diameters equal to or below 0.5 cm may be treated less aggressively.
Highlights
Papillary thyroid microcarcinoma (PTMC) is a thyroid cancer with small tumors that are 1.0 cm maximum in diameter [1]
Kaliszewski et al World Journal of Surgical Oncology (2019) 17:91 lymph nodes as the first sign of PTMC; these tumors are known as occult papillary thyroid microcarcinomas
After considering all the mentioned dilemmas, a fundamental question appears: which PTMC cases should be treated as “true cancer” and which as “precancer”? To answer this question, we evaluated some clinicopathological features of PTMCs in stage pN1 to select tumors that should be treated aggressively as “true cancers,” and we evaluated some clinicopathological features of PTMCs in stage pN0, which may be treated less aggressively as “precancers.”
Summary
Papillary thyroid microcarcinoma (PTMC) is a thyroid cancer with small tumors that are 1.0 cm maximum in diameter [1]. Kaliszewski et al World Journal of Surgical Oncology (2019) 17:91 lymph nodes as the first sign of PTMC; these tumors are known as occult papillary thyroid microcarcinomas. To promote not aggressive surgical approach and save patients’ psychological distress of cancer diagnosis, a new name for indolent PTMC such as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced [19]. The tumor has to present encapsulation, purely follicular architecture, the presence of nuclear features of papillary thyroid cancer (PTC), and absence of capsular and vascular invasions. They strictly formulated the inclusion and exclusion criteria because not every PTMC can be classified as NIFTP. The aim of the study was to evaluate some clinicopathological features of PTMC as the risk factors for lymph node metastasis
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