Understanding the Risks Related to Papillary Thyroid Microcarcinoma
Posted: Monday, March 16, 2020
Although papillary thyroid microcarcinoma is currently treated less aggressively, this subtype of cancer could exhibit advanced features in 19% of patients who have had surgery, and some of these features are undetectable with preoperative workup. Zaid Al-Qurayshi, MD, MPH, of the University of Iowa, and colleagues published this work in the Journal of the American College of Surgeons.
“The study provides a good, general perspective about the landscape of [papillary thyroid microcarcinoma]. More granular, clinical data are needed to help understand the risk factors for advanced disease and develop a preoperative test that could identify these patients who have them,” said Dr. Al-Qurayshi in an American College of Surgeons press release.
Researchers conducted a retrospective analysis utilizing the National Cancer Database from 2010 to 2014 to identify patients with papillary thyroid microcarcinoma who were treated with surgical interventions. There were 30,180 patients identified, of whom 18.7% presented with advanced features. These advanced features included central lymph node metastasis (8.0%), lateral lymph node metastasis (4.4%), microscopic and gross extrathyroidal extension (6.7%, 0.3%), lymphovascular invasion (4.4%), and distant metastasis (0.4%).
All features of advanced disease were associated with a significantly lower survival, except for microscopic extrathyroidal extension and lymphovascular invasion. In addition, there was interaction among these features. Distant metastasis was associated with central lymph node metastasis (odds ratio = 2.44), lateral lymph node metastasis (odds ratio = 3.18), and gross extrathyroidal extension (odds ratio = 9.91). Nodal metastasis was associated with microscopic extrathyroidal extension (odds ratio = 4.23) and lymphovascular invasion (odds ratio = 7.17). Death rates were three times higher for patients with disease in the lymph nodes and six times higher for patients with distant metastasis compared with those without metastasis.
Disclosure: The authors reported no conflicts of interest.