Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort

Domínguez, José Miguel; Nilo, Flavia; Martínez, María Teresa; Massardo, José Miguel; Muñoz, S Rodríguez; Contreras, Tania; Carmona, Rocı́o; Jerez, Joaquín; González, Hernán; Droppelmann, Nicolás; León, Augusto

doi:10.20945/2359-3997000000013

Cited by 18 publications

(10 citation statements)

References 34 publications

(52 reference statements)

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“…The criterion of minimal ETE for T-staging has been removed from AJCC/TNM system version 8. One reason is that minimal ETE is not an independent risk factor associated with prognosis for patients with PTC (33–35). However, the change has sparked widespread controversy, and some specialists put proposed a different perspective in which minimal ETE would increase the risk for recurrence (36, 37).…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Radiomic Nomogram for Preoperative Prediction of Extrathyroidal Extension in Papillary Thyroid Carcinoma

et al. 2019

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Objectives: Determining the presence of extrathyroidal extension (ETE) is important for patients with papillary thyroid carcinoma (PTC) in selecting the proper surgical approaches. This study aimed to explore a radiomic model for preoperative prediction of ETE in patients with PTC.Methods: The study included 624 PTC patients (without ETE, n = 448; with minimal ETE, n = 52; with gross ETE, n = 124) whom were divided randomly into training (n = 437) and validation (n = 187) cohorts; all data were gathered between January 2016 and November 2017. Radiomic features were extracted from computed tomography (CT) images of PTCs. Key radiomic features were identified and incorporated into a radiomic signature. Combining the radiomic signature with clinical risk factors, a radiomic nomogram was constructed using multivariable logistic regression. Delong test was used to compare different receiver operating characteristic curves.Results: Five key radiomic features were incorporated into the radiomic signature, which were significantly associated with ETE (p < 0.001 for both cohorts) and slightly better than clinical model integrating significant clinical risk factors in the training cohort (area under the receiver operating characteristic curve (AUC), 0.791 vs. 0.778; F1 score, 0.729 vs. 0.714) and validation cohort (AUC, 0.772 vs. 0.756; F1 score, 0.710 vs. 0.692). The radiomic nomogram significantly improved predictive value in the training cohort (AUC, 0.837, p < 0.001; F1 score, 0.766) and validation cohort (AUC, 0.812, p = 0.024; F1 score, 0.732).Conclusions: The radiomic nomogram significantly improved the preoperative prediction of ETE in PTC patients. It indicated that radiomics could be a valuable method in PTC research.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography Radiomic Nomogram for Preoperative Prediction of Extrathyroidal Extension in Papillary Thyroid Carcinoma

et al. 2019

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“…Wang [76]. The frequency of minimal ETE was reported to range from 6.3% to 48% [54,[77][78][79][80][81].…”

Section: Commentsmentioning

confidence: 99%

Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults

et al. 2021

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The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.

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“…Studies have reported that PTMC accounts for nearly 50% of newly found papillary thyroid carcinoma. 5 Although PTMC progresses slowly and has a good prognosis, 6 there is still a local recurrence rate of 2%-6%, and distant metastasis occurs in 1%-2% of patients. 7 At present, the best treatment for papillary thyroid carcinoma is surgery + RAI + TSH suppression therapy.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Curative Effect and Influencing Factors of N1 Stage Papillary Thyroid Micro-Carcinoma and Papillary Thyroid Non-Micro Carcinoma After Initial Radioactive Iodine Ablation Therapy

Yun¹,

Wu²,

Liu³

et al. 2021

CMAR

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Objective To compare the efficacy and influencing factors of initial radioactive iodine (RAI) ablation therapy for postoperative N1 stage papillary thyroid micro-carcinoma (PTMC) and papillary thyroid non-micro carcinoma (PTC), and to explore the necessity of RAI for N1 stage PTMC. Methods A retrospective analysis of patients with N1 stage papillary thyroid cancer who underwent RAI in our department from January 2018 to June 2019. According to the tumor diameter, papillary thyroid carcinoma was divided into PTMC group (≤ 1.0cm) with 129 patients and PTC group (> 1.0 cm) with 214 patients. According to the 2015 ATA guidelines, the patient’s treatment response was evaluated 6–8 months after discharge from the hospital: excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR). IDR, BIR, and SIR were classified into NER group. Chi-squared test, independent sample t -test, Mann–Whitney U test, and binary logistic regression analysis were used to compare the differences between PTMC and PTC patients. Results The ps-Tg of the PTMC group was significantly lower than that of the PTC group ( P = 0.001), and the ER ratio of the PTMC group was higher (χ 2 = 5.445, P < 0.05). The ER ratio of PTMC patients in the N1a group was significantly higher than that of PTC patients (80%, 66.7%, χ 2 = 4.076, P < 0.05), while the ER ratio of PTMC in the N1b group was not significantly different from that of PTC. Gender, N stage, and ps-Tg were found to be independent factors of RAI treatment response. Conclusion The efficacy of the initial RAI of PTMC patients was significantly better than that of PTC patients. There was no significant difference in the efficacy of RAI between males with PTMC, N1b stage, ps-Tg ≥ 5.87ng/mL and PTC patients, which suggested that RAI is necessary for these patients.

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Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort

Cited by 18 publications

References 34 publications

Computed Tomography Radiomic Nomogram for Preoperative Prediction of Extrathyroidal Extension in Papillary Thyroid Carcinoma

Computed Tomography Radiomic Nomogram for Preoperative Prediction of Extrathyroidal Extension in Papillary Thyroid Carcinoma

Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults

Analysis of Curative Effect and Influencing Factors of N1 Stage Papillary Thyroid Micro-Carcinoma and Papillary Thyroid Non-Micro Carcinoma After Initial Radioactive Iodine Ablation Therapy

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